Search Results (36,400)

Background: Accumulating evidence suggests that dietary factors may affect cardiometabolic health, but the associations between the quality of plant-based diets and chronic-low grade inflammation have been insufficiently explored. The aim of this study was to examine the association between dietary indices and inflammatory markers in the studied cohort of vegans and vegetarians living in urban Poland. Methods: The study population comprised 198 individuals (mean age 33.6 yrs) including vegans (VG; n = 50), vegetarians (VN; n = 101) and omnivores (OV; n = 47). The following methods were used in this analysis: a questionnaire interview, anthropometric measurements and blood sample collection. Dietary patterns were evaluated using the Food Frequency Questionnaire and overall plant-based diet index (PDI) and healthful plant-based index (hPDI) were used to define adherence to plant-based dietary patterns. Results: Vegans had substantially lower hsCRP concentration and lymphocyte counts than VN and OV (p < 0.05). IL-6 concentrations, as well as total WBC, neutrophils, and lymphocytes counts, were significantly higher in OV compared to the other groups. In the overall study population, higher intake of plant-based foods was associated with lower mean levels of hsCRP, IL-6, glucose, lipids, neutrophil, lymphocyte, and total WBC counts (p < 0.05). Among vegetarians, higher consumption of healthful plant-based foods was associated with lower levels of total cholesterol, triglycerides, and selected inflammatory biomarkers. Conclusions: Our research indicates that the quality of plant-based diets is a critical determinant of cardiometabolic and inflammatory health. Importantly, eliminating animal products alone does not guarantee health benefits; rather, the composition and quality of plant-based foods are key. Full article

Background: Systemic Sclerosis (SSc) is a heterogeneous autoimmune disease with variable clinical expression influenced by genetic, environmental, and sex-related factors. Understanding sex-based differences in disease phenotypes and severity can improve personalized management strategies, especially in underrepresented populations. This study aims to explore sex-based differences in disease phenotypes and severity in a population with a distinct genetic background. Materials and Methods: This cross-sectional study included 197 SSc patients (177 females and 20 males) enrolled from 5 tertiary care centres across Egypt. All participants met the 2013 ACR/EULAR classification criteria for SSc and the criteria proposed by LeRoy and Medsger. The demographic, clinical, and serological data were collected and defined according to the previously developed severity score and activity index. Results: This study highlights key sex-related differences in disease severity and management. Egyptian male patients exhibited more severe skin involvement and were more likely to receive more aggressive treatment regimens, including corticosteroids and phosphodiesterase inhibitors. Conversely, female patients demonstrated a higher frequency of moderate general systemic involvement and comparatively lower rates of pulmonary complications. Conclusions: Sex-related differences in Egyptian SSc patients appear limited, suggesting that population-specific genetic and environmental factors may play a more prominent role in disease expression than sex alone. Full article

Accurately quantifying associated microbes is essential to understand the interactions between microplankton and their associated microbes. Most DNA-based methods, such as high-throughput sequencing, primarily assess the ratio of target objects to references in microplankton samples. However, simple random sampling (SRS) of individuals may lead to deviations in quantifying these ratios at the population level if these characteristics are associated with the reference content of individuals. This study considered group analysis, which involves detecting k groups with n individuals in each group, as an alternative approach and used simulated data based on the detection of Microcystis populations to evaluate the accuracy of different sampling plans. Our results indicate that increasing the number of individuals in each group could reduce sampling bias and improve the accuracy of comparisons between populations. Group analysis could also minimize the impact of the detection limit. This study demonstrated that, when detection methods only provide the ratio of target objects to references, group analysis is more appropriate than SRS for characterizing microplankton populations. Group analysis can be used not only for detecting associated microbes but also for identifying ingested organisms or the biochemical composition of microplankton. Our results also demonstrate how in situ individual-level studies support ecological investigations. Full article

The Amazon Basin was historically hyperendemic for HBV and HDV, associated with severe outcomes like fulminant hepatitis. Brazil initiated its hepatitis B vaccination in 1989. This study assessed the current prevalence in this endemic region to evaluate the impact of vaccination. A cross-sectional population-based survey enrolled 1100 urban and rural residents. HBsAg prevalence was 1.5%, with no cases in individuals under 20 years, demonstrating interrupted vertical and horizontal transmission. Anti-HBc positivity (30.9%) indicated past exposure, predominantly in those over 30 years. Isolated anti-HBc (10.3%) included two occult HBV infections. HDV coinfection occurred in 25% of HBsAg-positive cases, with HDV RNA detected in two. Anti-HDV positivity was exclusive to adults over 30. Vaccination coverage was poorly documented, but 23.7% had protective anti-HBs titers. HBV vaccination has reduced HBsAg prevalence from high to low endemicity in the region, eliminating chronic infections in younger generations. Persistent HDV in older age groups underscores the need for targeted screening. Despite vaccination record gaps, the findings highlight the program’s success in interrupting transmission and support continued efforts toward HBV/HDV elimination. Full article

Background/objectives: Calculation of vascular age can help patients to understand the importance of adherence to a healthy lifestyle and medications. There are different methods of calculating vascular age, but different methods can provide different vascular age results. Our aim was to evaluate vascular age based on the Systematic Coronary Risk Evaluation (SCORE), Systematic Coronary Risk Evaluation 2 (SCORE 2) and Framingham Risk Score (FRS) methods. Methods: Subjects between the ages of 40–65 were involved. Vascular ages were defined based on SCORE, SCORE2 and FRS methods according to data from the literature. Results: In total, 141 patients were involved in the study; among them 94 had hypertension (HT) and 23 had white-coat hypertension. In the total population, SCORE2 and FRS vascular ages were higher compared to chronological age. SCORE2 and FRS vascular ages were higher than SCORE vascular age, and FRS vascular age was higher compared to SCORE2 as well. These tendencies were the same in the case of hypertensive patients and in patients with white-coat hypertension. In healthy patients, there were no differences between chronological age and vascular age. Conclusions: The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrant further comparison of different vascular age calculation methods. Full article

Objective: Allergic rhinitis (AR) continues to adversely affect the life quality of a substantial patient population, highlighting the necessity for enhanced treatment modalities. Our research utilized licorice extract (LE) in nasal irrigation for managing this condition, with its therapeutic efficacy gauged against traditional saline nasal irrigation (SNI) through clinical trials. Additionally, the study incorporated traditional Chinese medicine (TCM) principles, measuring not just subjective symptom relief but also the objective shifts in lung meridian electrical conductance (MEC), to provide a comprehensive evaluation of the treatment’s effectiveness. Methods: Based on our previous laboratory and animal studies, we developed an LE solution and applied it through nasal irrigation to treat AR. In a one-month controlled trial, 60 patients with AR received either licorice nasal irrigation (LNI) or SNI daily. We assessed treatment efficacy by subjective questionnaire scores (Total Nasal Symptom Score [TNSS] and 22-item Sino-Nasal Outcome Test [SNOT-22]) and objective lung MEC analysis. Result: In the trial, 30 participants were randomly allocated to each group, and 28 individuals in the LNI group and 24 in the SNI group finished the study without any side effects. The LNI group had better improvements in sneezing, nasal itchiness, and rhinorrhea, along with a greater overall TNSS reduction. On the SNOT-22, the LNI group scored better across most nasal and extra-nasal symptoms, sleep, and physiological and psychosocial well-being. Participants were sorted into low, normal, and high lung MEC subgroups. After treatment, those in the LNI group normalized their lung MEC levels in both the low and high subgroups, which was not observed in the SNI group. Conclusions: LNI markedly improves symptoms in patients with AR, enhancing their quality of life. This treatment method, integrating Western and TCM practices, also normalizes abnormal lung MEC values following therapy. It offers a method of objectively validating the effectiveness of treatments based on TCM theories. Full article

Background: The GLA:D^® program is an evidence-based intervention widely used in Western countries to improve knee function and exercise adherence among individuals with osteoarthritis. However, its application in postoperative total knee arthroplasty (TKA) populations is limited, particularly in Asia. This study evaluated two modified GLA:D^® interventions tailored to the Korean clinical environment. Methods: Patients who underwent TKA participated in one of two programs. The GLA:D-M group received therapist-supervised neuromuscular training with structured progression. The GLA:D-C group received a modified GLA:D^® program with additional lower-limb strengthening, primarily conducted as home-based exercise. Outcomes at 3 and 6 months included functional performance, isokinetic strength, gait speed, and psychosocial measures. Statistical significance, minimal clinically important difference (MCID), and effect sizes were used to assess clinical relevance. Results: Both groups improved; however, recovery patterns differed. GLA:D-M demonstrated statistically significant (p < 0.05) and clinically meaningful improvements in functional and psychosocial outcomes, exceeding MCID thresholds with large effect sizes. GLA:D-C showed significant gains in lower-limb strength, but many changes did not meet the MCID and did not consistently translate into higher-level functional recovery. These findings suggest that supervised neuromuscular training may facilitate more comprehensive recovery than home-based strengthening alone. Conclusions: Adapting the GLA:D^® program for TKA patients in a Korean clinical setting was feasible and beneficial. Additionally, the delivery method, particularly therapist supervision, played a vital role in maximizing outcomes. Both program content and delivery format should be considered in rehabilitation models. Larger, long-term studies are warranted to confirm these findings and explore broader clinical applications. Full article

Background/Objectives: Patients that undergo percutaneous coronary intervention (PCI) require effective antiplatelet therapies to minimize the risk of thrombotic cardiovascular events. Oral P2Y12 inhibitors are often utilized, however co-administered opioids may lead to gastric absorption issues in these patients, affecting the efficacy of oral inhibitors. Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor that could be explored as a potential treatment option for patients with gastric absorption issues during ST-elevation myocardial infarction. The objective was to estimate the UK budget impact of introducing cangrelor for ST-elevation myocardial infarction (STEMI) patients with gastric absorption issues undergoing PCI. Methods: A budget impact model was developed to calculate the impact of introducing cangrelor to treat STEMI patients with gastric absorption issues undergoing PCI, to the UK National Health Service and personal social services, over 5 years. Oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban), and aspirin and heparin alone were included as base case comparators. Cangrelor uptake ranged from 10% to 30% in years 1–5. The cangrelor-eligible population was estimated at 10,903 patients per year. Results: Over 5 years, cangrelor leads to a small cost saving (0.29%), varying from −GBP 261,989 in year 1 to GBP 174,778 in year 5. The introduction of cangrelor is estimated to lead to 314 fewer hospital days and 190 clinical events avoided over 5 years. Conclusions: Introducing cangrelor to STEMI patients with gastric absorption issues undergoing PCI in the UK is estimated to generate a small cost saving and reduced length of stay for some patients. Full article

In the last decade, knowledge of gut microbiota has expanded. Several studies have demonstrated a correlation between certain diseases and alterations in gut microbiota. A comprehensive understanding of this complex ecosystem is still lacking; however, this review highlights the importance of microorganisms in oncology. Recently, several studies have demonstrated that the gut microbiota influences therapeutic efficacy and tumor formation, also known as tumorigenesis. We must remember that these microorganisms also play a crucial role in tumor prognosis. Since the discovery of Fusobacterium nucleatum in colorectal carcinoma (CRC), it has been established that tumor tissues are not sterile and contain microorganisms that can lead to either beneficial or harmful pathways, affecting tumor size and response to chemotherapeutic agents. Additionally, it should be noted that data on the pediatric population are limited, as this area has not been widely researched due to the low number of cases and the complexity of therapeutic approaches. In children, the only available data are mainly based on hematological malignancies, such as acute lymphoblastic leukemia (ALL). For a better understanding, larger cohorts are required. Full article

This paper introduces TRIDENT-DE, a novel ensemble-based variant of Differential Evolution (DE) designed to tackle complex continuous global optimization problems. The algorithm leverages three complementary trial vector generation strategies best/1/bin, current-to-best/1/bin, and pbest/1/bin executed within a self-adaptive framework that employs jDE parameter control. To prevent stagnation and premature convergence, TRIDENT-DE incorporates adaptive micro-restart mechanisms, which periodically reinitialize a fraction of the population around the elite solution using Gaussian perturbations, thereby sustaining exploration even in rugged landscapes. Additionally, the algorithm integrates a greedy line-refinement operator that accelerates convergence by projecting candidate solutions along promising base-to-trial directions. These mechanisms are coordinated within a mini-batch update scheme, enabling aggressive iteration cycles while preserving diversity in the population. Experimental results across a diverse set of benchmark problems, including molecular potential energy surfaces and engineering design tasks, show that TRIDENT-DE consistently outperforms or matches state-of-the-art optimizers in terms of both best-found and mean performance. The findings highlight the potential of multi-operator, restart-aware DE frameworks as a powerful approach to advancing the state of the art in global optimization. Full article

Background: Antimicrobial resistance (AMR) remains a critical major public health challenge, largely driven by the inappropriate use of antibiotics in the community. In Spain, the National Action Plan on AMR (PRAN) emphasizes the need for robust surveillance systems based on standardized indicators and high-quality data sources. Objective: This study aimed to evaluate the feasibility of calculating PRAN prescribing indicators using the National Electronic Database for Pharmacoepidemiological Research in Primary Care (BIFAP) and to validate BIFAP as a data source for national antimicrobial prescribing surveillance. Methods: A population-based cross-sectional study was conducted using 2018 data from 9.4 million individuals. Results: Overall, 23.3% received at least one antibiotic prescription during the year, with an average of 1.8 treatments per patient. First-line recommended antibiotics represented 26.5% of total dispensed defined daily doses. Notable age-related variability in prescribing patterns was observed: children predominantly received first-line narrow-spectrum antibiotics, whereas older adults were more frequently prescribed broad-spectrum agents. Discusion: BIFAP-based indicators closely aligned with PRAN data while allowing for the calculation of additional metrics, such as prevalence of use, treatments per patient-year, and variations by age and sex. The findings underscore the importance of patient-level monitoring to identify demographic-age-specific priorities for targeted interventions aimed at optimizing antibiotic use in Primary Care. Conclusions: This study confirms the feasibility of using BIFAP to strengthen antibiotic consumption monitoring and policy evaluation efforts in Spain. Full article

Panama, with nearly 3000 km of coastline and half its population living in coastal zones, faces high vulnerability to sea level rise, flooding, and extreme events. The most vulnerable areas include low-lying coastal provinces such as Panama, Colón, and Chiriquí. This review explores the use of sustainable concrete to address the effects of climate change in Panama towards coastal resilience. The methodology combined a bibliometric analysis using VOSviewer, a systematic literature review (2015–2025) of 99 sources including regulations and technical standards, and a socioeconomic SWOT analysis to assess adoption drivers and barriers. A 2050 permanent inundation map was examined to identify vulnerable areas, and an inventory of concrete-based protection structures was developed. The results highlight that concrete is already used in Panama for coastal resilience through structures such as breakwaters, dolos, and Xbloc units. However, as the country still needs to expand its coastal protection infrastructure, there is a crucial opportunity to implement lower-impact, sustainable concrete alternatives that minimize environmental burdens while ensuring long-term durability and performance. Sustainable options, including supplementary cementitious materials (SCMs), recycled aggregates, and CO₂ injection technologies, demonstrate strong mitigation potential, with national initiatives such as Vertua, Greentec, and Argos pozzolan offering early pathways. The conclusions emphasize the need to expand sustainable concrete applications, integrate nature-based solutions, and strengthen Panama’s regulatory and technical capacity to achieve resilient, low-carbon coastal infrastructure. Full article

As a multi-ethnic border region of China, Xinjiang hosts revolutionary cultural tourism resources (RCTRs) that embody historical memory and the spirit of frontier reclamation, while also playing a strategic role in strengthening national identity and maintaining regional stability. Yet, their spatial distribution is highly uneven due to geographical, historical, and socio-economic constraints. This study analyzes 135 representative sites using a dual framework of spatial pattern analysis and driving mechanism quantification. Nearest neighbor index, imbalance index, Lorenz curve, geographic concentration index, kernel density estimation, and hotspot analysis results reveal a clustered “multi-core–peripheral attenuation” pattern with pronounced regional disparities. GIS-based overlay analysis identifies natural thresholds of moderate elevation (834–2865 m) and gentle slopes (0–8.65°), while socio-economic factors such as transportation corridors and population density amplify clustering effects. Geographic Detector results confirm road network density (q = 0.85, p < 0.01) and historical site density (q = 0.79, p < 0.01) as dominant drivers, with interactions between natural and social factors enhancing explanatory power above 0.90. These findings highlight the coupled influence of topographic suitability and socio-economic accessibility. Policy recommendations include optimizing road network layouts, adopting tiered heritage protection, and fostering cross-regional cooperation. The study provides scientific evidence for balanced development and sustainable conservation of RCTRs, contributing to the achievement of sustainable development goals (SDGs) related to cultural heritage, regional equity, and inclusive growth Full article

Population growth, urbanization, improved infrastructure, and climate change are reshaping land use systems worldwide, creating spatial trade-offs between economic development, ecosystem services, and cultural heritage. In Ladakh, Himalayan India, mass tourism and recent political changes have triggered a particularly rapid transition from traditional subsistence farming to market-oriented production, raising concerns about the sustainability of changing land management practices, cultural identity, and growing dependence on external inputs. To disentangle these concerns, we investigated land use changes, development patterns, and socio-economic drivers over the past 40 years. To this end we merged Landsat-based remote sensing data with household surveys in two contrasting, urbanizing regions—the Union Territory’s capital Leh and its more remote, third largest town of Diskit. Spatially explicit land cover maps for three periods of the 1970s, the 2000s, and the 2020s revealed an eightfold increase in residential area in Leh, with 41.7% of agricultural land converted to urban use, compared to a twofold increase and only 1.7% farmland loss in Diskit. Expansion of urban land use in Leh occurred in all directions across multiple land use types, while in Diskit, it remained localized to previously unused land. Survey data on socio-economic parameters showed a production shift toward goods demanded by tourism and the military, the latter being linked to border tensions with China and Pakistan. The divergent dynamics highlight the need for integrated spatial planning and scenario analysis to balance globalization-driven development with the conservation of cultural landscapes and ecosystem services. We recommend ecotourism-based strategies as an optimized pathway toward sustainable and multifunctional land systems in mountain regions. Full article

Accurately mapping urban residents’ exposure to green space at high spatiotemporal resolutions is essential for assessing disparities and equality across blocks and enhancing urban environment planning. In this study, we developed a framework to generate hourly green space exposure maps at 0.5 m resolution using multiple sources of remote sensing data and an Object-Based Image Classification with Graph Convolutional Network (OBIC-GCN) model. Taking the main urban area in Nanjing city of China as the study area, we proposed a Dynamic Residential Green Space Exposure (DRGE) metric to reveal disparities in green space access across four housing price blocks. The Palma ratio was employed to explain the inequity characteristics of DRGE, while XGBoost (eXtreme Gradient Boosting) and SHAP (SHapley Additive explanation) methods were utilized to explore the impacts of built environment factors on DRGE. We found that the difference in daytime and nighttime DRGE values was significant, with the DRGE value being higher after 6:00 compared to the night. Mean DRGE on weekends was about 1.5 times higher than on workdays, and the DRGE in high-priced blocks was about twice that in low-priced blocks. More than 68% of residents in high-priced blocks experienced over 8 h of green space exposure during weekend nighttime (especially around 19:00), which was much higher than low-price blocks. Moreover, spatial inequality in residents’ green space exposure was more pronounced on weekends than on workdays, with lower-priced blocks exhibiting greater inequality (Palma ratio: 0.445 vs. 0.385). Furthermore, green space morphology, quantity, and population density were identified as the critical factors affecting DRGE. The optimal threshold for Percent of Landscape (PLAND) was 25–70%, while building density, height, and Sky View Factor (SVF) were negatively correlated with DRGE. These findings address current research gaps by considering population mobility, capturing green space supply and demand inequities, and providing scientific decision-making support for future urban green space equality and planning. Full article