Search Results (12,244)

Inflammatory diseases are common in companion dogs. Although white blood cell (WBC) count and C-reactive protein (CRP) are routinely used to assess systemic inflammation, their individual prognostic value remains limited. The erythrocyte sedimentation rate (ESR), reflecting red blood cell aggregation driven by plasma proteins, has long been applied in human medicine as both an inflammatory and prognostic marker. This study evaluated the prognostic utility of ESR in dogs, including clinically healthy and diseased populations. Associations between ESR, other inflammatory markers, and age were examined, and its role as an independent predictor of mortality and optimal clinical cut-off were determined. A subgroup of dogs meeting the systemic inflammatory response syndrome (SIRS) criteria were also analyzed to assess the latter’s usefulness in acute settings. A total of 350 dogs were enrolled: 241 diseased and 109 healthy. ESR was measured using an automated analyzer. Receiver operating characteristic (ROC) curve analysis, expressed as the area under the curve (AUC), evaluated diagnostic accuracy, followed by Kaplan–Meier survival and Cox proportional hazard analyses. ESR values were significantly higher in the disease group than in the healthy group (p < 0.0001). ESR showed fair to good prognostic accuracy for mortality in both the overall cohort (AUC = 0.776 [95% CI: 0.709–0.842]) and the SIRS subgroup (AUC = 0.846 [95% CI: 0.747–0.946]). An ESR cut-off of 18 mm/h was associated with mortality in SIRS dogs with 87.5% specificity. In the multivariate analysis, ESR showed an independent association with mortality (hazard ratio 1.013 [95% CI: 1.004–1.022], p = 0.004). These findings support ESR as a practical and independent prognostic marker for risk stratification in dogs with systemic inflammation. Full article

Red mud is a highly alkaline solid waste with an annual emission of over 200 million tons, which requires large-scale utilization methods. Soil Cd remediation is a global concern, due to its high toxicity and strong mobility. Given red mud’s potential for soil Cd remediation, this study reviews its basic characteristics, the mechanisms of soil Cd immobilization by red mud, and the use of red mud-based passivators for agricultural soil Cd remediation. In general, red mud regulates soil pH, thus increasing the soil’s Cd adsorption capacity; provides abundant surface active sites for adsorption and complexation with soil Cd; introduces cations to immobilize Cd via ion exchange; and enriches Cd-resistant microbe species to reduce soil Cd toxicity. Furthermore, the potential environmental risks and suggestions on red mud application are discussed. Further research should focus on improving the remediation effectiveness of red mud on cadmium-contaminated agricultural soil, demonstrating its long-term efficacy and economic costs, and proposing practical technical models and standards for application. Full article

Objective: Vasovagal syncope (VVS) complicated by convulsions or incontinence (atypical VVS) has distinct manifestations prone to misdiagnosis. This study sought to investigate the clinical manifestations and contributing risk factors of atypical VVS in pediatric patients, with the goals of providing a scientific basis for early identification and improving diagnostic accuracy. Methods: We carried out a case–control study focusing on children with a diagnosis of VVS who received inpatient care in the Pediatric Department of Peking University First Hospital from January 2021 to June 2025. Patients who experienced convulsions or incontinence during syncopal episodes were assigned to the atypical VVS group, while those without these symptoms formed the control group. The clinical data of the two groups were compared, and logistic regression analysis was utilized to detect factors associated with atypical VVS. Results: A total of 393 qualified patients were recruited; there were 68 cases in the atypical VVS group and 325 cases in the control group. The age of the first syncopal episode in children with atypical VVS was significantly lower than that in the control group [9.5 (7.0, 12.0) vs. 11.0 (8.0, 13.0) years, p < 0.05]. Additionally, the atypical VVS group showed higher rates of syncope-related trauma (22.1% vs. 9.2%, χ² = 7.905, p < 0.01), positive syncope-related family history (35.3% vs. 22.8%, χ² = −4.067, p < 0.05), and syncope triggered by central factors (33.8% vs. 19.7%, χ² = 5.721, p < 0.05). The Holter monitoring results revealed that the minimum heart rate was significantly reduced in the atypical VVS group [48.0 (44.8, 52.0) vs. 50.0 (47.0, 54.0) beats/min, p < 0.01]. The analysis of heart rate variability (HRV) showed that the index of the percentage of adjacent normal-to-normal interval differences greater than 50 ms [pNN50; 23.4 (16.6, 34.2) vs. 20.1 (13.1, 28.4), p < 0.05)] and the root mean square of successive differences between adjacent normal cycles [rMSSD; 47.5 (41.0, 64.0) vs. 45.0 (36.0, 56.0), p < 0.05)] was significantly higher in the atypical VVS group than in the control group. Two independent factors associated with atypical VVS were detected with multivariate logistic regression: age at the first episode (OR = 0.874, 95% CI 0.802–0.952, p < 0.01) and minimum heart rate (OR = 0.921, 95% CI 0.879–0.965, p < 0.01). Conclusions: Pediatric patients with atypical VVS present with lower minimum heart rate and a higher incidence of syncope induced by central triggers. Compared with children with typical VVS, those with atypical VVS exhibit more pronounced autonomic nervous system imbalance, characterized by enhanced vagal tone. For children with VVS showing these clinical features, careful differential diagnosis, close follow-up, and vigilance against prolonged asystole during syncopal episodes are recommended. Full article

The Tourism Area Life Cycle shaped tourism research for decades, but its concepts Product Life Cycle and Carrying Capacity remain problematic. We apply a Path Dependence frame under an Urban Growth Machine Theory lens to explore the effects of growth pressure and resource undersupply on the decline and rejuvenation of Japan’s former premier hot spring resort Atami. We conduct structured data collection utilizing sampling and coding methods to collect quantitative and qualitative data from primary and secondary sources, reconstructing Atami’s development paths. Findings suggest that growth pressure conflicted with local supply such as land, water, labor and created negative externalities, most notably high prices. Decision makers’ uncompromising focus on growth aggravated displacement of key actors, disrupting local communities and undermining the human agency needed for small-scale product innovation; empowered associations obstructing promotion and diversification efforts; encouraged extreme specialization depriving Atami of new independent businesses; and drove local opposition to major new projects, thereby stalling product renewal. The framework helped recontextualize Atami’s recovery and demonstrated the value of directly incorporating factors of capacity into analysis. Results link displacement to long-term sustainability risks affecting ‘replaceable’ resorts reliant on innovation. Unencumbered access to local resources for residents (housing, training) is proposed as mitigation. Full article

Excessive copper (Cu) content in soil can affect plant growth and also cause damage to the soil ecosystem, making it one of the risk control projects for agricultural land soil pollution in China. Alternanthera philoxeroides exhibits stronger colonization ability in heavy metal-contaminated soil, but its physiological and ecological mechanisms of tolerance to excessive Cu remain unclear. A greenhouse incubation experiment was conducted to study the multifaced responses of A. philoxeroides to Cu stress at artificially augmented concentrations of 0, 250, 500, and 1000 mg kg⁻¹. The results showed that A. philoxeroides exhibited high tolerance to Cu²⁺, with a tolerance index (TI) exceeding 60%. As the Cu concentration increased from 0 mg kg⁻¹ to 500 mg kg⁻¹, root biomass and Cu concentration in the root increased. Additionally, soluble sugar (SS) and malondialdehyde (MDA) contents, and catalase (CAT) and peroxidase (POD) activities of A. philoxeroides continued to increase, whereas superoxide dismutase (SOD) enzyme activity, branch number, leaf area, and net photosynthetic rate kept declining. However, the trend of these indicators was opposite when Cu²⁺ concentrations were above 500 mg kg⁻¹, while the canopy area and underground root system of A. philoxeroides increased. These results suggested A. philoxeroides displayed a standing “silent” tolerance strategy to survive when soil copper was lower than 500 mg kg⁻¹ concentrations, and an “escape” strategy to avoid high copper stress by expanding the above- and below-ground areas of plants when soil copper concentrations were higher than 500 mg kg⁻¹. This study recommends the controlled utilization of A. philoxeroides for pollution remediation in Cu-contaminated soil areas where most local native plants are unable to survive. Full article

Cardiovascular–kidney–metabolic syndrome (CKMS) represents the intricate interconnection of cardiovascular, kidney, and metabolic disorders, with systemic inflammation now recognized as a key driver of both pathogenesis and prognosis. This systematic review aimed to synthesize current evidence on the prognostic value of inflammatory biomarkers in individuals with CKMS. A systematic search of PubMed, Embase, CINAHL, Web of Science, and Scopus were conducted to identify studies published between 1 January 2024 and 30 June 2025, following the recognition of CKMS as a distinct syndrome in December 2023. Eligible studies included adults (aged ≥ 18 years) with CKMS, that assesses one or more inflammatory markers and reported prognostic outcomes such as mortality or disease progression. Data extracted included study characteristics, biomarker types, outcome measures, and key findings. In addition to longitudinal cohorts, we included a small number of cross-sectional studies and treated them as association (non-prognostic) evidence analyzed in a separate stream from prognostic cohorts. Risk of bias was evaluated using the Quality in Prognostic Studies (QUIPS) tool. Due to considerable variability in prognostic outcomes, follow-up durations, and inflammatory indices, a meta-analysis was not feasible. Instead, a narrative synthesis was undertaken to summarize the evidence, identify consistent associations, and emphasize the need for standardized approaches and biomarker validation in future CKMS research. Analysis was conducted in line with the SWiM guidelines. Thirteen studies (n = 13) comprising 282,016 participants (100,590 males; 97,295 females) were included from 1404 initial records. Five of the studies were cross-sectional, providing information on associations rather than prognostic outcomes. Most were large-scale cohort studies conducted in the USA and China. Frequently assessed biomarkers included systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (hs-CRP/HDL-C), dietary inflammatory index (DII), and triglyceride–glucose (TyG) index. Elevated levels of these biomarkers were consistently associated with higher risk of all-cause and cardiovascular mortality, CKMS progression, and adverse metabolic outcomes. This review highlights systemic inflammation as a critical and associated marker of CKMS prognosis. Inflammatory biomarkers may assist in hypothesis generation, but clinical utility remains to be established pending standardized adjustment and external validation. Because CKMS has only recently been operationalized, we limited inclusion to studies published from 1 January 2024 onward, enhancing definitional comparability but narrowing the evidence base and potentially emphasizing early-adopter regions (predominantly the U.S. and China). Accordingly, these findings should be interpreted as early signals that require replication in diverse settings and confirmation through longitudinal and interventional studies to inform integrative CKMS management strategies. Across observational studies, the certainty of evidence is low to moderate due to indirectness and imprecision; findings should be treated as associational signals pending external validation. Full article

With the rapid development of the new energy vehicle industry, the efficiency of information sharing in the power battery recycling supply chain greatly affects resource utilization and sustainability. This paper examines battery manufacturers and third-party recyclers as game participants. We analyze incentive mechanisms for sharing technical information, considering both information quality and leakage risks. This study constructs three types of Stackelberg game models: contract mechanisms, profit-sharing mechanisms, and cost-sharing mechanisms. We analyze the impact of technical information quality and leakage costs on supply chain decisions. Results show that manufacturer profits increase with growing leakage costs, following optimal transitions through profit-sharing, contract, and cost-sharing mechanisms. Recycler profits are influenced by both the quality of technical information and leakage costs. Overall supply chain profits trend toward cost-sharing mechanisms when technical information quality is low and favor profit-sharing mechanisms when quality is high. Under low leakage risk, cost-sharing mechanisms dominate at the technological level and in terms of recycling quantity. Under high leakage risk, profit-sharing mechanisms share leakage costs and lead in technology investment and recycling quantity. Contract mechanisms consistently have the lowest levels and volumes because they lack cost sharing and profit compensation. This study provides a theoretical foundation and practical guidance for information-sharing strategies in power battery recycling supply chains. Full article

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurological disorder caused by persistent measles virus infection. Reliable prognostic biomarkers remain limited. Systemic inflammation has been implicated in the pathogenesis of neuroinfectious diseases, and hematology-derived indices are increasingly recognized as accessible markers of inflammatory burden. This retrospective case–control study was conducted at İnönü University Faculty of Medicine, Malatya, Türkiye, between 2010 and 2025, including 40 pediatric patients with SSPE and 40 age- and sex-matched healthy controls. Demographic and laboratory data were retrieved from institutional records, and disease severity was classified according to Jabbour stages. Compared with controls, patients with SSPE had significantly higher pan-immune inflammation value (PIV: 710.5 [320–1050] vs. 280.0 [150–460], p < 0.001), systemic immune-inflammation index (SII: 640.0 [310–1240] vs. 410.0 [210–720], p = 0.02), and neutrophil-to-lymphocyte ratio (NLR: 2.1 [1.2–3.8] vs. 1.6 [1.0–2.5], p = 0.03), along with lower lymphocyte counts (p = 0.04). Elevated PIVs were strongly associated with advanced Jabbour stages, impaired ambulation, and a higher case-fatality ratio (35%). Multivariate regression identified PIV as an independent predictor of death (OR: 3.25, 95% CI: 1.45–7.28, p = 0.004), and receiver operating characteristic analysis demonstrated superior discriminative accuracy of PIV (AUC = 0.87) compared with other indices. These findings suggest that PIV, a simple and inexpensive biomarker derived from routine blood tests, may provide useful prognostic information in SSPE and aid early risk stratification. Further multicenter, prospective studies are warranted to validate its clinical utility. Full article

Tsunamis and submarine earthquakes pose severe risks to coastal regions, demanding rapid and reliable monitoring systems. While the Deep-ocean Assessment and Reporting of Tsunamis (DART) system has been globally deployed, its dependence on pressure sensors and one-to-one communication limits its applicability to the Korean East Sea. This paper introduces the Korean Tsunami and Earthquake Monitoring System, which integrates seafloor seismometers and proposes a dedicated Medium Access Control (MAC) protocol optimized for multi-node underwater acoustic communication. The study performs a comprehensive analytical derivation of closed-form expressions for channel utilization and energy consumption under diverse node configurations and acoustic conditions. The analytical results confirm that the proposed MAC protocol maintains stable performance, supports multi-node operation, and enables long-term monitoring within the limited energy budget of underwater devices. The derived results also provide practical design implications for underwater network planning, including guidelines on node placement, frame duration, and control packet timing for efficient data delivery. Although empirical validation remains as future work, the findings establish theoretical benchmarks and engineering insights for the design of next-generation underwater monitoring systems tailored to Korean coastal environments. Full article

This study presents an integrated geological and environmental radiological analysis of basaltic volcanic rocks, which have been characterized by their suitability and potential for risk when used as construction materials. A total of thirty-five representative basaltic samples from the environment of studied area, located in the Northern Eastern Desert of Egypt, were utilized for this study. The rocks were then analyzed by means of HPGe high-resolution gamma-ray spectrometry methods. The petrographic studies show that the basalt samples were composed mostly of three main minerals: plagioclase, olivine, and pyroxene. In addition, these rocks have a significant degree of secondary alteration products, including sericite, epidote, and zoethite. For uranium-238 (²³⁸U), thorium-232 (²³²Th), and potassium-40 (⁴⁰K), the average activity concentration measured 53 ± 20 Bq kg⁻¹, 54 ± 14 Bq kg⁻¹, and 1178 ± 269 Bq kg⁻¹, respectively. Using the current global reference limits, all the measured values are above acceptable levels for the radionuclides ²³⁸U, ²³²Th, and ⁴⁰K. The radiological indices calculated for each of the basalt volcanic samples measured radium equivalent activity (Ra_eq = 221 Bq kg⁻¹), external hazard index (H_ex = 0.60), internal hazard index (H_in = 0.74), gamma index (Iγ = 0.84), and annual effective dose (AED = 0.52 mSv y⁻¹) indicate that the radiological hazard values of these samples are acceptable, unlike several samples, where values are near or exceed the accepted standards for indoor hazards. The most significant finding of this study reveals that the major contributions in the environment from radiological risk can be attributed to radionuclides ²³⁸U and ⁴⁰K based on correlation analysis, hierarchical clustering, and PCA analyses, and this study establishes the first multivariate perspective of how radiogenic materials controlled by the environment can affect basaltic rocks. Therefore, this study creates an important baseline for future environmental monitoring and states that caution is warranted when using basalt as a finished material for constructed environments, and for using basaltic products as raw materials in indoor environments. Full article

Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified by the Society for Cardiovascular Angiography and Interventions (SCAI) into stages A (at risk) through E (extremis), which informs treatment strategies, including pharmacotherapy and mechanical circulatory support (MCS). Recent advancements in percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABPs), Impella devices, TandemHeart, Protek-Duo, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), have transformed management paradigms by offering targeted hemodynamic support. While DanGer-SHOCK, a pivotal randomized trial, demonstrated improved outcomes with early Impella use in anterior STEMI-associated CS, the trial’s focus population and center expertise suggest that its findings should be interpreted in the context of broader AMI-CS and HF-CS presentations. Device selection is guided by shock severity, anatomical considerations, comorbidities, and institutional capabilities. This review synthesizes current evidence, evaluates the clinical utility and efficacy of existing and emerging percutaneous MCS technologies, and highlights ongoing clinical trials and future directions in optimizing CS management. Emphasis is placed on individualized patient selection, evidence-based deployment of MCS devices, and multidisciplinary team collaboration, which collectively represent a critical transition towards improving clinical outcomes in CS. Full article

Background: Older adults face increased risks of influenza infection and related complications due to declining immunity and reduced vaccine responsiveness. Despite widespread vaccination, only 30–40% mount immune response due to immunosenescence. However, no biomarkers exist to identify potential non-responders, limiting the ability to target vaccine strategies, like high-dose or adjuvanted formulations, to those unlikely to benefit from standard options. Methods: We analysed publicly available baseline bulk RNA sequencing data from peripheral blood mononuclear cells of individuals aged ≥65 years to determine baseline transcriptomic signatures predictive of influenza vaccine response. Using two independent cohorts (discovery and validation), we classified individuals as triple responders (TRs) or triple non-responders (TNRs) based on hemagglutination inhibition assay titers at Day 0 and Day 28 for three components: A/H1N1, A/H3N2, and B/Yamagata. Results: We identified 1152 differentially expressed genes between TRs and TNRs at baseline. TRs exhibited enrichment of genes involved in B cell activation and protein synthesis, while TNRs showed enrichment of genes associated with innate immune responses and platelet activation. A response score derived from gene expression achieved high predictive accuracy in the discovery cohort (area under the curve [AUC] = 0.98). However, performance declined in the validation cohort (AUC = 0.69), and did not outperform clinical predictors, such as baseline titers, sex and vaccine dose. Conclusions: While baseline transcriptomic profiles may reveal mechanistic insights into vaccine responsiveness in the elderly, they offer limited predictive utility. Future work should prioritise higher-resolution or combined cell-specific approaches, such as single-cell RNA-sequencing or flow cytometry. Full article

Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by multisystem involvement, including renal cysts, hepatic cysts, intracranial aneurysms, and aortic root dilatation and dissection. Though exceedingly rare, cervical artery dissections (CeAD) have been reported in association with ADPKD. The aim of this retrospective observational study is to investigate clinical features in patients with ADPKD that increase the probability of an associated CeAD diagnosis. Materials and Methods: The National Inpatient Sample from 2016 to 2020 was utilized to compare clinical features for patients with an ICD-10 code diagnosis of ADPKD, CeAD, and both ADPKD and CeAD. The Cochran–Armitage test and Chi-square test were utilized to assess clinical features or trends in ADPKD patients associated with a concurrent CeAD diagnosis. Results: Between 2016 and 2020, there were 224,065 people with ADPKD, 86,135 with CeAD and 155 with both (0.05%). The total cohort had a mean age of 56.74 years, with 47.26% female participants (p = 0.70), and was predominantly white (66.15%, p < 0.001). In patients with ADPKD, comorbid acute ischemic stroke (p < 0.001), transient ischemic attack (p < 0.001), aortic dissection (p < 0.001), coronary artery dissection (p < 0.001), subarachnoid hemorrhage (p < 0.001), coagulation defects (p = 0.002), and hypertension (p < 0.001) are risk factors associated with an increased probability of concomitant CeAD. Conclusions: CeAD in ADPKD patients is rare. In ADPKD patients, acute ischemic stroke, transient ischemic attack, aortic dissection, coronary artery dissection, subarachnoid hemorrhage, coagulation defects, and hypertension are risk factors of concomitant CeAD. Recognizing these factors can aid in the decision to screen for concomitant CeAD in patients with ADPKD. Full article

Symptomatic male hypogonadism, defined by low serum testosterone with associated clinical symptoms, is increasingly treated with testosterone replacement therapy. Traditional oral formulations were limited by hepatotoxicity and poor bioavailability, leading to reliance on injectable and transdermal routes. Recent advances in oral testosterone undecanoate formulations have introduced safer and more effective options. This review compares Jatenzo, Tlando, and Kyzatrex, highlighting their pharmacology, efficacy, safety, and clinical utility. Clinical trial data demonstrate restoration of eugonadal testosterone levels in most patients (80–88%), with shared risks including hypertension, polycythemia, and lipid changes. Differences in dosing regimens, titration requirements, and insurance coverage influence choice of therapy and patient adherence. Kyzatrex offers flexible titration and self-pay access, Tlando provides a fixed-dose regimen, and Jatenzo combines titratability with established clinical data. Collectively, these agents expand the therapeutic landscape of hypogonadism, offering effective, non-invasive alternatives that support individualized treatment strategies. Full article

Fast-track extubation has emerged as a vital component of Enhanced Recovery After Surgery pathways, designed to optimize recovery and resource utilization after cardiac surgery, contrasting with traditional prolonged ventilation. This review explores the evidence supporting fast-track extubation, detailing patient selection criteria based on preoperative risk factors and functional status and outlining perioperative management strategies. It synthesizes findings from various studies, including randomized controlled trials, retrospective studies, and meta-analyses, focusing on intraoperative techniques such as low-dose opioids, neuromuscular blockade reversal, controlled cardiopulmonary bypass duration, judicious inotrope use, and minimal transfusion, alongside structured postoperative protocols emphasizing early sedative weaning and spontaneous breathing trials. Results demonstrate that fast-track extubation decreases intensive care unit stay, reduces costs and ventilator-associated complications, with a safety comparable to conventional care. Prolonged cardiopulmonary bypass time, dependency on inotropes, and intraoperative blood transfusions are identified as critical predictors of fast-track extubation failure. In conclusion, the successful implementation of fast-track extubation protocols requires a collaborative, multidisciplinary approach, proving essential for improving patient outcomes, minimizing complications such as postoperative delirium, and enhancing hospital efficiency in cardiac surgery. Further research should aim to refine patient selection and standardize protocols across healthcare systems. Full article