Search Results (19,107)

Obstructive sleep apnea (OSA) is a common disorder caused by recurrent upper airway obstruction during sleep, affecting individuals across the lifespan. In children, OSA commonly results from adenotonsillar hypertrophy and may resolve spontaneously or following surgical intervention. Among adolescents and adults, OSA is more frequently associated with modifiable lifestyle factors, particularly obesity. The natural history of OSA may evolve from intermittent snoring and mild disease to moderate or severe forms if left untreated, leading to reduced health-related quality of life and overall health deterioration. Early identification of OSA, especially in mild and moderate cases, allows timely interventions to improve OSA-associated indices and may prevent progression to severe disease. Continuous positive airway pressure therapy remains the treatment of choice for adults, providing effective symptom control and reducing long-term complications, although adherence rates vary. In obese patients, sustained weight reduction represents the most effective disease-modifying strategy: a ≥5% weight loss is associated with an approximately 80% reduction in progression risk, while bariatric surgery achieves remission in up to 60–65% of cases at one year. Emerging anti-obesity pharmacotherapies have also demonstrated clinically meaningful reductions in the apnea–hypopnea index. Comorbid conditions such as hypertension, type 2 diabetes, and depression exacerbate OSA severity, impair treatment response, and complicate overall disease management. This review uniquely integrates pediatric and adult longitudinal data, treatment-modified trajectories, and emerging therapeutic approaches to provide a life-course perspective on OSA natural history, highlighting opportunities for early, phenotype-directed intervention to possibly alter disease course and long-term outcomes. Full article

The extraction of land gas resources requires efficient methods to address the issue of pipeline obstruction due to the accumulation of natural gas hydrates. The existing ground heating, downhole throttling, and decompression measures are energy-intensive. The metal-reinforced composite heat-insulation pipe serves as the production string for terrestrial natural gas wells, effectively minimizing temperature loss of natural gas within the wellbore. This innovation eliminates the need for ground heating equipment and downhole throttling devices in large-scale gas well production, thereby fundamentally achieving environmentally sustainable natural gas extraction, energy conservation, and cost reduction. This research simulates the operational circumstances and environmental characteristics of the Sulige gas field. Utilizing predictions and analyses of the formation characteristics of natural gas hydrate, the gas–solid two-phase flow DPM model, RNG k-ε turbulence model, heat transfer characteristics, and population balance model are employed to examine the concentration distribution, pressure distribution, velocity distribution, and heat transfer characteristics of natural gas hydrate within the vertical tube of the structure. The findings indicate that a reduction in natural gas production or an increase in hydrate volume fraction leads to significant accumulation of hydrate adjacent to the tube wall, while the concentration distribution of hydrate is more uniform at elevated production conditions. The pressure distribution of hydrate under each operational state exhibits a pattern characterized by a high central concentration that progressively diminishes towards the periphery. The unit pressure drop of hydrate markedly escalates with an increase in flow rate. As the ambient temperature of the formation rises or the flow rate escalates, the thermal loss of the hydrate along the pipeline diminishes, resulting in an elevated exit temperature. Minimizing the thermal conductivity of the composite pipe can significantly decrease the temperature loss of the hydrate along the pipeline, greatly aiding in hydrate inhibition during the extraction of natural gas from terrestrial wells. This paper’s research offers theoretical backing for the enduring technical application of metal-reinforced composite insulating pipes in terrestrial gas fields, including the Sulige gas field. Full article

This study aimed to biosynthesize silver nanoparticles (AgNPs) using aqueous leaf extract of Galega officinalis and to evaluate their insecticidal activity against key stored-product pests. AgNP formation was confirmed through UV–vis spectroscopy, which showed a surface plasmon resonance peak at 380 nm. FTIR analysis indicated the presence of plant-derived functional groups likely involved in the reduction and stabilization of Ag⁺ ions. Dynamic light scattering revealed an average hydrodynamic diameter of 25.07 nm, a PDI of 0.39, and a zeta potential of −22 mV, while TEM images showed predominantly spherical and polydisperse particles ranging from 4.3 to 42.4 nm. Insecticidal bioassays performed on Sitophilus granarius, Tribolium confusum, Plodia interpunctella, and Ephestia kuehniella revealed concentration-dependent mortality. The highest mortality rates were recorded at 1000 ppm, reaching 100% in T. confusum, 83.33% in P. interpunctella, and 76.67% in both S. granarius and E. kuehniella. These findings demonstrate the potent insecticidal activity of G. officinalis-mediated AgNPs and support their potential as environmentally friendly alternatives for stored-product pest management, warranting further studies on safety, large-scale synthesis, and integration into pest-control programs. Full article

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Hemadsorption therapies remove inflammatory mediators and are used as adjunctive treatment in selected patients. Although increased immature granulocyte (IG) levels correlate with inflammatory severity, changes in IG levels after hemadsorption therapy have not been previously evaluated. Methods: This retrospective observational study included patients with sepsis who received hemadsorption therapy in intensive care units between January 2021 and July 2025. Sepsis was diagnosed according to the Surviving Sepsis Campaign 2021 guidelines, and hemadsorption was initiated for persistent hemodynamic instability despite standard therapy. Treatment was performed using a Jafron HA330 cartridge for at least three 6 h sessions. IG count and percentage, inflammatory parameters, lactate levels, and organ dysfunction scores were recorded before and after therapy. ICU mortality was the primary outcome. Statistical analyses included paired comparisons, multivariable logistic regression, and ROC curve analysis. Results: Among 887 patients with sepsis, 196 met the inclusion criteria. The ICU mortality rate was 43.9%, and the median time between pre- and post-treatment measurements was 4 days (IQR: 3–5). After hemadsorption therapy, IG count, IG%, inflammatory parameters, lactate levels, SOFA scores, and vasopressor requirements decreased (all p-values < 0.001). IG parameters were higher in non-survivors. Post-treatment IG# (AUC 0.880) and IG% (AUC 0.812) showed good discriminative performance. Conclusions: Hemadsorption therapy was associated with reductions in IG parameters and inflammatory indicators in sepsis. These findings support IG parameters as complementary measures of immune and inflammatory dynamics during hemadsorption therapy. Accordingly, this study should be regarded as a hypothesis-generating investigation describing associations of IG dynamics in septic patients undergoing hemadsorption, rather than demonstrating treatment efficacy or causal effects. Full article

The widespread adoption of electric vehicles (EVs) has posed significant challenges to the security of distribution grid loads. To address issues such as increased grid load fluctuations, rising user charging costs, and rapid load surges around midnight caused by uncoordinated nighttime charging of household electric vehicles in communities, this paper first models electric vehicle charging behavior as a Markov Decision Process (MDP). By improving the state-space sampling mechanism, a continuous space mapping and a priority mechanism are designed to transform the charging scheduling problem into a continuous decision-making framework while optimizing the dynamic adjustment between state and action spaces. On this basis, to achieve synergistic load forecasting and charging scheduling decisions, a forecast-augmented deep reinforcement learning method integrating Gated Recurrent Unit and Twin Delayed Deep Deterministic Policy Gradient (GRU-TD3) is proposed. This method constructs a multi-objective reward function that comprehensively considers time-of-use electricity pricing, load stability, and user demands. The method also applies a single-objective pre-training phase and a model-specific importance-sampling strategy to improve learning efficiency and policy stability. Its effectiveness is verified through extensive comparative and ablation validation. The results show that our method outperforms several benchmarks. Specifically, compared to the Deep Deterministic Policy Gradient (DDPG) and Particle Swarm Optimization (PSO) algorithms, it reduces user costs by 11.7% and the load standard deviation by 12.9%. In contrast to uncoordinated charging strategies, it achieves a 42.5% reduction in user costs and a 20.3% decrease in load standard deviation. Moreover, relative to single-objective cost optimization approaches, the proposed algorithm effectively suppresses short-term load growth rates and mitigates the “midnight peak” phenomenon. Full article

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002–2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129–0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities. Full article

Objective: This study assessed the efficacy of the cervical pessary combined with progesterone to prevent preterm birth in pregnant women with short cervix and previous preterm birth. Methods: This post hoc analysis of the randomized, multicenter P5 trial examined the efficacy of the cervical pessary associated with vaginal progesterone versus progesterone alone for preventing recurrent preterm birth in 155 pregnant women with cervical length ≤30 mm and prior spontaneous preterm birth (sPPTB) (main subgroup), and in 85 women with cervical length ≤25 mm and sPPTB (higher-risk population). The primary outcome was spontaneous preterm birth (sPTB) before 34 weeks; secondary outcomes included sPTB rates before 37, 32, and 28 weeks, analyzed using Odds Ratio (OR) and Kaplan–Meier curves. A secondary objective was to identify predictive factors for sPTB recurrence in the cohort with prior preterm birth (n = 479), irrespective of treatment allocation. Results: Demographic profiles were balanced between groups. The addition of a cervical pessary to progesterone did not result in a significant reduction in sPTB before 34 weeks: to cervix ≤30 mm, OR 1.169 (95% CI 0.524–2.609; p = 0.703) and 1.167 (95% CI 0.466–2.921; p = 0.742) for ≤25 mm; similar null findings were observed across all gestational age thresholds. Kaplan–Meier survival curves demonstrated no significant differences between groups (p > 0.05). Secondary analysis (n = 479) identified principal predictors of sPTB recurrence, regardless of the cervical length: higher education (OR 2.37; 95% CI 0.99–5.63; p = 0.024), previous cervical conization (OR 4.78; 95% CI 1.08–21.19; p = 0.039) previous low birth weight < 2.5 kg (OR 2.43; 95% CI 1.22–4.85; p = 0.051), prior miscarriages (OR 1.36; 95% CI 1.10–1.69; p = 0.005), current twin pregnancy (OR 14.86; 95% CI 4.35–50.68; p < 0.001) and cervical funneling (OR 3.60; 95% CI 1.79–7.24; p < 0.001). Predictive models achieved an AUC of 0.719, with 87.0% sensitivity and 58.8% specificity. Conclusions: These findings do not support the routine use of cervical pessary combined with progesterone in women with dual risk factors. In this Brazilian population, specific clinical and obstetric characteristics—including higher education, cervical funneling, prior low birth weight delivery, previous conization, current twin gestation, and prior miscarriage—could identify women at increased risk for recurrent preterm birth. Full article

This study aims to enhance the development effectiveness of infill wells in the strongly heterogeneous conglomerate reservoir of the Baikouquan Formation in the Bai 21 well area of the Junggar Basin. By optimizing the synergy between fracturing and waterflooding development, it provides a basis for improving the recovery rate of such reservoirs. Integrating geomechanical modeling, fracturing numerical simulation, and reservoir dynamic analysis, the influence mechanisms of fracturing parameters—including pumping rate, pad fluid ratio, and proppant intensity—on fracture propagation, waterflooding response, and stress field evolution were systematically investigated. The results indicate that an optimal parameter combination of a pumping rate of 3.5–4.0 m³/min, a pad fluid ratio of 40–50%, and a proppant intensity of 3.0–4.0 m³/m can create short, wide fractures with half-lengths of 40–45 m, effectively delaying water breakthrough and reducing inter-well interference. Stress field simulations further reveal non-uniform evolution during injection and production: the stress near injection wells initially increases and then decreases, dropping by 9.3% compared to the initial value, while the stress around production wells continuously decreases, with a reduction of up to 37.3%. These findings provide valuable guidance for the synergistic development of fracturing and waterflooding in infill wells in similar strongly heterogeneous conglomerate reservoirs. Full article

The rapid proliferation of connected vehicles equipped with both Vehicle-to-Vehicle (V2V) sidelink and cellular interfaces creates new opportunities for real-time vehicular applications, yet achieving ultra-reliable communication without prohibitive cellular costs remains challenging. This paper addresses reliable inter-vehicle video streaming for safety-critical applications such as See-Through for Passing and Obstructed View Assist, which require stringent Service Level Objectives (SLOs) of 50 ms latency with 99% reliability. Through measurements in Seoul urban environments, we characterize the complementary nature of V2V and Vehicle-to-Network-to-Vehicle (V2N2V) paths: V2V provides ultra-low latency (mean 2.99 ms) but imperfect reliability (95.77%), while V2N2V achieves perfect reliability but exhibits high latency variability ($P_{99}$: 120.33 ms in centralized routing) that violates target SLOs. We propose a hybrid framework that exploits V2V as the primary path while selectively retransmitting only lost packets via V2N2V. The key innovation is a dual loss detection mechanism combining gap-based and timeout-based triggers leveraging Real-Time Protocol (RTP) headers for both immediate response and comprehensive coverage. Trace-driven simulation demonstrates that the proposed framework achieves a 99.96% packet reception rate and 99.71% frame playback ratio, approaching lossless transmission while maintaining cellular utilization at only 5.54%, which is merely 0.84 percentage points above the V2V loss rate. This represents a $7\times$ cost reduction versus PLR Switching (4.2 GB vs. 28 GB monthly) while reducing video stalls by $10\times$. These results demonstrate that packet-level selective redundancy enables cost-effective ultra-reliable V2X communication at scale. Full article

With the development of novel production routes enabling near-zero emissions from lime manufacturing, the use of lime as a carbon-sequestering component in cementitious materials has attracted increasing attention. To address the intrinsically low early-age strength of lime-enriched binders (LP), this study investigates the modification effect of polyvinyl alcohol (PVA) on LP, with systematic comparisons to ordinary Portland cement (PO) and pure lime systems (LE). The results indicate that, in terms of mechanical performance, the incorporation of PVA significantly enhances the early-age strength of LP, particularly the flexural strength, which increases by 119.3%. In contrast, the strength of PO shows a certain degree of reduction after PVA addition. Regarding carbon uptake performance, the CO₂ sequestration capacity of PO and LE increases by 16.8% and 16.9%, respectively, whereas that of LP slightly decreases by 5.5%. From the hydration perspective, both the heat release rate and cumulative heat of PO and LP are reduced after PVA incorporation. Combined with microstructural analysis, the mechanical enhancement of LP induced by PVA is mainly attributed to the polymer film-forming effect, which compensates for the negative impact caused by the inhibition of hydration. Full article

Background/Objectives: Reduced-ejection-fraction heart failure (HFrEF) constitutes a challenge due to its high morbidity and mortality. The use of sacubitril/valsartan (angiotensin receptor–neprilysin inhibitors [ARNI]) and SGLT2 inhibitors (SGLT2i) represents a change in management approach with a demonstrated association with positive ventricular remodeling and a reduction in cardiovascular events. We describe the clinical and therapeutic course of patients with HFrEF in a specialized unit, comparing two consecutive periods (2011–2016 vs. 2017–2021), with emphasis on the impact of ARNI and SGLT2i upon clinical parameters and the use of devices. Methods: A retrospective, longitudinal observational study was carried out in 1363 outpatients with HFrEF, with at least two years of follow-up. Clinical characteristics, treatments, the evolution of left ventricular ejection fraction (LVEF), mortality, and the use of devices (implantable cardioverter–defibrillator [ICD], cardiac resynchronization therapy [CRT]) were evaluated. Results: A total of 1363 patients were analyzed, showing a significant therapeutic change in the 2017–2021 group with the incorporation of ARNI (40%) and SGLT2i (25%). This cohort achieved better ventricular recovery, with a significantly higher mean LVEF at one year compared to the 2011–2016 group (44.3% vs. 42.1%; p = 0.004). Regarding devices, ICD implantation rate decreased in the recent period (7.2% vs. 11.1%; p = 0.016), while CRT indication increased. Most importantly, all-cause mortality after two years fell from 9.4% to 5.9% (p = 0.023). Multivariate analysis confirmed that this survival improvement was independently associated with the study period (HR 1.57 for the earlier group) and was linked to the protective effect of contemporary pharmacological treatments. Conclusions: The systematic introduction of ARNI and SGLT2i in the treatment of HFrEF was associated with improved ventricular function, reduced need for device implantation, and lower mortality over the middle term in a real-life clinical setting. Full article

Deep learning algorithms are pivotal in the identification and classification of microseismic signals in mines subjected to impact pressure. However, conventional machine learning techniques often struggle to balance interpretability, computational efficiency, and accuracy. To address these challenges, this paper presents a hybrid feature selection and Transformer-based model for microseismic signal classification. The proposed model employs a hybrid feature selection method for data preprocessing, followed by an enhanced Transformer for signal classification. The study first outlines the underlying principles of the method, then extracts key seismic features—such as zero-crossing rate, maximum amplitude, and dominant frequency—from various microseismic signal types. These features undergo importance and correlation analyses to facilitate dimensionality reduction. Finally, a Transformer-based classification framework is developed and compared against several traditional deep learning models. The results reveal significant differences in the waveforms and spectra of different microseismic signal types. The selected feature parameters exhibit high representativeness and stability. The proposed model achieves an accuracy of 90.86%, outperforming traditional deep learning approaches such as CNN (85.2%) and LSTM (83.7%) by a considerable margin. This approach provides a reliable and efficient solution for the rapid identification of microseismic events in rockburst-prone mines. Full article

Background: Walking cadence is commonly adjusted in sport and rehabilitation, yet its effects on spatiotemporal gait parameters and regional plantar pressure distribution under controlled speed conditions remain incompletely characterized. Therefore, this study aimed to determine whether imposed cadence increases at a constant walking speed would (i) systematically reduce temporal gait parameters while preserving inter-limb symmetry and (ii) be associated with region-specific increases in forefoot plantar loading, representing the primary novel contribution of this work. Methods: Fifty-two adults walked at three imposed cadences (110, 120, 130 steps·min⁻¹) while maintaining a fixed treadmill speed of 1.39 m·s⁻¹ via auditory biofeedback. Spatiotemporal parameters were recorded with an OptoGait system, and plantar pressure distribution was measured using in-shoe pressure insoles. Normally distributed variables were analyzed using repeated-measures ANOVA, whereas plantar pressure metrics were assessed using the Friedman test, followed by Wilcoxon signed-rank post-hoc comparisons with false discovery rate (FDR) correction. Associations between temporal parameters and plantar loading metrics (peak pressure, pressure–time integral) were examined using Spearman’s rank correlation with FDR correction (α = 0.05). Results: Increasing cadence produced progressive reductions in gait cycle duration (~8–10%), contact time (~7–8%), and step time (all p < 0.01), while inter-limb symmetry indices remained below 2% across conditions. Peak plantar pressure increased significantly in several forefoot regions with increasing cadence (all p_FDR < 0.05), whereas changes in the first ray were less consistent across conditions. Regional forefoot pressure–time integral also increased modestly with higher cadence (p_FDR < 0.01). Spearman’s correlations revealed moderate negative associations between temporal gait parameters and global plantar loading metrics (ρ = −0.38 to −0.46, all p_FDR < 0.05). Conclusions: At a constant walking speed, increasing cadence systematically shortens temporal gait components and is associated with small but consistent region-specific increases in forefoot plantar loading. These findings highlight cadence as a key temporal constraint shaping plantar loading patterns during steady-state walking and support the existence of concurrent temporal–mechanical adaptations. Full article

Additive manufacturing offers rapid and customizable production, yet conventional plastic-based methods remain energy-intensive and environmentally harmful, often resulting in higher impacts per part than traditional manufacturing. The goal of this study was to evaluate whether upcycled biomaterials, specifically oyster shells, pistachio shells, and clay, could be used as lower-impact alternatives to PLA in 3D printing. The scope included detailed measurement of print parameters for each material and a full life cycle assessment (LCA) of the printed elements, covering printer manufacturing, raw material extraction, transport, operation, and end of life. The results show that ambient-temperature extrusion of these upcycled biomaterials can reduce energy consumption by up to 89% and overall environmental impact by up to 94% (as measured by ReCiPe Endpoint H points) compared to PLA printing. These reductions were observed for the Netherlands and EU contexts, where electricity mixes are relatively clean and recycling rates are high; even greater improvements were observed for the US. Although the printed biomaterial objects exhibit lower mechanical strength, limited waterproofness, and reduced print resolution, they are already suitable for low-load applications such as prototypes and architectural models. Overall, the findings demonstrate that upcycled biomaterial extrusion has strong sustainability potential, outperforming both conventional plastics and bioplastics such as PLA in terms of material impacts and energy use. Continued development of material formulations as well as pre- and post-processing techniques could further expand functionality and support the broader adoption of low-impact 3D printing across a wide range of applications. Full article

Polypropylene microplastics (PP-MPs) represent a persistent class of marine pollutants due to their hydrophobicity, high crystallinity, and resistance to environmental degradation. This review summarizes recent advances in understanding the environmental behavior, physicochemical aging, and ecotoxicological risks of PP-MPs, with emphasis on microbial degradation pathways involving bacteria, fungi, algae, and filter-feeding invertebrates. The biodegradation of PP-MPs is jointly regulated by environmental conditions, polymer properties, and the structure and function of plastisphere communities. Although photo-oxidation and mechanical abrasion enhance microbial colonization by increasing surface roughness and introducing oxygenated functional groups, overall degradation rates remain low in marine environments. Emerging mitigation strategies include biodegradable polymer alternatives, multifunctional catalytic and adsorptive materials, engineered microbial consortia, and integrated photo–biodegradation systems. Key research priorities include elucidating molecular degradation mechanisms, designing programmable degradable materials, and establishing AI-based monitoring frameworks. This review provides a concise foundation for developing ecologically safe and scalable approaches to PP-MP reduction and sustainable marine pollution management. Full article