Search Results (1,947)

Background: The urea-to-creatinine ratio (UCR) is used to support the differential diagnosis of acute kidney injury (AKI); however, its diagnostic utility remains debated. We explored the clinical relevance of UCR in the initial etiological assessment of AKI, also considering relevant clinical modifiers. Methods: We retrospectively analyzed 590 hospitalized patients classified as pre-renal (n = 319), parenchymal (n = 135), or post-renal (n = 136) AKI. UCR was compared across AKI subtypes and stratified by pre-existing chronic kidney disease (CKD). Logistic regression models assessed the association between UCR and pre-renal AKI, excluding post-renal cases. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. An exploratory analysis was performed within parenchymal AKI according to histopathological patterns and the presence of nephrotic syndrome. Results: Baseline characteristics differed across AKI subtypes, including age, sex, and CKD. UCR was higher in pre-renal than in parenchymal and post-renal AKI (p < 0.001), despite substantial overlap. Stratification by CKD did not reveal differences within AKI subtypes; however, in pre-renal AKI, UCR decreased progressively with advancing CKD stage (p < 0.001). UCR was significantly associated with pre-renal AKI, and diagnostic performance improved when combined with age and advanced CKD. Within parenchymal AKI, higher UCR values were observed in glomerular disease, particularly with nephrotic syndrome. Conclusions: UCR varies across AKI etiologies and is influenced by age and baseline kidney function. Although its standalone diagnostic performance is limited, integration with simple clinical variables improves discrimination between pre-renal and parenchymal AKI, supporting its use as a complementary tool in early AKI evaluation while emphasizing the need for comprehensive clinical assessment. Full article

Background: Anterior cruciate ligament reconstruction (ACLR) is the standard of care for ACL injuries, and graft choice may influence the recovery of function assessed with vertical jump tests. Objective: To evaluate the effect of graft type on vertical jump performance in adults after ACLR and to synthesise the differences between grafts. Material and Methods: This systematic review was conducted in accordance with the PRISMA 2020 and SWiM guidelines. The following databases were searched: Scopus, Web of Science, PubMed, MEDLINE and SPORTDiscus (EBSCOhost), up to 31 January 2026. Studies with an unambiguously defined graft type and objective jump tests (CMJ, SL CMJ/SL VJ, DVJ/DJ, SJ) were included. Risk of bias was assessed using the RoB 2, ROBINS-I, JBI and MINORS tools, and the certainty of evidence using the GRADE approach. Because of substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed in accordance with the SWiM guidelines; no pooled analysis was undertaken. Results: Forty-seven studies (>3400 participants) were included. BPTB was associated with greater eccentric-phase asymmetry in the bilateral CMJ in the early/intermediate phase compared with HT, with equalisation after 9–12 months. QT provided jump height comparable to HT but a more favourable dynamic valgus profile. Autograft and allograft did not differ in jump performance. Deficits followed a biphasic course: normalisation of symmetry after approximately 2 years, with reduced height/power for up to 5 years. Conclusions: Forty-two of the studies (89.4%) were non-randomised, and the certainty of evidence was low for one clinical question and very low for all others. Studies comparing BPTB with HT showed an association suggesting greater eccentric-phase asymmetry in the bilateral CMJ in the early and intermediate phase after BPTB, but findings were inconsistent and two studies reported no difference. Evidence suggesting that these differences equalise after 9–12 months derives from between-study comparisons. Jump height did not differ between QT and HT; a single study of 26 patients reported smaller dynamic valgus after QT. Autograft and allograft did not differ in vertical jump performance. Registration: This review was registered in the PROSPERO database and is available under the number CRD420261386307. Full article

Distributed generation (DG) is reshaping distribution networks through bidirectional power flows, operational variability, and dependence on coordinated regulation, pricing, and control. This paper examines how regulatory architecture, grid-code requirements, tariff design, and Distributed Energy Resource Management Systems (DERMS) influence DG integration, emphasizing Honduras. A structured mixed-source review is applied, combining Scopus-based bibliometric analysis of 2438 records (2000–2026) with targeted synthesis of technical, regulatory, tariff-related, and institutional sources. The bibliometric results show sustained growth and a thematic shift from conventional voltage-control studies toward active distribution networks, DER coordination, storage, demand response, tariff reform, and digital energy management. The analytical synthesis shows that effective DG integration requires more than interconnection compliance: it depends on grid-support functions, cost-reflective and equitable tariffs, and operational tools capable of managing voltage deviations, reverse power flow, congestion, protection coordination, and limited visibility. DERMS is an enabling layer for voltage control, active and reactive power management, congestion mitigation, adaptive protection, and predictive operation. For Honduras, current regulatory progress should be complemented by phased modernization focused on observability, smart metering, data infrastructure, local flexibility, and progressive DERMS deployment. The study provides an integrated framework for aligning regulatory, economic, and operational dimensions of DG integration in emerging distribution systems. Full article

Background/Objectives: Obesity is a chronic, progressive, and relapsing disease that requires long-term, multidisciplinary management rather than episodic weight-loss treatment. Although novel incretin-based anti-obesity pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have markedly improved the clinical management of obesity, weight reduction alone does not fully capture treatment success. Body composition, lean mass preservation, physical function, nutritional adequacy, psychological well-being, adherence, and long-term weight-loss maintenance are increasingly recognized as essential therapeutic outcomes. This narrative review critically examines the role of lifestyle medicine as a co-therapeutic strategy during modern anti-obesity pharmacotherapy, with particular attention to physical activity, nutrition, behavioral support, and individualized monitoring. Methods: A narrative literature search was conducted in PubMed up to June 2026. The review included studies addressing adults with overweight or obesity and evidence related to anti-obesity pharmacotherapy, physical activity, nutrition, body composition, functional outcomes, eating behavior, quality of life, treatment tolerability, adherence, weight regain, and long-term maintenance. Results: Current evidence indicates that incretin-based therapies produce substantial and clinically meaningful weight loss, but pharmacological efficacy may be limited by reductions in lean mass, gastrointestinal adverse events, inadequate nutritional intake, treatment discontinuation, and weight regain after drug withdrawal. Physical activity should be considered a therapeutic component rather than only a tool for increasing energy expenditure, as aerobic exercise supports cardiometabolic health and cardiorespiratory fitness, while resistance training helps preserve muscle strength, bone health, and functional capacity. Nutritional strategies are equally important, particularly during appetite suppression, to maintain adequate protein, fiber, fluids, micronutrients, and diet quality. Behavioral factors, including sleep, stress, mood, stigma, self-regulation, and the food environment, may influence adherence and long-term outcomes. Conclusions: Novel anti-obesity drugs should not be viewed as replacements for lifestyle medicine but as powerful tools within an integrated chronic-care model. The goal of treatment should move beyond maximal body-weight reduction to durable improvements in body composition, metabolic health, physical function, nutritional status, quality of life, and weight-loss maintenance. Full article

Adequate soil quality is essential for ensuring the productivity and sustainability of agriculture, with soil pH being a key variable due to its influence on nutrient availability, microbial activity, and plant development. This study proposes a Mamdani fuzzy inference system (FIS) optimized through metaheuristic algorithms for soil pH prediction in papaya (Carica papaya L.) cultivation, a crop highly sensitive to pH fluctuations within the rhizosphere. Soil temperature and soil moisture were used as independent variables, while the estimated soil pH constituted the dependent variable of the system. Three optimization techniques—genetic algorithms (GAs), Differential Evolution (DE), and Particle Swarm Optimization (PSO)—were evaluated to optimize the membership functions and fuzzy rule base of the Mamdani FIS. Model performance was assessed through 30 independent runs using 1500 records collected from a commercial papaya plantation. Across the 30 independent runs, the GA-optimized model achieved the best overall predictive performance, with a Mean Absolute Error (MAE) of 0.3636 ± 0.0035, Mean Relative Error (MRE) of 0.0554 ± 0.0004, and mean coefficient of determination (r²) of 0.8699 ± 0.0048. The best observed GA values were an MAE of 0.3305, MRE of 0.0513, and r² of 0.8957. In addition, a web-based decision support platform and an automated Telegram alert system were developed for event-driven pH alert notification. The results confirm that GA-optimized fuzzy systems constitute an effective, interpretable, and practical tool for pH-based soil condition monitoring and agronomic decision support in precision agriculture. Full article

Freeze-drying is one of the most effective and widely applied techniques for microbial preservation, playing an increasingly important role in the development of microbial bioinputs for sustainable agriculture. Beyond maintaining microbial viability, successful freeze-dried formulations require the integration of preservation science, formulation engineering, storage stability, and functional performance to ensure product efficacy under industrial and field conditions. This review discusses the current state of the art in freeze-drying for microbial preservation, focusing on the physicochemical mechanisms of cellular damage and protection, formulation strategies, storage stability, and technological factors influencing the development of agricultural bioinputs. Recent advances in computational modeling, systems biology, and rational formulation design are also highlighted as emerging tools for optimizing preservation systems and accelerating product development. Finally, the challenges associated with industrial implementation, quality assurance, and commercial translation are discussed, emphasizing the need for multidisciplinary approaches to develop robust, scalable, and effective freeze-dried microbial bioinputs for sustainable and regenerative agriculture. Full article

Jujube (Ziziphus jujuba Mill.) is an important functional fruit with high levels of bioactive compounds. However, its high moisture content limits its postharvest shelf life. The biochemical properties of jujube fruits influenced by hot-air drying at 50, 60, and 70 °C were studied and predictive models were evaluated to optimize drying. The drying kinetics were modeled using the six classical thin-layer models and artificial neural network (ANN) approach. The Midilli–Kucuk model was the best classical model, and the ANN model showed the best predictive performance, with the RMSE values improved up to 19.52% in the independent validation dataset. The drying temperature significantly influenced the color, composition of sugars, organic acids, total phenolic content, and antioxidant activity. Color difference (ΔE = 5.88) and browning index of the 70 °C treatment showed less color change, indicating better color retention. Sugar and organic acid concentrations were significantly higher in dried fruits than in fresh fruits. The highest total phenolic content (5393.43 mg GAE 100 g⁻¹) and DPPH radical scavenging activity (73.56%) were found at 50 °C and progressively decreased with increasing drying temperature. Multivariate analyses further showed clear biochemical differentiation between fresh and dried samples according to drying temperature. Generally, the drying temperature had a significant effect on the nutritional and functional quality of jujube fruits. Although 50 °C was the most effective for maintaining phenolic compounds and antioxidant activity, 70 °C offered better color retention and shorter drying time. The ANN method was a useful tool to predict the drying behavior and optimize processing conditions in the production of jujube fruit. Full article

Cover cropping can be a promising management strategy to improve soil health in the tropics. Our study evaluated physical, chemical, and microbiological indicators of soil health three years after implementing a maize and cowpea cover crop rotation with five fertilizer rates in replicated plots on a Torrifluventic Haplustepts in the southern semiarid coast of Puerto Rico. The Soil Management Assessment Framework (SMAF) was used to integrate different soil parameters to provide a comprehensive overview of soil health changes. Water aggregate stability (WAS) was not affected by cover crops. Soil pH significantly decreased with increasing nitrogen (N) fertilization rate and with cover crop rotation. Chemical and microbial indicators of soil health related to organic matter dynamics and nutrient cycling potential [e.g., microbial biomass nitrogen (MBN), potentially mineralizable N (PMN), β-glucosidase activity, combined enzyme activity for carbon (C), N, and phosphorus (P) cycling (β-glucosidase, β-glucosaminidase, and acid phosphatase] were significantly (p < 0.1) improved by cover crop but were not affected by fertilizer rate or cover crop x fertilizer rate. Fatty acid methyl esters (FAME) analysis showed that only G+ bacteria were significantly higher due to cover cropping. Principal component analysis revealed that total FAMEs and markers for G+ bacteria, G− bacteria, actinobacteria, and saprophytic fungi responded similarly to management and were generally influenced by cover cropping. Overall, improvements in microbial communities led to significant increases in key functions supporting soil health and sustainability within just three years of cover cropping adoption. The SMAF, as a well-known soil quality/health index, detected early benefits of using cover crops. Our study provided evidence that these indicators can serve as tools to assist farmers in selecting sustainable management practices such as cover crops in the tropics, yet long-term monitoring is still needed. Full article

Background/Objectives: Frailty is increasingly recognized as an important condition in polymyalgia rheumatica (PMR), although different instruments may assess different dimensions of vulnerability. This study aimed to compare the determinants and clinical correlates of frailty measured by the Comprehensive Rheumatologic Assessment of Frailty (CRAF) and the Italian Kihon Checklist (I-KCL). Methods: Fifty-two patients with PMR were evaluated. The discriminative performance of CRAF and I-KCL was assessed against the Cardiovascular Health Study (CHS) frailty phenotype using ROC analysis. Multivariable linear regression identified the independent determinants of each frailty measure. Results: The distribution of frailty status varied across the three assessment tools. The CRAF score identified a higher proportion of non-frail patients (44.2%) and a lower proportion of frail individuals (19.2%) compared to both the I-KLC and CHS criteria. Discriminative accuracy of CRAF and I-KCL scores against the CHS/Fried phenotype reference standard was excellent for both instruments: CRAF AUC = 0.96 (95% CI 0.888–1, bootstrap, 2000 stratified resamples) and I-KCL AUC = 0.899 (95% CI 0.704–1). The difference between CRAF and I-KCL discriminative accuracy was therefore not statistically significant (z = 0.941, p = 0.3467). In multivariable linear regression models adjusted for age, disease duration, PMR-AS(CRP), comorbidity count, HAQ, and fatigue, PMR-AS(CRP) (standardized β = 0.51, p < 0.001) and comorbidity count (standardized β = 0.36, p < 0.001) were independently associated with the CRAF score (adjusted R² = 0.787, n = 51), while PMR-AS(CRP) (standardized β = 0.40, p < 0.001) and comorbidity count (standardized β = 0.46, p < 0.001) were independently associated with the I-KCL score (adjusted R² = 0.675, n = 51). A further finding was that functional impairment, measured by the HAQ, was independently associated with the CRAF score (standardized β = 0.19, p = 0.018) but not with the I-KCL score (standardized β = 0.06, p = 0.512). Conclusions: Although CRAF and I-KCL share these core determinants, they capture different dimensions of frailty: CRAF is more strongly influenced by functional impairment, whereas I-KCL appears less affected by disability. These instruments should therefore be considered complementary rather than interchangeable. Full article

Background: Population ageing, increasing care demands, and rapid advances in artificial intelligence and robotics have intensified interest in care robots as potential tools to support independent living and complement human caregiving. However, the successful implementation of robotic technologies depends largely on public acceptance, which is influenced by functional, psychological, ethical, cultural, and generational factors. Objective: This study examined generational differences in the acceptance of care robots among Portuguese adults by integrating the Almere Model of technology acceptance with the Katz Index of Activities of Daily Living (ADL) and the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale. The research sought to determine whether acceptance varies according to generation and the type of caregiving activity performed by the robot. Methods: A cross-sectional quantitative study was conducted using an online questionnaire administered to a purposive sample of 235 adults residing primarily in the Lisbon Metropolitan Area, Portugal. The questionnaire combined constructs from the Almere Model with perceptions of robotic assistance for ADLs and IADLs. Principal Component Analysis, reliability analysis, descriptive statistics, and inferential analyses were performed to examine differences across generational groups. Results: Acceptance of care robots was strongly task-dependent. Participants expressed significantly greater acceptance of robots assisting with instrumental activities, including housekeeping, shopping, transportation, meal preparation, and medication management, than with intimate personal care activities such as bathing, dressing, toileting, feeding, and continence care. Contrary to common assumptions regarding digital natives, Generation Z reported higher levels of fear, discomfort, and perceived intimidation than Generation X and Baby Boomers. Older generations generally demonstrated more pragmatic acceptance of robotic assistance, particularly regarding future support needs associated with ageing. Across generations, respondents preferred robots with more human-like appearances; however, emotional trust remained substantially lower than perceived functional usefulness. Conclusions: The findings suggest that acceptance of care robots is conditional rather than universal and is shaped by the nature of the caregiving task, generational differences, and broader emotional and cultural perceptions of care. Integrating the Almere Model with established ADL and IADL frameworks provides a novel perspective by linking technology acceptance to specific functional domains of caregiving. The results support the view that care robots are more likely to be accepted as complementary tools that enhance human-centred care rather than as substitutes for professional or family caregivers. Given the purposive and geographically limited sample, the findings should be interpreted cautiously and not generalised to the wider Portuguese population. They nevertheless provide valuable implications for the design of socially assistive robots, healthcare practice, and public policy in ageing societies. Full article

Urban green spaces play a fundamental role in maintaining ecological stability, supporting biodiversity, regulating urban microclimates, and improving human wellbeing. Because photosynthetic activity is a key indicator of vegetation functionality and environmental adaptation, this study evaluated the photosynthetic performance of vegetation across eight urban green spaces within the campus of the University of Life Sciences “King Michael I” in Timișoara, Romania. Vegetation structure, spatial organization, and estimated photosynthetic rates of selected ornamental species were comparatively analyzed under the temperate climatic conditions of the study area. Two-factor analysis of variance (ANOVA) revealed that the spatial characteristics of the investigated green spaces had a highly significant effect on photosynthetic variability (F(7, 42) = 6.783; p = 0.000021), explaining approximately 46% of the total variance, whereas species identity accounted for only 13.3% and showed no statistically significant influence (p = 0.052863). The highest photosynthetic performance was recorded in structurally diverse green spaces characterized by dense tree canopy and balanced woody–herbaceous vegetation, whereas the lowest values occurred in highly urbanized areas with limited vegetation cover. These findings demonstrate that the structural organization and vegetation composition of urban green spaces strongly influence photosynthetic performance and support the use of integrated ecological assessment as a decision-support tool for sustainable and climate-resilient urban green infrastructure planning. Full article

Background: Gut microbiota plays a key role in the aging process, with age-related microbial shifts contributing to chronic inflammation, metabolic dysfunction, frailty, and cognitive decline. Despite growing interest, an integrated synthesis of how diet and lifestyle modifications influence gut microbiota remains limited. This overview of reviews summarizes the current evidence on how dietary and lifestyle interventions shape microbial composition and affect aging outcomes. Methods: Following the PRISMA guidelines, we searched PubMed and Scopus for English-language reviews (January 2023–October 2025) including human adults aged ≥ 18 years, evaluating dietary or lifestyle interventions, and reporting gut microbiota with healthy-aging outcomes. Quality of the reviews was appraised using the SANRA tool. Results: Mediterranean and plant-based diets, calorie restriction, and microbiota-targeted approaches such as probiotics, prebiotics, symbiotics, and fecal microbiota transplantation were associated with increases in short-chain fatty acid-producing bacteria, including Faecalibacterium, Bifidobacterium, Lactobacillus, and Akkermansia muciniphila, while reducing pro-inflammatory taxa. These changes were linked to improved metabolic and immune function, reduced inflammaging, lower frailty, and greater physical resilience. Cognitive benefits included decreased neuroinflammation and a lower risk of Alzheimer’s and Parkinson’s diseases. Conclusions: Maintaining microbial balance through targeted dietary strategies may support healthier, more resilient aging, offering practical insights for public health and clinical nutrition planning. Full article

Point-of-care (POC) technologies are promising tools to decentralize and accelerate the diagnosis of rare diseases. Among them, electrochemical immunosensors offer advantages such as high sensitivity, low cost, portability, low sample consumption, and suitability for use in resource-limited settings. However, the performance of these devices is dependent on electrode surface properties, which influence electron transfer, biomolecule immobilization, and analytical sensitivity. In this work, screen-printed carbon electrodes (SPCEs) were modified through two strategies: (i) gold electrodeposition and (ii) cold plasma treatment. The modified electrodes were functionalized with EDC/NHS, followed by the immobilization of anti-SMN antibodies and electrochemical characterization using cyclic voltammetry and differential pulse voltammetry. The impact of each modification approach on the electrochemical response and reproducibility of the sensor was evaluated. Gold electrodeposition resulted in higher and more reproducible electrochemical responses, demonstrating improved electron transfer properties and surface homogeneity. The primary objective of this study was to investigate how different surface modification strategies affect the electrochemical performance of SPCE-based immunosensors, employing the detection of Survival Motor Neuron (SMN) protein, a biomarker associated with Spinal Muscular Atrophy (SMA), as a proof-of-concept application. The resulting platform successfully differentiated specific and non-specific protein recognition events through distinct electrochemical patterns, demonstrating the suitability of gold-modified SPCEs for immunosensing applications. These findings provide insights into the influence of surface engineering strategies on sensor performance and support the future development of optimized electrochemical platforms for biomarker detection. Full article

Assessing climate performance through emission-centric metrics provides an incomplete picture of countries’ progress toward integrated climate objectives. This study proposes the Climate Integrated Performance Index (CIPI), a multidimensional and explainable composite indicator for 27 European countries during 2015–2023. CIPI integrates six thematic dimensions: emissions, energy systems, mitigation capacity, transport, agriculture, and waste–land-use interactions, using robust normalization, a policy-informed weighting framework, and formal statistical validation. Based on 243 country–year observations, the results indicate that CIPI is non-redundant. Pearson correlations reveal strong positive associations with the Energy Index (r = 0.899) and Mitigation Index (r = 0.894), alongside a significant negative association with the Agriculture Index (r = −0.659), highlighting sectoral trade-offs. Variance decomposition further shows that energy and mitigation dimensions jointly account for approximately 87% of explained variance, whereas agriculture exerts a systematic counterbalancing influence. To support structural interpretation, an explainable machine learning framework combining XGBoost and SHAP was implemented as a diagnostic layer. Renewable-energy capacity emerged as the dominant structural driver of integrated climate performance, and SHAP-based analyses revealed a nonlinear threshold effect, with positive contributions accelerating beyond a normalized renewable-capacity level of approximately 0.58 (95% bootstrap confidence interval: 0.54–0.62), particularly under low fossil-fuel dependency conditions. Because the machine learning models use indicators that also contribute to index construction, the results are interpreted as evidence of structural consistency and diagnostic interpretability rather than independent predictive discovery. To address this limitation, repeated cross-validation, subsample validation, benchmark comparisons, and weighting-sensitivity analyses were conducted. Ranking robustness remained high under alternative weighting schemes (Spearman ρ > 0.96), while comparison with an emission-centric benchmark demonstrated substantial rank reversals, indicating that broader sectoral and policy dimensions influence climate-performance assessment. Overall, CIPI functions not only as a benchmarking tool but also as a transparent diagnostic framework for identifying structural trade-offs, nonlinear relationships, and policy-relevant climate-transition dynamics. Full article

Starch-modifying glycoside hydrolases (GHs) typically operate via a retaining double-displacement mechanism, involving formation of a covalent glycosyl–enzyme intermediate. This intermediate can be resolved either by water, resulting in hydrolysis, or by a glucan acceptor, leading to transglucosylation. Many GHs exhibit both catalytic activities, although they are classified according to their predominant reaction. For example, branching enzymes (BEs) catalyse α-(1→4) bond cleavage and α-(1→6) branch formation via transglucosylation, while also exhibiting minor hydrolytic and disproportionation activities that broaden their catalytic repertoire. More recent research indicates that the different catalytic activities of BEs can be interconnected, thereby collectively determining the final α-glucan architecture. This challenges the classical view that the predominant branching activity of BEs is catalysed independently. Moreover, the balance between these coupled activities influences substrate specificity and can broaden the substrate scope to include chemically modified starches. Furthermore, the co-application of BEs with other GHs reveals synergistic interactions between catalytic activities, enabling the generation of α-glucan structures that cannot be produced by any of the enzymes individually. In this perspective paper, and based on recent developments, we argue that the catalytic framework of BEs provides multiple strategies for tailoring diverse α-glucan architectures. This enables modulation of structural features across hierarchical levels, from supramolecular to macromolecular organisation. As a result, BEs represent versatile tools for engineering starch functionality beyond digestibility, extending their potential toward pharmaceutical and non-food applications. Looking ahead, we discuss how enzyme-designed and chemically functionalised α-glucan polymers may emerge as a new class of sustainable materials. These materials could provide biodegradable, water-soluble, and renewable alternatives to petrochemical-derived polymers used in personal and home care products. Full article