Search Results (12,820)

Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder characterized by partial or complete obstruction of the upper airway, typically resulting in a decrease in arterial oxygen saturation and repeated awakenings from sleep. It is the most common sleep-related respiratory disorder, affecting 9% to 38% of adults. OSA is associated with loss of tone, improper contraction of the tongue, and pharyngeal dilator muscles of the upper airway during sleep. The gold-standard treatment for moderate-to-severe OSA is continuous positive airway pressure (CPAP). However, many patients have poor long-term compliance with CPAP. Stimulation of the upper airway with electrical activation of the hypoglossal nerve has emerged as a promising treatment for patients with moderate-to-severe OSA who have failed CPAP therapy. Objectives: The present paper aims to review the literature regarding neurostimulation for the treatment of OSA. Conclusions: Hypoglossal nerve stimulation (HNS) has shown favorable success and low morbidity in the management of moderate-to-severe OSA. Full article

Honey is a natural product of honeybees that has been consumed for centuries due to its nutritional value and potential health benefits. Recent scientific research has focused on its antioxidant capacity, which is linked to a variety of bioactive compounds such as phenolic acids, enzymes (e.g., glucose oxidase, catalase), flavonoids, ascorbic acid, carotenoids, amino acids, and proteins. Together, these components work synergistically to neutralize free radicals, regulate antioxidant enzyme activity, and reduce oxidative stress. This review decisively outlines the antioxidant effects of honey and presents compelling clinical and experimental evidence supporting its critical role in preventing diseases associated with oxidative stress. Honey stands out for its extensive health benefits, which include robust protection against cardiovascular issues, notable anticancer and anti-inflammatory effects, enhanced glycemic control in diabetes, immune modulation, neuroprotection, and effective wound healing. As a recognized functional food and dietary supplement, honey is essential for the prevention and adjunct treatment of chronic diseases. However, it faces challenges due to variations in composition linked to climatic conditions, geographical and floral sources, as well as hive management practices. The limited number of large-scale clinical trials further underscores the need for more research. Future studies must focus on elucidating honey’s antioxidant mechanisms, standardizing its bioactive compounds, and examining its synergistic effects with other natural antioxidants to fully harness its potential. Full article

Background: Artificial intelligence (AI) and robotics are increasingly pivotal for reducing carbon emissions in supply chain management (SCM); however, research exploring their combined potential from a sustainability perspective remains fragmented. This study aims to systematically map the research landscape and synthesize evidence on the applications, benefits, and challenges. Methods: A systematic scoping review was conducted on 23 peer-reviewed studies from the Scopus database, published between 2013 and 2024. Data were systematically extracted and analyzed for publication trends, application domains (e.g., transportation, warehousing), specific AI and robotic technologies, emissions reduction strategies, and implementation challenges. Results: The analysis reveals that AI-driven logistics optimization is the most frequently reported strategy for reducing transportation emissions. At the same time, robotic automation is commonly associated with improved energy efficiency in warehousing. Despite these benefits, the reviewed literature consistently identifies significant barriers, including the high energy demands of AI computation and complexities in data integration. Conclusions: This review confirms the transformative potential of AI and robotics for developing low-carbon supply chains. An evidence-based framework is proposed to guide practical implementation and identify critical gaps, such as the need for standardized validation benchmarks, to direct future research and accelerate the transition to sustainable SCM. Full article

This study presents the scientific and methodological foundation of Spain’s first national framework for the ethical management of community cat populations: the Action Plan for the Management of Community Cat Colonies (PACF), launched in 2025 under the mandate of Law 7/2023. This pioneering legislation introduces a standardized, nationwide obligation for trap–neuter–return (TNR)-based management of free-roaming cats, defined as animals living freely, territorially attached, and with limited socialization toward humans. The PACF aims to support municipalities in implementing this mandate through evidence-based strategies that integrate animal welfare, biodiversity protection, and public health objectives. Using standardized data submitted by 1128 municipalities (13.9% of Spain’s total), we estimated a baseline population of 1.81 million community cats distributed across 125,000 colonies. These data were stratified by municipal population size and applied to national census figures to generate a model-ready demographic structure. We then implemented a stochastic simulation using Vortex software to project long-term population dynamics over a 25-year horizon. The model integrated eight demographic–environmental scenarios defined by a combination of urban–rural classification and ecological reproductive potential based on photoperiod and winter temperature. Parameters included reproductive output, mortality, sterilization coverage, abandonment and adoption rates, stochastic catastrophic events, and territorial carrying capacity. Under current sterilization rates (~20%), our projections indicate that Spain’s community cat population could surpass 5 million individuals by 2050, saturating ecological and social thresholds within a decade. In contrast, a differentiated sterilization strategy aligned with territorial reproductive intensity (50% in most areas, 60–70% in high-pressure zones) achieves population stabilization by 2030 at approximately 1.5 million cats, followed by a gradual long-term decline. This scenario prioritizes feasibility while substantially reducing reproductive output, particularly in rural and high-intensity contexts. The PACF combines stratified demographic modeling with spatial sensitivity, offering a flexible framework adaptable to local conditions. It incorporates One Health principles and introduces tools for adaptive management, including digital monitoring platforms and standardized welfare protocols. While ecological impacts were not directly assessed, the proposed demographic stabilization is designed to mitigate population-driven risks to biodiversity and public health without relying on lethal control. By integrating legal mandates, stratified modeling, and realistic intervention goals, this study outlines a replicable and scalable framework for coordinated action across administrative levels. It exemplifies how national policy can be operationalized through data-driven, territorially sensitive planning tools. The findings support the strategic deployment of TNR-based programs across diverse municipal contexts, providing a model for other countries seeking to align animal welfare policy with ecological planning under a multi-level governance perspective. Full article

Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. Despite significant advances in graft survival, rejection continues to pose a major clinical challenge. Conventional monitoring tools, such as serum creatinine, donor-specific antibodies, and proteinuria, lack sensitivity and specificity for early detection of graft injury. Moreover, while biopsy remains the current gold standard for diagnosing rejection, it is prone to confounders, invasive, and associated with procedural risks. However, non-invasive novel biomarkers have emerged as promising alternatives for earlier rejection detection and improved immunosuppression management. This review focuses on the leading candidate biomarkers currently under clinical investigation, with an emphasis on their diagnostic performance, prognostic value, and potential to support personalised immunosuppressive strategies in kidney transplantation. Full article

Background/Objectives: Gallbladder cancer (GBC) is a lethal malignancy curable only by surgical resection in early stages (Tis, T1, T2). Significant controversy exists regarding the optimal extent of surgery. This review summarizes recent trends and evidence on surgical strategies for Tis, T1, and T2 GBC to guide practice and research. Methods: This narrative review synthesizes recent literature on surgical management of Tis, T1a, T1b, and T2 GBC based on American Joint Committee on Cancer (AJCC) 8th edition staging. It examines simple vs. extended cholecystectomy (simple cholecystectomy (SC) vs. extended/radical cholecystectomy (EC/RC)), the role of lymphadenectomy (LND) and hepatectomy, and minimally invasive surgery (MIS). Results: Simple cholecystectomy is curative for Tis/T1a GBC. For T1b, regional LND is essential for staging/potential benefit, especially examining ≥5–6 nodes. Tumor size is critical; SC alone may suffice for T1b < 1 cm (low lymph node metastasis (LNM) risk), while EC/RC with LND is indicated for ≥1 cm (higher LNM risk). Routine hepatectomy for T1b lacks survival support. For T2 GBC, mandatory regional LND (≥6 nodes) is required for both T2a and T2b substages due to high LNM rates; T2b has higher LNM than T2a. Routine hepatectomy for T2 is debated; evidence suggests no routine benefit for T2a beyond LND, with conflicting findings for T2b. R0 resection is paramount. MIS is feasible for early stages in experienced hands. Conclusions: Management of early GBC is moving towards risk stratification. SC is standard for Tis/T1a. Adequate regional LND is crucial for T1b (especially ≥1 cm) and mandatory for T2 GBC. Routine hepatectomy, particularly for T2b, remains controversial. Tailored surgery prioritizes R0 resection and comprehensive LND, necessitating further standardized research. Full article

The correlation between fermented vinegar’s physicochemical properties and functional characteristics, particularly skin-related functionalities, remains unclear. We analyzed the quality of widely consumed Korean fermented vinegars, including grain and persimmon vinegars, and their correlation with skin-related functionalities to establish quality control criteria linked to functional properties. Fifteen traditional Korean grain vinegars and fourteen persimmon vinegars were collected; distilled white vinegar was used as the control group. Grain vinegars showed 3.57–100.00% collagenase and 62.38–77.03% tyrosinase inhibition; persimmon vinegars showed 0.00–94.50% and 30.75–71.54%, respectively. To determine which quality characteristics are high in fermented vinegar with high skin-related functionality, a correlation analysis was conducted. In grain vinegar, total nitrogen and free amino acids were strongly associated with skin-related functionalities. In persimmon vinegar, organic acids, particularly lactic acid, were correlated with skin-related effects; thus, both demonstrated the importance of quality assessment. Insights into relationships between the composition and functional properties of fermented vinegar were gained. Specific quality markers for managing skin-related functionality of Korean fermented vinegar established a scientific basis for standardizing quality control, developing high-value functional vinegar products, and ensuring consistent product quality. Full article

Digestate valorization is essential for sustainable waste management and circular economy strategies, yet large-scale adoption faces technical, economic, and environmental challenges. Beyond waste-to-energy conversion, digestate is a valuable soil amendment, enhancing soil structure and reducing reliance on synthetic fertilizers. However, its agronomic benefits depend on feedstock characteristics, treatment processes, and application methods. This study reviews digestate composition, treatment technologies, regulatory frameworks, and environmental impact assessment through Life Cycle Assessment. It analyzes the influence of functional unit selection and system boundary definitions on Life Cycle Assessment outcomes and the effects of feedstock selection, pretreatment, and post-processing on its environmental footprint and fertilization efficiency. A review of 28 JCR-indexed articles (2018–present) analyzed LCA studies on digestate, focusing on methodologies, system boundaries, and impact categories. The findings indicate that Life Cycle Assessment methodologies vary widely, complicating direct comparisons. Transportation distances, nutrient stability, and post-processing strategies significantly impact greenhouse gas emissions and nutrient retention efficiency. Techniques like solid–liquid separation and composting enhance digestate stability and agronomic performance. Digestate remains a promising alternative to synthetic fertilizers despite market uncertainty and regulatory inconsistencies. Standardized Life Cycle Assessment methodologies and policy incentives are needed to promote its adoption as a sustainable soil amendment within circular economy frameworks. Full article

Objective: Cervical pregnancy (CP) accounts for less than 1% of all ectopic pregnancies. The standard of management for CP is still under detailed investigation; however, among the known treatment methods, super-selective uterine artery embolization (UAE) and the use of methotrexate (MTX) have emerged as effective and minimally invasive options in recent years. Our aim is to present our center’s experience and provide available evidence evaluating the efficacy of UAE in the treatment of CP. Materials and Methods: This single-center and retrospective study evaluated the procedural and clinical outcomes of patients with CP who underwent endovascular uterine embolization with MTX between 2017 and 2024. Both procedural and clinical efficacy and safety, as well as the rate of complications and long-term outcomes, were noted. Results: A total of nine patients were diagnosed with CP (imaging examination included transvaginal ultrasound and/or magnetic resonance imaging) and referred for endovascular treatment. The mean age of the patients was 36.7 years, and the mean gestational age on admission was 9 weeks. In all cases, selective catheterization of supplying vessels and subsequent embolization with a mixture of methotrexate and gel sponge was carried out. The technical success rate was 100% with no complications. Follow-up ultrasound confirmed the disappearance of the flow signal around the intracervical gestational sac in all cases. Conclusions: In conclusion, this retrospective study demonstrated the procedural and clinical safety and efficacy of uterine artery embolization in patients with cervical pregnancy. This is why endovascular therapy should be proposed to these individuals and be included in treatment options discussed during multidisciplinary boards. Full article

As an important ecological barrier and animal husbandry resource base in arid and semi-arid areas, grassland degradation directly affects regional ecological security and sustainable development. Ili Prefecture is located in the western part of Xinjiang, China, and is a typical grassland resource-rich area. However, in recent years, driven by climate change and human activities, grassland degradation has become increasingly serious. In view of the lack of comprehensive evaluation indicators and the inconsistency of grassland evaluation grade standards in remote sensing monitoring of grassland resource degradation, this study takes the current situation of grassland degradation in Ili Prefecture in the past 20 years as the research object and constructs a comprehensive evaluation index system covering three criteria layers of vegetation characteristics, environmental characteristics, and utilization characteristics. Net primary productivity (NPP), vegetation coverage, temperature, precipitation, soil erosion modulus, and grazing intensity were selected as multi-source indicators. Combined with data sources such as remote sensing inversion, sample survey, meteorological data, and farmer survey, the factor weight coefficient was determined by analytic hierarchy process. The Grassland Degeneration Comprehensive Index (GDCI) model was constructed to carry out remote sensing monitoring and evaluation of grassland degradation in Yili Prefecture. With reference to the classification threshold of the national standard for grassland degradation, the GDCI grassland degradation evaluation grade threshold (GDCI reduction rate) was determined by the method of weighted average of coefficients: non-degradation (0–10%), mild degradation (10–20%), moderate degradation (20–37.66%) and severe degradation (more than 37.66%). According to the results, between 2000 and 2022, non-degraded grasslands in Ili Prefecture covered an area of 27,200 km², representing 90.19% of the total grassland area. Slight, moderate, and severe degradation accounted for 4.34%, 3.33%, and 2.15%, respectively. Moderately and severely degraded areas are primarily distributed in agro-pastoral transition zones and economically developed urban regions, respectively. The results revealed the spatial and temporal distribution characteristics of grassland degradation in Yili Prefecture and provided data basis and technical support for regional grassland resource management, degradation prevention and control and ecological restoration. Full article

Background: Prostate cancer (PC) is the second leading cause of cancer-related death in men in the United States. A subset of patients develops non-metastatic, castration-resistant PC (nmCRPC), for which management requires a personalized consideration for appropriate treatment. However, there is no consensus regarding when to switch from androgen deprivation therapy (ADT) to more aggressive treatments like abiraterone or enzalutamide. Methods: We analyzed 5037 nmCRPC patients and employed a Weibull Time to Event Recurrent Neural Network to identify patients who would benefit from switching from ADT to abiraterone/enzalutamide. We evaluated this model using differential treatment benefits measured by the Kaplan–Meier estimation and milestone probabilities. Results: The model achieved an area under the curve of 0.738 (standard deviation (SD): 0.057) for patients treated with abiraterone/enzalutamide and 0.693 (SD: 0.02) for patients exclusively treated with ADT at the 2-year milestone. The model recommended 14% of ADT patients switch to abiraterone/enzalutamide. Analysis showed a statistically significant absolute improvement using model-recommended treatments in progression-free survival (PFS) of 0.24 (95% confidence interval (CI): 0.23–0.24) at the 2-year milestone (PFS rate increasing from 0.50 to 0.74) with a hazard ratio of 0.44 (95% CI: 0.39–0.50). Conclusions: Our model successfully identified nmCRPC patients who would benefit from switching to abiraterone/enzalutamide, demonstrating potential outcome improvements. Full article

Beyond continual reductions in catch, common octopus frequently suffer damage during pot fishing, which can reduce the quality of the product and consequently, its value. This study evaluated how pots with different mesh sizes affect the integrity of common octopuses captured by commercial fisheries. Experimental fishing was conducted in Taean-gun and Incheon-si using pots with different mesh sizes (16.3, 18.3, and 22.4 mm). Common octopuses were classified as either damaged or undamaged based on whether the number of injured arms exceeded a specific threshold value, and logistic regression was applied to estimate the probability of damage, based on the mesh size and region. Smaller mesh sizes significantly reduced the damage in common octopuses and increased the catch effectiveness; however, the degree of impact differed according to the region. This study provides quantitative estimates of the mesh sizes associated with specific damage probabilities, offering a scientific basis for refining regionally tailored management practices. By reducing the mesh size from the current legal standard of 22 mm to 16 mm, the probability of damage that leads to a decline in commercial value (i.e., threshold = 2) is projected to decrease from 77.8% to 46.5% in Taean-gun, and from 93.4% to 39.3% in Incheon-si. Full article

Climate change is generally having a negative impact on forest health by inducing drought stress and favouring the spread of pest species, such as bark beetles. The terrestrial monitoring of bark beetle infestation is very time-consuming, especially in the early stages, and therefore not feasible for extensive areas, emphasising the need for a comprehensive approach based on remote sensing. Although numerous studies have researched the use of optical data for this task, radar data remains comparatively underexplored. Therefore, this study uses the weekly and cloud-free acquisitions of Sentinel-1 in the Bavarian Forest National Park. Time series analysis within a Multi-SAR framework using Random Forest enables the monitoring of moisture content loss and, consequently, the assessment of tree vitality, which is crucial for the detection of stress conditions conducive to bark beetle outbreaks. High accuracies are achieved in predicting future bark beetle infestation (R² of 0.83–0.89). These results demonstrate that forest vitality trends ranging from healthy to bark beetle-affected states can be mapped, supporting early intervention strategies. The standard deviation of 0.44 to 0.76 years indicates that the model deviates on average by half a year, mainly due to the uncertainty in the reference data. This temporal uncertainty is acceptable, as half a year provides a sufficient window to identify stressed forest areas and implement targeted management actions before bark beetle damage occurs. The successful application of this technique to extensive test sites in the state of North Rhine-Westphalia proves its transferability. For the first time, the results clearly demonstrate the expected relationship between radar backscatter expressed in the Kennaugh elements K₀ and K₁ and bark beetle infestation, thereby providing an opportunity for the continuous and cost-effective monitoring of forest health from space. Full article

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that can greatly affect quality of life in middle-aged and elderly individuals. Nutritional supplements are increasingly used for KOA due to their low risk, but direct comparative evidence on their efficacy and safety remains scarce. This study aimed to systematically compare the effectiveness and safety of seven common nutritional supplements for KOA. Methods: A systematic review and network meta-analysis were conducted following PRISMA guidelines. Embase, PubMed, and the Cochrane Library were searched through December 2024 for randomized controlled trials (RCTs) evaluating use of eggshell membrane, vitamin D, Boswellia, curcumin, ginger, krill oil, or collagen, versus placebo, in adults with KOA. Primary outcomes included changes in scores for WOMAC pain, stiffness and function, and pain visual analog scale (VAS). Adverse events were also assessed. Bayesian network meta-analyses estimated ranking probabilities for each intervention. Results: In total, 39 RCTs (42 studies; 4599 patients) were included. Compared with placebo, Boswellia showed significant improvements in WOMAC pain (mean difference [MD] = 10.58, 95% CI: 6.45 to 14.78, p < 0.05), stiffness (MD = 9.47, 95% CI: 6.39 254 to 12.74, p < 0.05), function (MD = 14.00, 95% CI: 7.74 to 20.21, p < 0.05), and VAS pain (MD = 17.26, 95% CI: 8.06 to 26.52, p < 0.05). Curcumin, collagen, ginger, and krill oil also demonstrated benefits in some outcomes. No supplement was associated with increased adverse events compared to placebo. Bayesian rankings indicated Boswellia had the highest probability of being most effective for pain and stiffness, with krill oil and curcumin showing potential for function improvement. Conclusions: Nutritional supplements, particularly Boswellia, appear to be effective and well-tolerated for improving KOA symptoms and function. These results suggest that certain supplements may be useful as part of non-pharmacological KOA management. However, further large-scale, well-designed randomized controlled trials (RCTs) are needed to confirm these findings, particularly those that include more standardized dosages and formulations, as well as to evaluate their long-term efficacy. Full article

Background/Objectives: Nonoperative management (NOM) of patients with locally advanced rectal cancer (LARC) who achieve a complete clinical response (cCR) to total neoadjuvant therapy (TNT) has been shown to be oncologically safe and is an attractive treatment option for patients. However, identifying responders to TNT that may benefit from nonoperative management is clinically challenging. Circulating tumor DNA (ctDNA) testing has shown promise in detecting minimal residual disease but has not yet been studied extensively within this clinical context. Methods: This is a single-institution retrospective case series study of LARC patients treated with TNT from 2019 to 2023 who underwent ctDNA testing as an adjunct to standard clinical response assessments. Results: A total of 28 patients had ctDNA testing as part of their response assessments after TNT. In total, 9 patients had positive ctDNA, and 19 patients had negative ctDNA during surveillance. Baseline characteristics of these two groups were not different. In this study, 6/9 (67%) patients who had positive ctDNA required surgery for residual rectal cancer, whereas only 4/19 (21%) patients who had negative ctDNA required surgery (p = 0.035). Conclusions: ctDNA testing has the potential to detect MRD in LARC patients treated with TNT. Full article