Search Results (8,831)

Background: Recalcitrant plantar fasciitis (RPF) is a common cause of chronic heel pain, resistant to conservative treatment in up to 10% of cases. A biomechanical association exists between isolated gastrocnemius contracture and increased tension on the plantar fascia. In this context, gastrocnemius recession (GR) has emerged as a surgical intervention aimed at reducing fascial strain and improving functional outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251028862). Randomized controlled trials evaluating the efficacy of GR in patients with RPF were included. Searches were performed in PubMed, Cochrane Library, and Web of Science. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Primary outcomes included foot function (AOFAS), pain (VAS), and ankle dorsiflexion range (FDTPA). Results: Five studies encompassing 150 patients were included. Meta-analysis revealed statistically significant improvements in foot function (AOFAS, standardized mean difference [SMD] = 0.81; 95% CI: 0.26–1.36), pain reduction (VAS, SMD = −1.17; 95% CI: −1.99 to −0.36), and ankle dorsiflexion (FDTPA, SMD = 0.74; 95% CI: 0.26–1.22). GR demonstrated advantages over plantar fasciotomy in terms of postoperative recovery and preservation of fascial structure. No major complications were reported, and some studies documented sustained benefits up to six years postoperatively. Moderate to high heterogeneity was observed, largely due to variations in surgical technique and follow-up durations. Conclusions: Gastrocnemius recession is a safe and effective surgical option for treating RPF, particularly in patients with isolated gastrocnemius contracture and failure of conservative therapies. It significantly improves foot function, reduces pain, and enhances ankle mobility, with durable long-term outcomes. Trial Registration: This systematic review is registered with PROSPERO (CRD420251028862). Full article

Introduction: Low vision affects more than visual acuity; it substantially disrupts daily functioning and may contribute to long-term cognitive, emotional, and social consequences. When medical or surgical treatment options are no longer effective, structured low-vision rehabilitation becomes essential, providing strategies and tools that support functional adaptation and promote independence. This review aims to map the current outcomes of rehabilitation services, identify gaps in existing research, and highlight opportunities for further study. Methods: An article search was conducted via PubMed, Scopus, PsycInfo, and Google Scholar. Then, title, abstract, and full-text screenings for inclusion were performed by all the authors independently, and disagreements were resolved through discussion. The relevant outcomes from the eligible publications were extracted by four authors and then cross-checked by the other authors. The results are presented via the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist. Results: A total of 13 studies met the inclusion criteria. Most were randomized controlled trials (n = 10,77%), with the majority conducted in the United States and the United Kingdom. Study populations consisted of adults aged 18 years and older. Across the included studies, low-vision rehabilitation interventions particularly visual training, magnification-based programs, and multidisciplinary approaches, were associated with significant improvements in visual function, activities of daily living, and vision-related quality of life. Conclusions: Low vision rehabilitation interventions demonstrate clear benefits for visual acuity, contrast sensitivity, reading speed, and functional independence. However, substantial gaps remain, including limited evidence on long-term outcomes, inconsistent assessment of psychosocial influences, and underrepresentation of diverse populations. Standardized outcome measures and long-term, inclusive research designs are needed to better understand the sustained and equitable impact of low-vision rehabilitation. Full article

Starch and its derivatives have undergone substantial advancement in the food and beverage industry, driven by growing demand for improved functionality and health-promoting attributes. Native starches are widely used as thickeners and stabilizers; however, their applications are limited by deficiencies such as poor freeze–thaw stability. To overcome these constraints, a range of physical, chemical, and enzymatic modification techniques has been developed, yielding starches with tailored and enhanced properties. Recent innovations include polyphenol-modified starches, which improve physicochemical characteristics and confer additional health benefits, such as reduced digestibility and increased antioxidant activity—features that are particularly valuable for functional foods targeting hyperglycemia. Enzymatic modifications further enhance starch quality and processing efficiency, while chemically modified forms, such as oxidized and acetylated starches, improve emulsification and water-binding capacities in various processed foods. Starch nanoparticles have also gained attention as encapsulating agents and carriers for bioactive compounds, broadening their technological applications. In parallel, the exploration of unconventional starch sources derived from fruit-processing by-products supports sustainability efforts while introducing novel functional attributes. Collectively, these developments are contributing to the creation of healthier, more stable food products that align with consumer expectations and regulatory standards. The following sections of this article examine emerging applications of starch and its derivatives, with particular emphasis on their health benefits and sustainable production pathways. Full article

Pests contribute significantly to the loss of Apis mellifera colonies in a multifactorial context that includes viruses, pesticides, nutritional deficiencies, and climate change. This review critically summarises diagnostic techniques (morphological, molecular, automated) and epidemiological methods for the main parasites (Varroa destructor, Vairimorpha spp., Acarapis woodi, Tropilaelaps spp., Aethina tumida, Lotmaria passim, Crithidia mellificae), evaluating trade-offs between sensitivity, specificity, cost, and practicality. There is no universal gold standard; the methodological choice must be contextualised. A decision-making framework structured on four pillars (Primary objective, Resource constraints, Epidemiological context, Ethics/Regulatory) is proposed to guide optimal selections, with application examples and testable hypotheses for future validation. Limitations of emerging technologies (reduced accuracy in the field for AI and LAMP), gaps in multi-pathogen synergies (including viruses and bacteria), interactions with pesticides, and climate impacts with explicit uncertainties are discussed. A global perspective and a One Health approach are adopted, identifying research priorities for integrated diagnostic tools, validated predictive models, and sustainable strategies. Full article

Background: High residual platelet reactivity (HRPR) and persistent dyslipidemia remain important unmet needs in cardiovascular risk management, particularly in patients undergoing coronary revascularization. Despite intensive lipid-lowering and antiplatelet therapy, a substantial proportion of patients fail to reach recommended low-density lipoprotein cholesterol (LDL-C) targets or exhibit inadequate platelet inhibition. Inclisiran, a PCSK9-targeting small interfering RNA, represents an emerging approach for long-term LDL-C reduction. Methods: A narrative review of the literature published between 2009 and 2025 was performed using PubMed, Scopus, Web of Science, and MEDLINE. Studies evaluating the addition of inclisiran to standard lipid-lowering therapy in patients with dyslipidemia and HRPR, assessed using the VerifyNow assay, were included. Illustrative clinical cases from Kazakhstan were analyzed to demonstrate real-world changes in LDL-C levels and platelet reactivity following insufficient response to conventional treatment. The review had a descriptive design. Results: Available evidence indicates that a significant proportion of high- and very-high-risk patients do not achieve LDL-C targets or are unable to tolerate high-intensity statin therapy. Inclisiran consistently induces sustained reductions in LDL-C and circulating PCSK9 levels. Emerging data suggest a potential indirect modulation of platelet reactivity associated with intensive lipid lowering. In patients at extreme cardiovascular risk—including those after coronary artery bypass grafting (CABG) and with long-standing multivessel coronary artery disease—inclisiran therapy was associated with marked LDL-C reduction and a trend toward normalization of platelet reactivity. Conclusions: Assessment of platelet function using the VerifyNow assay may improve identification of residual thrombotic risk in patients with advanced atherosclerotic disease. Inclisiran appears to be a promising adjunctive therapy for dyslipidemic patients with persistently elevated cardiovascular risk and HRPR despite standard treatment. Further prospective studies are warranted to clarify the relationship between intensive LDL-C lowering, platelet reactivity, and clinical outcomes, and to optimize integrated lipid-lowering and antiplatelet strategies. Full article

Availability of irrigation water during growing seasons in the Republic of South Africa (RSA) remains a significant concern. Persistent droughts and unpredictable rainfall patterns attributed to climate change, coupled with an increasing population, have exacerbated irrigation water scarcity. Globally, treated wastewater has been utilised as an irrigation water source; however, despite global advances in the usage of treated wastewater, its suitability for irrigation in RSA remains a contentious issue. Considering this uncertainty, this review article aims to unravel the South African scenario on the suitability of treated wastewater for irrigation purposes and highlights the potential environmental impacts and public health risks. The review synthesised literature in the last two decades (2000–present) using Web of Science, ScienceDirect, ResearchGate, and Google Scholar databases. Findings reveal that treated wastewater can serve as a viable irrigation source in the country, enhancing various soil parameters, including nutritional pool, organic carbon, and fertility status. However, elevated levels of salts, heavy metals, and microplastics in treated wastewater resulting from insufficient treatment of wastewater processes may present significant challenges. These contaminants might induce saline conditions and increase heavy metals and microplastics in soil systems and water bodies, thereby posing a threat to public health and potentially causing ecological risks. Based on the reviewed literature, irrigation with treated wastewater should be implemented on a localised and pilot basis. This review aims to influence policy-making decisions regarding wastewater treatment plant structure and management. Stricter monitoring and compliance policies, revision of irrigation water standards to include emerging contaminants such as microplastics, and intensive investment in wastewater treatment plants in the country are recommended. With improved policies, management, and treatment efficiency, treated wastewater can be a dependable, sustainable, and practical irrigation water source in the country with minimal public health risks. Full article

Sustainable production of high-quality chitosan from agro-industrial by-products remains a challenge in biotechnology. This study aimed to improve chitosan production from fermented rice bran and rice husk using Rhizopus oryzae in solid-state fermentation (SSF), and evaluated the physicochemical and biological properties of the resulting biopolymer. A full factorial design (2³) was applied to assess key fermentation parameters, including moisture content, substrate composition, and nitrogen supplementation. Among the tested conditions, the highest chitosan yield was at 55% moisture, 50% rice husk, and 1.8 g/L urea. The obtained chitosan was characterized for degree of deacetylation (DD) using FTIR and NMR, and molecular weight (MW) by viscometry. Antimicrobial activity was tested against Gram-positive and Gram-negative bacteria, and antioxidant capacity was measured via DPPH and ABTS assays. The chitosan exhibited a high DD (86.4 ± 0.6%) and a MW of 59.65 kDa, values comparable to commercial standards. It showed strong antimicrobial activity, particularly against Gram-negative strains. Antioxidant assays confirmed concentration-dependent activity, reaching 94% DPPH inhibition at 5.00 mg mL⁻¹. Overall, the results demonstrate that agro-industrial residues can be effectively transformed into high-quality, bioactive chitosan, offering a sustainable and circular alternative to conventional production routes. Full article

Fungi have emerged as versatile biotechnological platforms for addressing environmental challenges with potential co-benefits for human health. Among them, Pleurotus ostreatus stands out for its ligninolytic enzyme systems (notably laccases), capacity to valorize lignocellulosic residues, and ability to form functional mycelial materials. We conducted an evidence-mapped review, based on a bibliometric analysis of the Scopus corpus (2001–2025; 2085 records), to characterize research fronts and practical opportunities in environmental remediation and sustainable bioprocesses involving P. ostreatus. The mapped literature shows sustained growth and global engagement, with prominent themes in: (a) oxidative transformation of phenolic compounds, dyes and polycyclic aromatic hydrocarbons; (b) biodegradation/bioconversion of agro-industrial residues into value-added products; and (c) development of bio-based materials and processes aligned with the circular bioeconomy. We synthesize how these strands translate to real-world contexts, reducing contaminant loads, closing nutrient loops, and enabling low-cost processes that may indirectly reduce exposure-related risks. Key translational gaps persist: standardization of environmental endpoints, scale-up from laboratory to field, performance in complex matrices, life-cycle impacts and cost, ecotoxicological safety, and long-term monitoring. A practical agenda was proposed that prioritizes field-scale demonstrations with harmonized protocols, integration of life-cycle assessment and cost metrics, data sharing, and One Health frameworks linking environmental gains with plausible health co-benefits. In conclusion, P. ostreatus is a tractable platform organism for sustainable remediation and bio-manufacturing. This evidence map clarifies where the field is mature and where focused effort can accelerate the impact of future research. Full article

In response to recent policies on sustainable finance, nature restoration, soil protection, and biodiversity conservation, it is increasingly important for projects to assess their impacts on natural capital to safeguard Ecosystem Services (ES). Nature-Based Solutions (NBSs) are recognized as strategic tools for fostering cost-effective, nature- and people-centered development. Yet, standard economic and financial assessment methods often fall short, as many ES lack market prices. Indirect, ecosystem-based approaches—such as ES monetization and environmental cost accounting—are therefore critical. This study evaluates the feasibility of investing in NBSs by estimating their economic and financial value through indirect ES valuation. An empirical methodology is applied to quantify environmental costs relative to ES delivery, using Willingness to Pay (WTP) as a proxy for the economic relevance of NBSs. The proposed ES-Cost Accounting (ES-CA) framework was implemented across major NBS categories in Europe. Results reveal that the scale of NBS implementation significantly influences both unit environmental costs and ES provision: larger interventions tend to be more cost-efficient and generate broader benefits, whereas smaller solutions are more expensive per unit but provide more localized or specialized services. The findings offer practical guidance for robust cost–benefit analyses and support investment planning in sustainable climate adaptation and mitigation from an ES perspective. Full article

This study investigates the integration of 3D laser scanning technology in the retrofitting of Ballast Water Treatment Systems (BWTS) on existing commercial vessels, addressing the global challenge of invasive aquatic species. The methodology combines a bibliometric analysis of keywords—indicating recent trends and knowledge gaps, a feasibility study, and detailed engineering design with on-site supervision. A case study is presented on a crude oil tanker, employing a multi-station 3D scanning strategy across the engine and pump rooms—performed using 63 and 45 scan positions, respectively. These data were processed with removal filters and integrated into specialized CAD software for detailed piping design. The implementation of high-fidelity point clouds served as the digital foundation for modeling the vessel’s existing piping infrastructure and retrofitting with the installation of an electrolysis-based BWTS. Results confirm that 3D scanning enables precise spatial analysis, minimizes retrofitting errors, reduces installation time, and ensures regulatory compliance with the IMO Ballast Water Management Convention. By digitally capturing complex onboard environments, the approach enhances accuracy, safety, and cost-effectiveness in maritime engineering projects. This work underscores the transition toward point cloud-based digital twins as a standard for sustainable and efficient ship conversions in the global shipping industry. Full article

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. The aim of this study is therefore to assess how ethical issues are managed in Italian NICUs, with particular attention to the availability, use, and perceived usefulness of clinical ethics support in everyday practice. Methods: A 25-item questionnaire was developed by adapting an existing tool for investigating clinical ethics activities to the neonatal context. Following expert review by the GIBCE (Gruppo Interdisciplinare di Bioetica Clinica e Consulenza Etica in ambito sanitario), the final instrument covered four areas (general data, experience with ethical dilemmas, tools and procedures, opinions and training needs). A manual web search identified all Italian NICUs and their clinical directors, who were asked to disseminate the survey among staff. Participation was voluntary and anonymous. Data collection was conducted via Google Forms and analyzed through qualitative thematic analysis. Results: A total of 217 questionnaires were collected. The most frequent ethical dilemmas concern quality of life with anticipated multiple or severe disabilities (72.4%) and decisions to withdraw or withhold life-sustaining treatments (64.5%). Major challenges include fear of medico-legal repercussions (57.6%) and communication divergences between physicians and nurses (49,8%). More than half of respondents (52.1%) reported no formal training in clinical ethics, and 68.7% had never developed a Shared Care Plan (Shared Document for healthcare ethics planning) as defined by the Italian Law 219/2017. Conclusions: Findings highlight marked fragmentation in ethical practices across Italian NICUs. On this basis, establishing structured and accessible CEC services could help promote consistency, reinforce shared ethical standards, and support transparent and equitable decision-making in critical neonatal care. Full article

Coal gangue, as a predominant solid byproduct of the global coal industry, poses severe environmental challenges because of its massive accumulation and low utilization rate. This review systematically synthesizes and analyzes published experimental and analytical studies on the dual-pathway utilization of coal gangue in concrete, including Pathway 1 (aggregate substitution) and Pathway 2 (cementitious activity activation). While the application of coal gangue aggregates is traditionally limited by their inherent high porosity and lower mechanical strength than those of natural aggregates, this review demonstrates that performance barriers can be effectively overcome. Through multiscale modification strategies—including surface densification, biological mineralization (MICP), and matrix synergy—the interfacial defects are significantly mitigated, allowing for feasible substitution in structural concrete. Conversely, for the mineral admixture pathway, controlled thermal activation is identified as a key process to optimize the phase transformation of kaolinite, thereby significantly enhancing pozzolanic reactivity and long-term durability. According to reported studies, the partial replacement of natural aggregates or cement with coal gangue can reduce CO₂ emissions by approximately tens to several hundreds of kilograms per ton of coal gangue utilized, depending on the substitution level and activation strategy, highlighting its considerable potential for carbon reduction in the construction sector. Nevertheless, challenges related to energy-intensive activation processes and variability in raw gangue composition remain. These limitations indicate the need for future research focusing on low-carbon activation technologies, standardized classification of coal gangue resources, and long-term performance validation under realistic service environments. Based on the synthesized literature, this review discusses hierarchical utilization concepts and low-carbon activation approaches as promising directions for promoting the sustainable transformation of coal gangue from an environmental liability into a carbon-reduction asset in the construction industry. Full article

The transition to Outcome-Based Education (OBE) in engineering demands instructional tools that bridge theoretical knowledge and practical engineering competencies. However, traditional Learning Management Systems (LMS) primarily function as static resource repositories, lacking the semantic structure necessary to support deep learning and precise competency tracking. To address this, this study developed a three-layer domain Knowledge Graph (KG) for Structural Geology and integrated it into the ChaoXing LMS (a widely used Learning Management System in Chinese higher education). A semester-long quasi-experimental study (N = 84) was conducted to evaluate its impact on student performance and specific graduation attribute achievement compared to a conventional folder-based approach. Empirical results demonstrate that the KG-integrated group significantly outperformed the control group (p < 0.01, Cohen’s d = 0.74). Notably, while performance on rote memorization tasks was similar, the experimental group showed marked improvement in identifying and solving complex engineering problems. LMS log analysis confirmed a strong positive correlation (r = 0.68) between graph navigation depth and academic success. KG effectively bridged the gap between theoretical knowledge and practical engineering applications (e.g., geohazard analysis). This research confirms that explicit semantic visualization acts as vital cognitive scaffolding, effectively enhancing higher-order thinking and ensuring the rigorous alignment of instruction with engineering accreditation standards. Ultimately, this approach promotes sustainable learning capabilities and prepares future engineers to address complex, interdisciplinary challenges in sustainable development. Full article

Civilisational progress contributes to an increase in the number of vehicles on the road, thereby intensifying air pollutant emissions and accelerating the degradation of the natural environment. Effective protection of urban areas against air pollution enhances safeguarding against numerous allergies and diseases resulting from unplanned and unintended absorption of harmful pollutants into the human body. Sustainable urban planning requires the collaboration of multiple scientific disciplines. In this context, measurement becomes crucial, as it reveals the spatial scale of the problem and identifies existing disparities. This study uses an integrated approach of standard measurement methods and statistical and geostatistical data analysis, identifying PM₁ fractions that are not included in EU air quality monitoring. The hypothesis explores how surface-based results correspond to point-based results from national air quality monitoring. The presented implications demonstrate similarities and differences between the studied measurement methods and the spatial distributions of PM₁₀, PM_2.5, and PM₁ dust. Full article

Traditional villages are vital carriers of cultural heritage and key foundations for rural revitalization and sustainable development, yet rapid urbanization increasingly threatens their survival, making it necessary to clarify their spatial distribution and driving mechanisms to support effective conservation and rational utilization. Yunnan Province, home to 777 nationally recognized traditional villages and the highest number in China, offers a representative context for such analysis. Methodologically, this study uses a 12 km × 12 km geographic grid (3005 cells) rather than administrative units. The count of catalogued traditional villages in each cell is taken as the dependent variable, and nine indicators selected from five dimensions (traffic accessibility, natural topography, climatic conditions, socioeconomic factors, and historical and cultural factors) serve as explanatory variables. Assuming that relationships between villages and their environment are spatially nonstationary and operate at multiple spatial scales, we combine spatial autocorrelation analysis with a multiscale geographically weighted regression (MGWR) model to detect clustering patterns and estimate location-specific coefficients and bandwidths. The results indicate that: (1) traditional villages in Yunnan exhibit significant clustering, with over 60% concentrated in Dali, Baoshan, Honghe, and Lijiang; (2) the spatial pattern follows a “more in the northwest, fewer in the southeast, dense in mountainous areas” distribution, shaped by both natural and socioeconomic factors; (3) natural geographic factors show the strongest associations, with sunshine duration and water availability strongly promoting village presence, while slope exhibits regionally differentiated effects; (4) socioeconomic development and transportation accessibility are generally negatively associated with village distribution, but in tourism-driven areas such as Dali and Lijiang, road improvements have facilitated protection and revitalization; and (5) historical and cultural factors, particularly proximity to nationally protected cultural heritage sites, contribute to spatial clustering and long-term preservation. The MGWR model achieves strong explanatory power (R² = 0.555, adjusted R² = 0.495) and outperforms OLS and standard GWR, confirming its suitability for analyzing the spatial mechanisms of traditional villages. Finally, the study offers targeted recommendations for the conservation and sustainable development of traditional villages in Yunnan. Full article