Search Results (53,782)

Background/Objectives: Abnormalities in the partial pressure of carbon dioxide (PCO₂) can occur during respiratory support and may contribute to adverse neonatal outcomes. This study aimed to assess the incidence of early hypocapnia and hypercapnia in mechanically ventilated preterm infants and their major associated outcomes. Methods: A single-center retrospective cohort study (2017–2024) was conducted in preterm infants < 32 weeks’ gestation who required > 24 h of invasive ventilation within the first 3 days of life. Perinatal–neonatal data were retrieved from the medical database. Admission blood gas values (arterial and capillary–venous) and the maximum and minimum PCO₂ in the first 72 h were evaluated. Normocapnia was defined as PCO₂ 35–45 mmHg, hypocapnia as < 35 mmHg, and hypercapnia as > 45 mmHg. Primary outcomes were the incidence of PCO₂ abnormalities; secondary outcomes included death or severe brain injury (SBI), SBI alone, and bronchopulmonary dysplasia (BPD) among survivors. Logistic regression identified independent predictors of the secondary outcomes. Results: Among the 134 infants evaluated, most experienced both hypercapnia and hypocapnia. Hypercapnia occurred in 81.3% of infants, and hypocapnia in 93.2%. Death or SBI was observed in 51.5%, and SBI alone in 42.5%. Gestational age < 28 weeks, air-leak syndromes, and pulmonary hemorrhage were independent predictors of death or SBI. Among survivors, hypercapnia and gestational age < 28 weeks independently predicted BPD. Infants with adverse outcomes had higher maximum PCO₂ values and greater PCO₂ variability, although these were not independent predictors of SBI or death. Conclusions: PCO₂ instability is highly prevalent in ventilated preterm infants, underscoring the need for individualized ventilation strategies. Extreme prematurity emerged as the primary risk factor for adverse outcomes, while hypercapnia was independently associated with BPD. Full article

Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables. Methods: A prospective cohort study was conducted over six months (September 2021–March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors. Results: The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders. Conclusions: Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care. Full article

This research explores public awareness, perceptions, and behavioral attitudes toward renewable energy in Saudi Arabia, drawing on data from a sample of 217 respondents predominantly based in the Riyadh region. The demographic profile reveals a diverse age distribution, with a notable concentration of younger participants, particularly those aged 16–25, who constituted 40.1% of the sample. Employing a descriptive survey design, the research explores key themes including environmental attitudes, economic considerations, personal behavior, media influence, and educational engagement. The findings indicate strong public support for the national transition to renewable energy, with 73.4% of the respondents expressing confidence in its potential as a primary energy source. Many of the respondents recognized both the ecological and financial advantages of renewable technologies, such as reduced emissions and job creation. The participants widely acknowledged the environmental and economic benefits of renewable technologies, such as reduced pollution and job creation. However, concerns persist regarding fossil fuel dependency, energy transition costs, and the adequacy of current educational and media efforts. The statistical analysis revealed significant associations between awareness levels and favorable attitudes toward investing in renewables. The results underscore the importance of targeted educational initiatives, strengthened communication strategies, and enhanced institutional transparency to reinforce public engagement and facilitate Saudi Arabia’s sustainable energy goals under Vision 2030. Full article

Sleep is tightly regulated by thermoregulatory processes that include core body temperature (CBT) modulation, the distal–proximal temperature gradient (DPG), and melatonin rhythms. In this review, we examine how these factors intersect with sleep physiology and contribute to the pathophysiology of common sleep disorders such as ADHD, insomnia, narcolepsy, Obstructive Sleep Apnea (OSA), depression, and Restless Legs Syndrome (RLS). We discuss evidence showing that delayed or disrupted CBT minima, impaired DPG, and altered melatonin secretion can prolong sleep latency, fragment rest, and lead to daytime symptoms. In addition, we explore temperature-based interventions, including foot baths, passive body heating, whole-body hyperthermia, and adjustments in room temperature, which have demonstrated potential to mitigate symptoms and enhance sleep quality. Collectively, these findings emphasize the need for personalized interventions to address thermoregulatory disruptions, presenting a noninvasive avenue for more effective sleep disorder management. Full article

The rapid growth in the spectrum of cyber threats, coupled with the evolution of digital uses, services and infrastructures in the healthcare sector, means that security measures need to be reassessed to ensure that they are in step with the reality on the ground and adapted accordingly, as smart healthcare systems show a dearth of privacy and security in the digitization and sharing of health records. Blockchain, being a new decentralized infrastructure, is one of the leading revolutionary emerging technologies that can be used to improve data integrity and traceability in healthcare systems. This study investigates how blockchain technology is affecting the healthcare domain, comprehensively analyzing its implications, challenges, and capabilities. The results indicate that blockchain is a revolutionary technology for creating transparent personal health records that can address the limitations of smart healthcare system management and provide a decentralized environment for exchanging healthcare data. However, there are still plenty of difficulties and obstacles that prevent it from being more widely accepted by healthcare stakeholders. Full article

Sleep is a cardinal biological process that backstops central nervous system function, which also plays a crucial role in regulating systemic homeostasis, including immune activities. Cytokines, particularly interleukin-1β and tumor necrosis factor-α, act as mediators bridging sleep and inflammation, also influencing both sleep architecture and sleep–wake cycle. Sleep deprivation and sleep disorders such as insomnia, narcolepsy, hypersomnia, or obstructive sleep apnoea may disrupt cytokine production, alter their circadian rhythm of release, and shift secretion peaks from night to day. These changes contribute to daytime fatigue, impaired cognitive and physical performance, increased susceptibility to infections and/or systemic inflammation. Molecular studies indicate that insufficient sleep primes immune cells to enhance pro-inflammatory responses, creating a feedback loop with neuroendocrine pathways that further exacerbates sleep patterns and inflammatory dysregulation. Understanding the bidirectional relationship between sleep and cytokines may highlight the role of sleep as an active component of immunity regulation and underscore the potential usefulness of multilevel interventions that include complementary and integrative health approaches restoring sleep, normalizing cytokine rhythms and mitigating inflammation. Full article

Traumatic brain injury (TBI) is a major cause of death and disability, mainly in persons under 45 years of age and it remains clinically challenging due to its heterogeneous pathophysiology and unpredictable course. Except from the initial mechanical damage, secondary injury —largely driven by neuroinflammation—plays a critical role in outcome and extent of recovery. Cytokines are central mediators of this immune response and have therefore been extensively studied as potential biomarkers for TBI diagnosis, need of imaging and prognosis. Among pro-inflammatory cytokines, IL-1β is rapidly upregulated after TBI and contributes to blood–brain barrier disruption and secondary damage. Furthermore, experimental studies suggest that IL-1 inhibition could be neuroprotective. IL-6 is up to date the most extensively studied cytokine and shows strong associations with injury severity, neuroimaging abnormalities, mortality and long-term functional outcomes across multiple adult and pediatric studies. Nevertheless, results vary depending on the biological compartment and timing. Anti-inflammatory IL-10 levels correlate with injury severity and has shown promise in distinguishing CT-positive from CT-negative mild TBI patients, potentially reducing unnecessary imaging, though findings are inconsistent. Other cytokines, including IL-17, TNF-α, IL-8, IL-9, and IL-15, have been correlated to post-traumatic neuroinflammation and may have diagnostic or prognostic value. Overall, IL-6 and IL-10 currently appear to be the most promising cytokine as biomarkers, however future research should focus on standardized cytokines assessment methods and possible use of multimarker panels. Full article

The high morbidity and mortality of cancer pose a severe challenge to human health. Traditional diagnostic and therapeutic strategies still exhibit obvious limitations in early diagnostic sensitivity, therapeutic precision, and real-time monitoring of treatment efficacy. The development of nanotechnology has provided novel solutions for precision cancer theranostics. Among nanomaterials, gold nanoparticles (AuNPs) have become a research hotspot in tumor nanomedicine due to their tunable size and morphology, excellent localized surface plasmon resonance (LSPR) effect, and favorable biocompatibility. However, despite encouraging preclinical outcomes, several challenges hinder their clinical translation, including an incomplete understanding of long-term toxicity, complex in vivo biological interactions, the lack of standardized evaluation protocols, and regulatory uncertainties and manufacturing reproducibility issues. This paper systematically reviews the physicochemical and biological mechanisms of AuNPs in cancer theranostics, and summarizes the latest research advances of AuNPs in cancer detection and diagnosis (including biomarker detection and multimodal imaging) as well as in therapeutic fields, covering photothermal therapy (PTT), photodynamic therapy (PDT), radiosensitization, targeted drug and nucleic acid delivery, and immunotherapy-assisted strategies. Furthermore, we discuss the development of intelligent and stimuli-responsive theranostic nanoplatforms based on AuNPs, and outline their future prospects in precision medicine and personalized cancer therapy, with particular emphasis on the requirements for clinical translation, including safety evaluation, large-scale production, and regulatory approval pathways. Full article

Diabetes mellitus (DM) is a complex metabolic disorder associated with a heightened risk of cardiovascular events, largely driven by a hypercoagulable and hypofibrinolytic state. The pathophysiological interplay between chronic hyperglycemia, oxidative stress, insulin resistance, and systemic inflammation fosters profound alterations in the coagulation cascade, endothelial function, and platelet activity. This narrative review synthesizes evidence from studies published between 2008 and 2026, focusing on coagulation and platelet-related biomarkers selected based on their biological relevance to thrombosis, endothelial dysfunction, and inflammation, as well as the availability of clinical and interventional data across different forms of DM. Although there are numerous biomarkers involved in the pathogenesis of various forms of diabetes, this narrative review critically examines key coagulation biomarkers—including D-dimer, fibrinogen, prothrombin, tissue thromboplastin or tissue factor, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, plasminogen activator inhibitor-1, von Willebrand factor, and β-thromboglobulin—across distinct diabetes subtypes, including type 1, type 2, gestational, and secondary forms linked to endocrinopathies and pancreatic diseases. The literature reveals substantial subtype-specific heterogeneity in hemostatic alterations. For instance, Type 1 DM is characterized by early endothelial dysfunction and platelet activation, while Type 2 DM presents with elevated coagulation factors, impaired fibrinolysis, and a proinflammatory milieu. Gestational DM exhibits pregnancy-specific changes in coagulation, yet distinguishing them from obesity-related effects remains challenging. Secondary diabetes forms, such as those associated with Cushing’s syndrome or pancreatitis, further underscore the diversity in thrombotic risk profiles. Among the coagulation and platelet activation biomarkers reviewed, fibrinogen, P-selectin, and plasminogen activator inhibitor-1 demonstrate the most consistent associations with glycemic control, vascular dysfunction, and therapeutic modulation, particularly in type 2 diabetes, suggesting greater potential for clinical translation. In contrast, evidence for markers such as D-dimer, tissue factor or tissue thromboplastin, and soluble urokinase plasminogen activator receptor remains heterogeneous and insufficient for routine clinical application. By synthesizing mechanistic insights and clinical data, this review highlights the urgent need for subtype-tailored coagulation assessment in diabetes management. A better understanding of the dynamic alterations in coagulation pathways may facilitate earlier detection of vascular complications and inform personalized antithrombotic strategies. Full article

Tumor budding (TB), defined as isolated single cells or small clusters of up to four tumor cells at the invasive front of colorectal carcinoma (CRC), is recognized as an important histopathologic marker associated with adverse tumor behavior. This review summarizes current knowledge on the morphologic assessment, biological significance, and clinical relevance of TB, emphasizing emerging artificial intelligence (AI) methods that aim to automate and standardize its quantification. Standardized reporting by the International Tumor Budding Consensus Conference (ITBCC) has improved reproducibility, while novel deep-learning algorithms demonstrate potential for objective and prognostically relevant TB assessment. Integration of AI-based TB evaluation with molecular and stromal biomarkers may refine patient stratification and facilitate personalized treatment strategies. Full article

Hepatocellular carcinoma (HCC) remains a major contributor to global cancer mortality, with many patients presenting beyond the bounds of upfront curative therapy (resection/transplant). Locoregional therapies, particularly transarterial chemoembolization (TACE), transarterial embolization (TAE), and transarterial radioembolization (TARE), therefore play an essential role in bridging and downstaging strategies designed to enable curative intent in otherwise ineligible patients. Bridging therapy aims to maintain transplant eligibility and reduce waitlist dropout, whereas downstaging seeks to reduce tumor burden to meet accepted criteria for resection or transplantation. This review synthesizes current evidence on TACE, TAE, and TARE for bridging to resection and transplantation, as well as for downstaging to surgical eligibility, drawing from systematic reviews and cohort studies in the recent literature. We examine modality-specific outcomes, contextualized by tumor biology, liver function, and treatment selection criteria. Comparative effectiveness and the need for standardized outcome measures will be highlighted, reflecting heterogeneity in study endpoints and patient populations. Finally, future directions in personalized locoregional therapy, integration with systemic therapies, and refined conversion strategies will be discussed, with emphasis on the need for consensus in defining treatment success. By integrating evolving clinical evidence with practical application, this review will help clarify the expanding role of locoregional therapies in enabling curative-intent strategies for HCC. Full article

The low participation of men in primary education is a persistent and structural phenomenon that cannot be adequately understood through homogeneous views of teachers’ motivations and experiences. This study is conducted in the Chilean context, which is characterized by a highly feminized teaching workforce and persistent challenges related to working conditions, social valuation of teaching, and teacher retention. It aims to analyze profiles of male primary school teachers, considering their motivations, perceptions, and the meanings they attribute to the teaching profession. A sequential explanatory mixed-methods design (QUAN → qual) was employed. First, 144 male in-service primary teachers completed the FIT-Choice scale and a latent class analysis was conducted. Subsequently, in-depth interviews were carried out with an intentionally selected subsample of 20 teachers, which were analyzed using qualitative content analysis. Three distinct motivational profiles were identified: altruistic, pragmatic, and critical. The qualitative findings complemented these profiles, highlighting the influence of personal trajectories and working conditions on teachers’ career choice and retention in the profession. Overall, the findings suggest that policies for training, support, and professional induction must recognize teacher heterogeneity and promote inclusive working environments, moving beyond approaches that focus exclusively on increasing the number of men in primary education. Implications for the design of policies aimed at attracting and retaining male primary school teachers are discussed. Full article

Background: Intensive care units (ICUs) are high-acuity environments that require respiratory therapists (RTs) to maintain vigilance, manage emotions, and make rapid clinical decisions. In such settings, performance stability is critical for patient safety. Although emotional intelligence (EI) and work–life balance (WLB) have been linked to professional outcomes in health care, their independent and direction-specific associations with job performance among ICU respiratory therapists remain underexamined. Methods: A national cross-sectional survey was conducted among respiratory therapists working in ICUs across Saudi Arabia (June 2025–January 2026). EI was measured using the Wong and Law Emotional Intelligence Scale. WLB was assessed using the work interference with personal life (WIPL), personal life interference with work (PLIW), and work–personal life enhancement (WPLE) scales. Job performance was evaluated using the Individual Work Performance Questionnaire. Correlation and multivariable linear regression analyses were performed to estimate independent associations. Results: A total of 392 RTs were included in the final analysis. Higher EI was independently associated with greater task performance (B = 0.21, p < 0.01) and contextual performance (B = 0.30, p < 0.001), and with lower counterproductive work behaviours (B = −0.24, p < 0.001). Among WLB dimensions, PLIW showed the strongest adverse association, predicting lower task performance (B = −0.20, p < 0.05) and higher counterproductive behaviours (B = 0.39, p < 0.001), but was not significantly associated with contextual performance in the fully adjusted model. WPLE demonstrated modest positive associations with performance, whereas WIPL was not significant in adjusted models. Conclusions: Job performance among ICU respiratory therapists is shaped by both emotional regulatory capacity and cross-domain strain. Personal life interference with work emerged as the most influential adverse predictor, whereas EI was associated with constructive performance patterns. Findings should be interpreted in light of the cross-sectional design and self-reported data. Sustaining performance in high-acuity settings requires attention to emotional competencies and structural sources of role conflict alongside clinical expertise. These findings inform workforce strategies to support performance and sustainability in critical care settings. Full article