Search Results (29,272)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Subclinical mastitis in dairy cows poses a significant challenge to the dairy industry, leading to reduced milk yield, altered milk composition, compromised animal health, and substantial economic losses for dairy farmers. A model based on the XGBoost algorithm, optimized with an Improved GOOSE Optimization Algorithm (IGOOSE), is presented in this work as an innovative approach for predicting subclinical mastitis in order to overcome these problems. The Dairy Herd Improvement (DHI) records of 4154 cows served as the model’s original foundation. A total of 3232 samples with 21 characteristics made up the final dataset, following extensive data cleaning and preprocessing. To overcome the shortcomings of the original GOOSE algorithm in intricate, high-dimensional problem spaces, three significant enhancements were made. First, an elite inverse strategy was implemented to improve population initialization, enhancing the algorithm’s balance between global exploration and local exploitation. Second, an adaptive nonlinear control factor was added to increase the algorithm’s stability and convergence speed. Lastly, a golden sine strategy was adopted to reduce the risk of premature convergence to suboptimal solutions. According to experimental results, the IGOOSE-XGBoost model works better than other models in predicting subclinical mastitis, especially when it comes to recognizing somatic cell scores, which are important markers of the illness. This study provides a strong predictive framework for managing the health of dairy cows, allowing for the prompt identification and treatment of subclinical mastitis, which enhances the efficiency and quality of milk supply. Full article

Dam monitoring tracks environmental variables (water level, temperature) and structural responses (deformation, seepage, and stress) to assess safety and performance. Structural health monitoring (SHM) refers to the systematic observation and analysis of the structural condition over time, and it is essential in maintaining the safety, functionality, and long-term performance of dams. This review examines monitoring data applications, covering structural health assessment methods, historical motivations, and key challenges. It discusses monitoring components, data acquisition processes, and sensor roles, stressing the need to integrate environmental, operational, and structural data for decision making. Key objectives include risk management, operational efficiency, safety evaluation, environmental impact assessment, and maintenance planning. Methodologies such as numerical modeling, statistical analysis, and machine learning are critically analyzed, highlighting their strengths and limitations and the demand for advanced predictive techniques. This paper also explores future trends in dam monitoring, offering insights for engineers and researchers to enhance infrastructure resilience. By synthesizing current practices and emerging innovations, this review aims to guide improvements in dam safety protocols, ensuring reliable and sustainable dam operations. The findings provide a foundation for the advancement of monitoring technologies and optimization of dam management strategies worldwide. Full article

Background: Small airway dysfunction (SAD) plays a critical role in the management of severe asthma, particularly in patients at risk of requiring biological therapies (BTs). Short-term studies have shown that switching to single-inhaler triple therapy (SITT) with extrafine beclomethasone–formoterol–glycopyrronium improves outcomes and helps achieve quiet asthma, a state marked by symptom control, no exacerbations or oral steroids, reduced inflammation, and better small airway function. This study investigated whether, over one year, patients could maintain this state as Steady Quiet Asthma (SQA) and whether baseline measures could predict this sustained response. Methods: Twenty-six patients with severe asthma and SAD were transitioned from open triple-inhaler therapy to a closed, single-inhaler triple therapy containing extrafine beclomethasone–formoterol–glycopyrronium. Assessments at baseline (T0) and at one-year follow-up (T12) included clinical evaluations, spirometry, and impulse oscillometry, with a focus on Fres as a predictor for the need for BT. When prescribed, biologic therapies included mepolizumab, benralizumab, and dupilumab. Results: Of the 26 patients, 9 (34.6%) achieved SQA and did not require biologic therapy at the one-year follow-up, while 17 patients (65.4%) initiated biologic treatment. At T0, patients who required biologics had significantly higher median Fres (21 (19.47; 24.58) vs. 17.61 (15.82; 20.63); p = 0.049) compared to those who remained biologic-free. They also exhibited higher residual volume to total lung capacity ratio (%RV/TLC) values and lower forced expiratory volume in one second/forced vital capacity ratios (FEV₁/FVC). At T12, patients spared from BT showed significant reductions in Fres (p = 0.014) and improvements in small airway function (difference in airway resistance between 5 Hz and 20 Hz (R5–20), forced expiratory flow between 25% and 75% of FVC (%FEF25–75), and better asthma control (ACT). In contrast, patients on BT demonstrated less favorable changes in these parameters. Conclusions: Baseline Fres, FEV1/FVC ratio, and %FEV25–75 are valuable predictors of achieving Steady Quiet Asthma (SQA) and sparing biologic therapy. These findings support the use of SITT in severe asthma and highlight the importance of early functional assessments to guide personalized management. Full article

Ecological security evaluation serves as the cornerstone for ecological management decision-making and spatial optimization. This study focuses on the Dongping Lake Basin. Based on the Pressure–State–Response (PSR) model framework, it integrates ecological risk, ecosystem health, and ecosystem service indicators. Utilizing methods including Local Indicators of Spatial Association (LISA), Transition Matrix, and GeoDetector, it analyzes the spatio-temporal evolution characteristics and driving mechanisms of watershed ecological security from 2000 to 2020. The findings reveal that the Watershed Ecological Security Index (WESI) exhibited a trend of “fluctuating upward followed by periodic decline”. In 2000, the status was “relatively unsafe”. It peaked in 2015 (index 0.332, moderately safe) and experienced a slight decline by 2020. Spatially, a significantly clustered pattern of “higher in the north and lower in the south, higher in the east and lower in the west” was observed. In 2020, “High-High” clusters of ecological security aligned closely with Shandong Province’s ecological conservation red line, concentrating in core protected areas such as the foothills of the Taihang Mountains and Dongping Lake Wetland. Level transitions were characterized by “predominant continuous improvement in low levels alongside localized reverse fluctuations in middle and high levels,” with the “relatively unsafe” and “moderately safe” levels experiencing the largest transfer areas. Geographical detector analysis indicates that the Human Interference Index (HI), Ecosystem Service Value (ESV), and Annual Afforestation Area (AAA) were key drivers of watershed ecological security change, influenced by dynamic interactive effects among multiple factors. This study advances watershed-scale ecological security assessment methodologies. The revealed spatio-temporal patterns and driving mechanisms provide valuable insights for protecting the ecological barrier in the lower Yellow River and informing ecological security strategies within the Dongping Lake Watershed. Full article

Obstructive sleep apnea syndrome (OSAS) is a prevalent disorder with significant systemic and oral health consequences. This narrative review synthesizes the current knowledge on the interplay between dental health and sleep apnea, highlighting the expanding role of dentists in the screening, early detection, and management of OSAS. Validated questionnaires, anatomical assessments, and anthropometric measurements have enhanced dentists’ capacity for early screening. However, knowledge and training gaps remain, particularly in low- and middle-income countries. Dentists are uniquely positioned to identify anatomical and oral risk factors, facilitate referrals for diagnosis, and provide therapeutic interventions such as oral appliance therapy. Interdisciplinary collaboration between dental and medical professionals is essential to improve early detection, treatment outcomes, and patient quality of life. Enhancing education, standardizing protocols, and integrating dentists into multidisciplinary care pathways are critical steps for advancing the management of sleep apnea. Full article

In highly urbanised and industrialised settings, managing environmental pressures and enhancing urban resilience demand integrated, spatially explicit approaches. This study presents a methodological framework that integrates topographic data, land cover information, and open geodata to produce a high-resolution vulnerability map. A multi-criteria analysis was performed using indicators such as land use, population density, proximity to emission sources, vegetation cover, and sensitive services (e.g., schools and hospitals). The result is a high-resolution vulnerability map that classifies the urban, peri-urban, and coastal zones into five levels of environmental risk. These evaluation levels are derived from geospatial analyses combining pollutant dispersion modelling with land-use classification, enabling the identification of the most vulnerable urban zones. These findings support evidence-based planning and can guide local governments and environmental agencies in prioritising Nature-based Solutions (NBSs), enhancing ecological connectivity, and reducing exposure for vulnerable populations. Full article

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes mellitus and obesity. However, their sustained effect on delaying gastric emptying raises new challenges in gastrointestinal endoscopy performed under sedation. This narrative review aims to summarize current evidence on the impact of GLP-1 RAs on gastric motility and to propose clinical strategies to mitigate associated procedural risks. Methods: A narrative review was conducted integrating findings from scintigraphy, capsule endoscopy, gastric ultrasound, and existing clinical guidelines. Emphasis was placed on studies reporting residual gastric content (RGC), anesthetic safety outcomes, and procedural feasibility in patients undergoing endoscopy while treated with GLP-1 RAs. Results: GLP-1 RAs significantly increase the prevalence of clinically relevant RGC, despite prolonged fasting, with potential implications for airway protection and sedation safety. Although the risk of pulmonary aspiration remains low (≤0.15%), procedural delays, modifications, or cancellations can occur in up to 30% of cases without adapted protocols. Several professional societies (AGA, ASGE, AASLD) advocate for individualized management based on procedure type, symptomatology, treatment phase, and point-of-care gastric ultrasound (POCUS), in contrast to the systematic discontinuation recommended by the ASA. Conclusions: Effective management requires personalized fasting protocols, risk-based stratification, tailored anesthetic approaches, and interprofessional coordination. We propose a clinical decision algorithm and highlight the need for training in gastrointestinal pharmacology, POCUS, and airway management for endoscopists. Future priorities include prospective validation of clinical algorithms, safety outcome studies, and the development of intersocietal consensus guidelines. Full article

The efficient and rational development of hydropower in the Lancang–Mekong River Basin can promote green energy transition, reduce carbon emissions, prevent and mitigate flood and drought disasters, and ensure the sustainable development of the entire basin. In this study, based on publicly available hydrometeorological observation data and satellite remote sensing monitoring data from 2001 to 2020, a machine learning model of the Lancang–Mekong Basin was developed to reconstruct the basin’s hydrological processes, and identify the occurrence patterns and influencing mechanisms of water-related hazards. The results show that, against the background of climate change, the Lancang–Mekong Basin is affected by the increasing frequency and intensity of extreme precipitation events. In particular, Rx1day, Rx5day, R10mm, and R95p (extreme precipitation indicators determined by the World Meteorological Organization’s Expert Group on Climate Change Monitoring and Extreme Climate Events) in the northwestern part of the Mekong River Basin show upward trends, with the average maximum daily rainfall increasing by 1.8 mm/year and the total extreme precipitation increasing by 18 mm/year on average. The risks of flood and drought disasters will continue to rise. The flood peak period is mainly concentrated in August and September, with the annual maximum flood peak ranging from 5600 to 8500 m³/s. The Stung Treng Station exhibits longer drought duration, greater severity, and higher peak intensity than the Chiang Saen and Pakse Stations. At the Pakse Station, climate change and hydropower development have altered the non-drought proportion by −12.50% and +15.90%, respectively. For the Chiang Saen Station, the fragmentation degree of the drought index time series under the baseline, naturalized, and hydropower development scenarios is 0.901, 1.16, and 0.775, respectively. These results indicate that hydropower development has effectively reduced the frequency of rapid drought–flood transitions within the basin, thereby alleviating pressure on drought management efforts. The regulatory role of the cascade reservoirs in the Lancang River can mitigate risks posed by climate change, weaken adverse effects, reduce flood peak flows, alleviate hydrological droughts in the dry season, and decrease flash drought–flood transitions in the basin. The research findings can enable basin managers to proactively address climate change, develop science-based technical pathways for hydropower dispatch, and formulate adaptive disaster prevention and mitigation strategies. Full article

Background/Objectives: Acute severe ulcerative colitis (ASUC) is often managed by tacrolimus induction therapy followed by maintenance therapy. We compared the effectiveness of ustekinumab versus vedolizumab as maintenance therapies after tacrolimus induced improvement in patients with ASUC. Methods: This single-center retrospective cohort study included patients with ASUC who received tacrolimus induction therapy followed by ustekinumab or vedolizumab between January 2018 and November 2024. The primary outcome was clinical remission at week 16. Secondary and exploratory outcomes included clinical remission at week 8, biologic persistence, and relapse risk. An inverse probability of treatment weighting (IPTW) analysis was performed using the following covariates: male sex, prior biologics or JAK inhibitors, partial Mayo score, CRP, and albumin. Results: Among 235 tacrolimus-treated patients, 29 received ustekinumab and 22 received vedolizumab. After IPTW adjustment, the clinical remission rates were significantly higher in the ustekinumab group at both week 8 (82.1% vs. 51.8%, p = 0.02) and week 16 (85.4% vs. 36.8%, p = 0.02). Biologic persistence was significantly higher in the ustekinumab group (p = 0.004), and ustekinumab significantly reduced the hazard of relapse in multivariable analyses (HR 0.42 [95% CI: 0.20–0.88], p = 0.02). Conclusions: Ustekinumab showed greater effectiveness than vedolizumab in terms of achieving remission at 16 weeks after tacrolimus induction therapy in patients with ASUC. Full article

Soil environmental quality in arid oases is crucial for regional ecological security but faces multi-source heavy metal (HM) contamination risks. This study aimed to (1) characterize the spatial distribution of soil HMs (As, Cd, Cr, Cu, Hg, and Zn) in the Ka Shi gar oasis, Xinjiang, (2) quantify the driving effect of irrigation water, and (3) elucidate interactions between HMs, soil properties, and land use types. Using 591 soil and 12 irrigation water samples, spatial patterns were mapped via inverse distance weighting interpolation, with drivers and interactions analyzed through correlation and land use comparisons. Results revealed significant spatial heterogeneity in HMs with no consistent regional trend: As peaked in arable land (5.27–40.20 μg/g) influenced by parent material and agriculture, Cd posed high ecological risk in gardens (max 0.29 μg/g), and Zn reached exceptional levels (412.00 μg/g) in gardens linked to industry/fertilizers. Irrigation water impacts were HM-specific: water contributed to soil As enrichment, whereas high water Cr did not elevate soil Cr (indicating industrial dominance), and Cd/Cu showed no significant link. Interactions with soil properties were regulated by land use: in arable land, As correlated positively with EC/TN and negatively with pH; in gardens, HMs generally decreased with pH, enhancing mobility risk; in forests, SOM adsorption immobilized HMs; in construction land, Hg correlated with SOM/TP, suggesting industrial-organic synergy. This study advances understanding by demonstrating that HM enrichment arises from natural and anthropogenic factors, with the spatial heterogeneity of irrigation water’s driving effect critically regulated by land use type, providing a spatially explicit basis for targeted pollution control and sustainable oasis management. Full article

With the rapid development of the social economy, human activities have increasingly disrupted water environments, and the continuous input of pollutants poses significant challenges for water environment management. Taking the Xiaoxingkai Lake basin as the study area, this paper develops a social–economic–water environment model based on the system dynamics methodology, incorporating subsystems for population, agriculture, and water pollution. The model focuses on four key indicators of pollution severity, namely, total nitrogen (TN), total phosphorus (TP), chemical oxygen demand (COD), and ammonia nitrogen (NH₃-N), and simulates the changes in pollutant loads entering the river under five different scenarios from 2020 to 2030. The results show that agricultural non-point sources are the primary contributors to TN (79.5%) and TP (73.7%), while COD primarily originates from domestic sources (64.2%). NH₃-N is mainly influenced by urban domestic activities (44.7%) and agricultural cultivation (41.2%). Under the status quo development scenario, pollutant loads continue to rise, with more pronounced increases under the economic development scenario, thus posing significant sustainability risks. The pollution control enhancement scenario is most effective in controlling pollutants, but it does not promote socio-economic development and has high implementation costs, failing to achieve coordinated socio-economic and environmental development in the region. The dual-reinforcement scenario and moderate-reinforcement scenario achieve a balance between pollution control and economic development, with the moderate-reinforcement scenario being more suitable for long-term regional development. The findings can provide a scientific basis for water resource management and planning in the Xiaoxingkai Lake basin. Full article

People with cystic fibrosis may experience polypharmacy, which can increase the risk of drug induced complications such as adverse events and drug–drug interactions. This study aimed to examine the prevalence of adverse events and to identify potential drug–drug interactions associated with elexacaftor/tezacaftor/ivacaftor (ETI). Three databases, the Australian Therapeutic Goods Administration Database of Adverse Event Notification (TGA DAEN), the Canada Vigilance Adverse Reaction Online Database (CVAROD), and the USA Food and Drug Administration Adverse Event Reporting System (FAERS) Database were searched for spontaneous ETI adverse events between 2019 and 2024. Descriptive analysis of the data was undertaken. The FAERS database was analysed to identify adverse events of interest such as anxiety and depression and concomitant drugs prescribed with ETI. A total of 10,628 ETI associated adverse events were identified in all system organ classes. The incidence of psychiatric adverse events ranged from 7 to 15% across the three databases. Potential drug–drug interactions with CYP 3A4/5 strong inhibitors and strong inducers were identified from the FAERS database and azole antifungals were implicated in several ETI dose modifications. The prevalence and types of ETI adverse events were varied and use of concomitant drugs with potential drug interactions was significant, requiring more research to manage them. Full article

The increasing prevalence of chronic metabolic diseases poses a significant challenge in the modern world, impacting healthcare systems and individual life expectancy. The World Health Organization (WHO) recommends that older adults (65+ years) engage in 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity physical activity, alongside muscle-strengthening and balance-training exercises at least twice a week. However, nearly one-third of the adult population (31%) is physically inactive, which increases the risk of developing obesity, type 2 diabetes, cardiovascular diseases, hypertension, and psychological issues. Physical activity in the form of aerobic exercise, resistance training, or a combination of both is effective in preventing and managing these metabolic diseases. In this review, we explored the effects of exercise training, especially on respiratory and pulmonary factors, including oxygen consumption, pulmonary ventilation, and blood gas analyses among adults. During exercise, oxygen consumption can increase up to 15-fold (from a resting rate of ~250 mL/min) to meet heightened metabolic demands, enhancing tidal volume and pulmonary efficiency. During exercise, the increased energy demand of skeletal muscle leads to increases in tidal volume and pulmonary function, while blood gases play a key role in maintaining the pH of the blood. In this review, we explored the influence of age, body composition (BMI and obesity), lifestyle factors (smoking and alcohol use), and comorbidities (diabetes, hypertension, neurodegenerative disorders) in the modulation of these physiological responses. We underscored exercise as a potent non-pharmacological intervention for improving cardiopulmonary health and mitigating the progression of metabolic diseases in aging populations. Full article