Search Results (23,130)

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress. Full article

Accurate monitoring of stress and workload in surgical environments is essential for improving performance and patient safety. Physiological signals, particularly heart rate variability (HRV), offer a promising approach for objective and continuous stress assessment. However, existing studies often rely on population-level models, limited temporal analysis, and evaluation strategies that may not reflect real-world generalisation. This study proposes an end-to-end pipeline for HRV-based classification of HRV-derived surrogate stress-like states in surgical settings, combining personalised feature extraction, surrogate label generation, and sequence-based deep learning. HRV data were collected from multiple surgeons during real colorectal procedures using wearable sensors and processed into minute-level feature representations. Stress labels were generated using subject-specific thresholds to account for individual physiological differences. Sequence-based models, including convolutional neural networks (CNNs) and long short-term memory (LSTM) networks, were evaluated across multiple temporal window lengths and validation strategies. The results show that mean-based Standard Deviation of Normal-to-Normal intervals (SDNN) provided the most consistent separation of physiological states. The highest-performing models were most frequently associated with temporal windows of 10–20 min, while CNN and LSTM architectures achieved comparable performance. Notably, in this dataset, leave-one-subject-out (LOSO) validation produced performance that was comparable to, and in some configurations higher than, pooled random splits, highlighting the influence of evaluation strategy and the potential benefits of personalised labelling. Overall, this work suggests that personalised HRV-based modelling and temporal sequence analysis may provide a feasible approach for identifying HRV-derived stress-like physiological states in real surgical environments. The findings also emphasise the importance of rigorous evaluation design when developing physiological machine learning systems. Full article

Psoriasis is a chronic immune-mediated systemic disorder that extends beyond the skin and may adversely affect cardiovascular function. Herbal therapies have emerged as promising complementary approaches for mitigating psoriasis-associated cardiac complications. The present study aimed to evaluate the cardioprotective potential of Melissa officinalis (MO) extract in psoriasis. Twenty-four male Wistar albino rats were randomly assigned to four experimental groups: control, MO, psoriasis (PSORI), and PSORI+MO. After induction, animals received MO extract (200 mg/kg b.w.) orally for three weeks. Cardiac function was assessed using the Langendorff isolated heart preparation. Oxidative stress and inflammatory cytokines were determined in blood. Psoriatic rats exhibited impaired myocardial contractility and relaxation, accompanied by elevated SLVP and DLVP across all perfusion pressures. Administration of MO significantly improved cardiac performance and attenuated these hemodynamic disturbances. Oxidative stress markers and inflammatory cytokines were markedly reduced in the PSORI+MO group compared with PSORI. Cardiomyocyte diameter and cross-sectional area were increased in both PSORI and PSORI+MO groups relative to controls. Collagen content was substantially elevated in the PSORI group and remained increased, although to a lesser extent, in the PSORI+MO group compared with controls. These findings suggest that MO extract may represent a promising complementary strategy for reducing psoriasis-associated cardiovascular alterations. Full article

Urban Heat Island (UHI) effects are increasingly affecting Mediterranean coastal cities, where climate change, urbanization, and seasonal tourism intensify thermal stress and environmental vulnerability. In this context, climate-oriented planning and green infrastructure are recognized as key strategies for urban adaptation. This study investigates the spatiotemporal evolution of Land Surface Temperature (LST) and vegetation cover in the coastal municipality of Lignano Sabbiadoro (northeastern Italy) through the analysis of Landsat imagery acquired between 1984 and 2023. Summer LST and Normalized Difference Vegetation Index (NDVI) maps were derived from June–August observations and used to assess long-term thermal dynamics, vegetation patterns, and Urban Heat Island development. Meteorological data indicate a significant increase in mean annual air temperature, with a warming trend of approximately 0.57 °C per decade between 1984 and 2023. Correspondingly, Landsat-derived LST maps reveal a marked intensification of summer surface temperatures, with mean summer LST increasing from 32.16 °C in 1984–1993 to a peak of 35.91 °C in 2004–2013, followed by a slight decrease to 35.77 °C during 2014–2023. During the same period, the proportion of municipal surfaces characterized by temperatures above 35 °C increased from 10.7% to more than 60%, while cooler areas (<30 °C) declined from 17.7% to 2.3%. The comparison between LST and NDVI patterns revealed a persistent inverse relationship between vegetation cover and surface temperature, with coastal pinewoods, green spaces, and water bodies consistently exhibiting lower thermal values than densely urbanized sectors. A key methodological contribution of the study is the operational integration of satellite-derived thermal remote sensing into the Green Plan of Lignano Sabbiadoro. LST mapping was used to identify priority areas for climate adaptation measures, including ecological corridors, wooded landscape connections, urban green corridors, and depaving interventions. The results demonstrate how multi-temporal thermal analysis can support evidence-based planning by linking climate assessment with the spatial prioritization and design of green infrastructure strategies. The proposed workflow provides a transferable framework for integrating remote sensing into climate-informed planning processes in Mediterranean coastal cities and other urban contexts increasingly exposed to heat-related risks. Full article

Reinforced concrete (RC) structures are susceptible to crack initiation and propagation during service, making accurate numerical simulation of crack behavior essential for assessing structural durability and safety. Current numerical approaches for simulating concrete cracking include smeared/continuum approaches, extended finite element method (XFEM), phase-field methods, and meso-mechanical models. In particular, smeared/continuum approaches (e.g., smeared crack and plastic-damage models such as CDP) indirectly reflect cracking through diffusive damage fields without providing explicit geometric information on crack locations and propagation paths. The XFEM module in commercial software is further restricted to first-order elements and encounters difficulties in simulating multi-crack propagation. These limitations indicate that further development of complementary crack-simulation frameworks is warranted. To this end, this paper presents a cracking simulation framework for RC members within the theoretical framework of the Specified Stress Method, adopting an adaptive degree-of-freedom strategy to balance computational accuracy and efficiency. The method introduces inelastic strain as an additional unknown and establishes a variational principle and the corresponding virtual work equation. Concrete cracking is described by specifying the stress on the crack plane to zero, so that the crack-surface stress remains zero after cracking, thereby avoiding the issue of damage reversibility and improving computational convergence. The method requires neither a predefined crack path nor remeshing after cracking. Unlike smeared/continuum approaches that rely on diffusive damage fields, the crack propagation paths, distribution characteristics, and evolution of multiple cracks are characterized through the spatial distribution of cracked integration points within the finite element mesh. In the present implementation, crack initiation is governed by the maximum tensile stress criterion, and a linear elastic constitutive model is adopted for concrete as a deliberate simplification to establish and verify the core computational mechanism of the framework. The proposed method was examined through three numerical examples. First, comparison with theoretical solutions confirmed the algorithm’s correctness in simulating cracking in heterogeneous RC tension members. Second, comparison with experimental results demonstrated qualitatively consistent crack propagation trends and load–displacement responses for RC beams under mixed-mode cracking; the calculated ultimate load of the plain concrete beam is lower than the experimental value, which is attributable to the use of the maximum tensile stress criterion without fracture energy considerations, and certain crack morphology deviations are observed due to the neglect of reinforcement–concrete bond-slip. Third, a multi-crack simulation of an under-reinforced RC beam showed that, whereas the XFEM module in ABAQUS captures only a single dominant crack near the mid-span, the proposed algorithm predicts multiple distributed cracking zones on both sides of the mid-span, qualitatively consistent with the typical flexural cracking behavior of under-reinforced RC beams; the algorithm also supports second-order elements (e.g., C3D20R) unavailable in the ABAQUS XFEM implementation. While the method is still in an exploratory stage, these results confirm the feasibility and potential of the Specified Stress Method as a complementary framework for RC cracking simulation, providing a basis for further development. Full article

Product Shezi (PS) is a polyherbal African traditional medicine (ATM) formulated from six known South African medicinal plants and is used for treating cutaneous wounds. However, its ethnopharmacological properties have not been scientifically validated. This study aimed to evaluate the antioxidant, anti-inflammatory, and antimicrobial activities of PS in vitro. Aqueous and methanolic extracts were prepared and qualitatively screened for phytochemical constituents. Cytotoxicity in fibroblasts and macrophages was assessed using an ATP-based viability assay. Antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging and a hydrogen peroxide (H₂O₂)-induced oxidative stress model. Anti-inflammatory effects in lipopolysaccharide (LPS)-stimulated macrophages were measured using the Griess reagent system, a human prostaglandin E₂ (PGE₂) ELISA, and a bovine serum albumin (BSA) anti-denaturation assay. Antimicrobial activity was assessed by twofold serial broth microdilution, agar well diffusion, and a crystal violet biofilm assay. Phytochemical screening confirmed the presence of saponins, alkaloids, tannins, glycosides, terpenoids, flavonoids, and steroids. PS exhibited IC₁₀ values of 3 and 10 μg/mL in fibroblasts and macrophages, respectively. PS (1–5 μg/mL) showed 70% DPPH scavenging potential and potent H₂O₂ cytoprotection (p < 0.001). Nitric oxide inhibition was non-significant (p > 0.05) whilst PGE₂ decreased significantly (p < 0.05) compared to LPS-stimulated cells. BSA denaturation was inhibited in a dose-dependent manner (p < 0.05). Staphylococcus aureus and S. epidermidis were the only microorganisms susceptible to PS (MIC 650–5000 μg/mL) with low SI (SI ≈ 0.05–0.06), while others were resistant. PS showed no antibiofilm activity (crystal-violet assay). Overall, PS demonstrated antioxidant and anti-inflammatory activities and selective antibacterial effects against planktonic bacteria in vitro. However, further optimization of extraction methods, detailed mechanistic studies, and in vivo investigations are warranted to substantiate therapeutic relevance. Full article

Interactions among the gut, brain, and skin are increasingly understood as a systemic regulatory network connecting intestinal activity, neuroimmune communication, and cutaneous homeostasis. Microbiota-derived metabolites, immune mediators, and neuroendocrine pathways can influence central nervous system activity and subsequently regulate skin homeostasis. This review summarizes current evidence on how functional ingredients modulate the gut–brain–skin axis in the context of aging and skin health. Polyphenols, probiotics, and omega-3 fatty acids appear to act through overlapping biological routes, including reshaping microbial communities, supporting epithelial barrier function, regulating immune activity, and limiting oxidative stress. These gut-derived signals may affect the brain through neural, endocrine, and immune pathways, thereby modulating neuroinflammation, hypothalamic–pituitary–adrenal (HPA) axis activity, and neurotransmitter balance. Through brain–skin communication, these changes may influence inflammation, epidermal barrier integrity, collagen remodeling, and skin aging processes. Emerging clinical evidence suggests potential improvements in skin-related outcomes and systemic inflammatory markers; however, studies remain heterogeneous, and integrated assessments of gut, brain, and skin endpoints are limited. Further studies that integrate multi-omics profiling with carefully designed clinical trials will be required to define causal pathways and support the development of evidence-based nutritional approaches targeting this axis. Full article

Since inflammation is a fundamental process involved in tissue injury and repair, the evaluation of the anti-inflammatory potential of novel compounds is of considerable importance. Acute toxicity evaluation in Swiss albino mice revealed that the synthesized thiazolidin-4-one derivatives of ferulic acid possess moderate toxicity. The in vivo biological activity of synthesized thiazolidin-4-one derivatives (1a–j) was assessed through a model of acute inflammation induced by carrageenan in rats and in a chronic inflammation model induced in rats using the granuloma test. The compounds exhibited significant anti-inflammatory effects, with maximum activity observed 24 h after administration, suggesting a prolonged duration of action. In the acute inflammation model, compound 1g exhibited the highest anti-inflammatory activity, achieving 97.43% inhibition of inflammatory edema after 24 h. In the chronic inflammation model, all derivatives reduced granulation tissue formation, indicating inhibition of the proliferative component of inflammation, with compound 1e showing the highest inhibition (79.85%). Safety evaluation was complemented by biochemical and hematological investigations performed on blood samples collected from the experimental animals. Hepatic function was assessed by measuring serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), together with renal and hematological parameters, revealing no significant toxicity. In addition, biochemical analysis of liver homogenates demonstrated modulation of oxidative stress markers, including malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) activities, indicating that the investigated thiazolidin-4-one derivatives do not induce marked oxidative imbalance under the experimental conditions. Overall, compound 1g emerged as the most promising derivative based on its balanced anti-inflammatory efficacy and favorable oxidative stress profile. Full article

Background: Cast removal is an essential but often stressful component of the Ponseti method for idiopathic clubfoot. The impact of different cast removal techniques on infant stress, parental anxiety, and treatment outcomes remains insufficiently explored. Methods: This prospective, quasi-randomized controlled trial included 84 infants with unilateral idiopathic clubfoot treated using the Ponseti method. Patients were allocated to cast removal by oscillating saw in the outpatient clinic (Group 1, n = 42) or by soaking and peeling at home prior to clinic visits (Group 2, n = 42). The primary outcome was the number of casts required to achieve correction and readiness for percutaneous Achilles tenotomy. Secondary outcomes included infant crying time, maximum heart rate during cast removal, parental anxiety assessed using the Short State Anxiety Inventory Scale (SAIS), cast removal time, hospital stay duration, and cast-removal–related complications. Results: There was no significant difference between groups regarding pre- or post-treatment Pirani and Dimeglio scores or the number of casts required (p > 0.05). Infant crying time, heart rate during cast removal, and parental anxiety scores were significantly higher in the oscillating saw group (p < 0.001). Cast-removal–related complications were more frequent in the oscillating saw group (p = 0.003). Conclusions: In this study, home-based soaking and peeling provided clinical outcomes comparable to oscillating saw removal and was associated with lower infant distress markers, lower parental anxiety scores, and fewer observed cast-removal–related complications. These findings suggest that soaking and peeling may represent a family-centered alternative for selected families receiving appropriate instruction. Full article

Cold-inducible RNA-binding protein (CIRP/CIRBP) is recognized as an extracellular damage-associated molecular pattern. However, its relationship to endothelial redox-inflammatory injury in atherosclerosis remains poorly characterized. Here, we explored the associations among CIRP, endothelial dysfunction, and TLR4-/SIRT6-related changes. In high-fat diet (HFD)-fed ApoE^−/− mice, circulating CIRP was elevated and positively correlated with atherosclerotic plaque burden. This increase coincided with systemic redox imbalance, impaired NO/eNOS activity, and vascular inflammation. In HUVECs, CIRP exposure reduced cell viability and impaired NO/eNOS function. These effects were accompanied by increased ROS accumulation and MDA content, together with reduced GSH-Px activity. CIRP also increased inflammatory cytokine production, NF-κB p65 phosphorylation, and THP-1 adhesion. At the molecular level, CIRP reduced SIRT6 expression. Overexpression of SIRT6 attenuated CIRP-induced endothelial injury, oxidative stress, and NO/eNOS dysfunction. CIRP also increased TLR4 expression. Accordingly, pharmacological TLR4 inhibition with TAK-242 attenuated CIRP-associated endothelial injury and partially restored SIRT6 expression and protein stability. Conversely, SIRT6 silencing weakened the protective effects of TAK-242. In addition, CIRP exposure was accompanied by increased overall eNOS acetylation. This increase was attenuated by TAK-242 and further enhanced by SIRT6 silencing. Exploratory cross-context transcriptomic analysis identified overlapping inflammatory and oxidative stress-related signatures. Representative antioxidant-related changes were further examined in CIRP-treated HUVECs through assessment of GPX4 and CAT mRNA expression and CAT activity. Finally, in a preliminary clinical cohort, serum CIRP levels were higher in patients with coronary heart disease and were positively associated with Gensini score, including selected exploratory multivariable models. Overall, these findings provide preliminary evidence that CIRP is associated with redox-inflammatory endothelial injury. The results are also consistent with the possible involvement of TLR4-/SIRT6-related signaling. These observations should be interpreted cautiously because of the relatively high CIRP concentration used in vitro, the cross-context transcriptomic comparison, and the small clinical cohort. Full article

Background: Inflammatory bowel disease is a complex intestinal inflammatory disorder linked to immune dysregulation, oxidative stress, and an imbalance in the gut microbiota. Grape seed flour (GSF), a winemaking by-product rich in polyphenols and fibres, displays antioxidant and anti-inflammatory properties and may help maintain gut homeostasis. Methods: The phenolic composition and antioxidant capacity of our GSF were evaluated. We assessed whether a diet containing 10% (w/w) GSF protects against dextran sulphate sodium (DSS)-induced acute colitis in BALB/c mice. Animals received either a standard diet or a GSF-supplemented diet before and during DSS exposure. Body weight and disease activity index were monitored. At sacrifice, colon length and colonic histology scoring were measured. The study of the faecal microbiota and predicted genome was performed using PICRUSt. Caecal metabolites, including short-chain fatty acids, were also quantified. Results: GSF is rich in fibres (64%) and exhibits a very high polyphenolic content and high antioxidant capacity. GSF supplementation attenuated DSS-induced weight loss and disease activity and limited colonic shortening and histological damage. It also improved biomarkers of colon, mesenteric lymph nodes (MLNs), and liver injury. At the molecular level, GSF downregulated key pro-inflammatory mediators in the colon and liver, while enhancing anti-inflammatory (e.g., IL-10) and antioxidant markers, indicating reinforcement of regulatory and redox-protective pathways along the gut–liver axis. At the gut microbiota level, GSF supplementation modulated α-diversity. Further analysis demonstrated that GSF reshaped the GM profile by preventing the blooming of some taxa, including UBA1819, Akkermansia, and Bacteroides caecimuris, and enriching butyrate-producing bacteria, such as Muribaculaceae and Ruminococcus. These shifts were accompanied by lower acetone and ethyl acetate levels and higher indole levels, which are known to support epithelial barrier integrity and mucosal homeostasis. Conclusions: Overall, GSF mitigates DSS-induced colitis through combined actions on inflammatory signalling, oxidative stress, immune regulation, microbiota composition and microbiota-derived metabolites, supporting its potential as a functional prebiotic ingredient for intestinal health. Full article

Close-to-nature silviculture, based on natural regeneration, provides a suitable framework for the use of wildlings (naturally regenerated seedlings), enabling their direct collection and transplantation. Wildlings are a promising tool for small-scale forestry, difficult terrain, post-disturbance restoration and assisted range expansion, although their establishment success remains insufficiently understood under varying site and physiological conditions. This study evaluated survival and temporal dynamics of vitality of wildlings of Norway spruce, silver fir, and European beech planted in six experimental forest gaps in a temperate Alpine forest (Pohorje Mountains, Slovenia). A total of 162 wildlings were monitored across 12 repeated assessments between 2018 and 2025, combining data on survival, vitality, morphology and environmental conditions. Survival differed strongly among species, with Norway spruce showing the highest survival (59.3%), followed by European beech (50.0%), while silver fir showed markedly lower survival (20.4%). Initial vitality emerged as the primary determinant of survival, whereas the influence of morphological traits was species-specific. Longitudinal analyses revealed contrasting vitality trajectories among species. Norway spruce exhibited a gradual decline consistent with cumulative stress effects, silver fir showed a strongly non-linear, threshold-like decline, and European beech demonstrated improving vitality over time, indicating progressive acclimation to local conditions. Structural traits such as crown development and root collar diameter were important predictors in Norway spruce, growth performance was dominant predictor in silver fir, and crown-related traits were most important in European beech. Models based on truncated trajectories improved model fit while maintaining consistent results, supporting the robustness of these patterns. The results indicate that early establishment acts as a critical filtering stage and suggest that differences in initial wildling quality, phenological status at planting, and biotic stress may contribute to variation in survival among species. In particular, the low survival of silver fir may partly reflect phenological differences associated with elevational transfer. These findings suggest that successful application of wildlings in assisted range expansion and climate-adaptive forest management requires not only appropriate species selection but also careful consideration of seedling quality, planting phenology, and microsite conditions. Full article

Underground spaces are becoming increasingly important in high-density urban environments, yet their restricted sensory conditions, limited natural references, and distinctive spatial characteristics make human responses difficult to evaluate. Virtual reality (VR) provides a controlled platform for investigating perception, cognition, and emotion in underground environments. This review synthesizes a focused body of evidence at the intersection of VR-based simulation, underground environments, and human-response assessment. A corpus of 28 studies was analysed using qualitative coding and evidence mapping. Environmental variables were organised into six categories, and reported outcomes were interpreted through a perception cognition emotion (PCE) framework. The reviewed studies show that visual conditions and biophilic interventions are frequently associated with perceptual, cognitive, and emotional outcomes, while wayfinding-related factors are most commonly represented in cognitive outcomes involving orientation, route choice, and decision-making under uncertainty or stress. The evidence also reveals a strong methodological emphasis on visually oriented and single-factor experimental designs, while multi-factor interactions and non-visual environmental influences remain comparatively underexplored. By providing a structured synthesis of current evidence, this review highlights methodological characteristics, identifies research gaps, and offers directions for future VR-based underground-environment research and human-centred design. Full article

Rolling bearings serve as core rotating components in high-end equipment such as aerospace systems, wind turbines, and high-speed electric multiple units, and their service life directly affects the operational reliability and service life of the host machinery. To clarify the research landscape of rolling bearing life prediction, summarize existing prediction techniques, and identify future development trends, this paper systematically reviews the major research advances in this field. The review first traces the evolution of bearing life models, with particular emphasis on the roles of key influencing factors, including stress thresholds, material defects, and lubrication conditions, in their development. Second, it presents a comparative analysis between conventional life calculation methods and those that account for dynamic variations in lubrication conditions, thereby revealing the influence patterns and underlying mechanisms through which surface topography and oil-film characteristics affect fatigue life. Third, it discusses methods for assessing bearing system life, with special attention given to accelerated life testing techniques and bearing condition monitoring approaches. Finally, it summarizes the state of the art in data-driven bearing life prediction and identifies online sensing of lubrication states, system-level reliability design, and improvements in the interpretability and robustness of AI-based prediction models as important future research directions in rolling bearing life prediction. Full article

Patients with heart failure require special considerations in the perioperative setting given the challenges caused by heart failure pathophysiology. This pathophysiology is complex and involves several mechanisms that contribute to both disease progression and the clinical syndrome, including cardiac remodeling, neurohormonal activation, and resultant hemodynamic derangements. Anesthetic management of these patients requires diligence at all stages of care. Preoperative assessment includes risk stratification, management of comorbid conditions, and heart failure medication management. Anesthetic agents have differing effects on hemodynamics and selection of these agents must be aimed at preventing hemodynamic collapse in patients with heart failure. In addition, the increased risk of intraoperative complications among these patients often necessitates means of invasive hemodynamic monitoring and use of vasopressor or inotropic support. Finally, the postoperative care of heart failure patients requires attention to the volume status of these patients, as well as considerations for pain management and modulation of the surgical stress response. In this review article, we aim to review how the pathophysiologic mechanisms and changes that occur with heart failure impact anesthetic management and patient-centered perioperative care. Full article