Search Results (170)

The continuous increase in the penetration rate of renewable energy has posed severe challenges to the flexibility of power systems, especially in coastal and island areas where local power supply is insufficient while electricity demand keeps growing. Focusing on the regional water–energy nexus system (WENS), this paper fully taps into the flexibility potential of seawater desalination plants (SWDPs) as adjustable loads, and proposes a bi-level optimal dispatch model. First, the operational characteristics of reverse osmosis (RO) seawater desalination loads are analyzed, and an operational model encompassing water intake equipment, high-pressure pumps, clear water tanks and product water tanks is established. Second, a dispatch framework for the regional WENS incorporating SWDP is designed, on the basis of which a bi-level optimal dispatch model is constructed: the upper-level model takes maximizing wind power accommodation and minimizing wind power output fluctuation as the objectives, so as to determine the wind power output and the charging/discharging strategy of supercapacitors; constrained by the decisions made by the upper-level model, the lower-level model comprehensively takes into account the operation cost of thermal power units (TPUs), the wind curtailment penalty cost of the system, the operation cost of energy storage systems and the operation cost of SWDP, and thus establishes an optimization model with the goal of minimizing the comprehensive operation cost of the system. Finally, a comparative analysis is carried out under different scenarios. The results show that compared with the optimal scheduling scheme in which the seawater desalination load does not participate in regulation, the proposed method can reduce the wind curtailment rate by 43.71%, the energy consumption cost of the seawater desalination load by 50.98%, and the total system operation cost by 22.51%, thus providing a feasible approach for the collaborative optimization of water–energy systems in coastal areas. Full article

The aim of this study was to measure per- and polyfluoroalkyl substance (PFAS) levels in eggs collected in Croatia and to identify differences between commercially produced eggs (cage, barn, and organic) and home-produced eggs (HPE). Thirty PFAS compounds were analyzed using high-performance liquid chromatography coupled with high-resolution mass spectrometry. In HPE, the highest detection frequencies above the limit of quantification were observed for perfluorooctane sulfonic acid (PFOS) at 67.6%, perfluorononanoic acid (PFNA) at 43.2%, perfluoro-n-decanoic acid (PFDA) at 43.2%, and perfluoro-n-dodecanoic acid (PFDoDA) at 35.8%. Perfluorooctanoic acid (PFOA) was detected only in HPE. Furthermore, HPE exhibited significantly higher mean lower bound (LB) and upper bound (UB) levels for all measured compounds, as well as for the sum of the four main PFAS (∑4PFAS: PFOS, PFOA, PFNA, and perfluorohexane sulfonic acid [PFHxS]), with values of 0.263 and 0.44 µg/kg, respectively. Cage eggs showed the lowest LB and UB levels. The dietary contribution of ∑4PFAS to the established tolerable weekly intake (TWI) limit of 4.4 ng/kg bw indicated that children up to nine years old are the most vulnerable to exposure, particularly infants and toddlers consuming HPE. Significantly lower exposure was observed with cage eggs; therefore, consumers are advised to prefer these eggs. Full article

Amino acid availability is central for the synthesis of macromolecules and numerous bioactive compounds. Amino acids are also involved in ATP production, cell signaling, and the epigenetic regulation of gene expression in human cells. From clinical and experimental studies, it appears that supplementation with specific amino acids may be relevant to correct for amino acid deficiency in the case of insufficient supply from dietary proteins with regards to the amounts needed for optimal metabolism and physiological functions. Clinical and experimental arguments suggest that amino acid supplementation may be indicated in specific situations under a specific nutritional context. However, it is essential not to overdose with excessive quantities of amino acids in supplements beyond the upper levels of safe intake (ULSI). In this narrative review, I recapitulate the protein and amino acid requirements for the general population and for subgroups of the population, and these requirements are compared to the usual consumption. Typical examples of clinical trials showing the benefits from amino acid supplementation in different physiological and pathophysiological contexts are presented together with results obtained from experimental studies. Parameters such as the no-observed-adverse-effect-level (NOAEL) values used to determine the ULSI for amino acid supplementation are defined, and values determined in clinical trials are given and discussed. Finally, prospects for future research in the field are proposed. Full article

Background: Early surgical intervention is associated with improved outcomes in hip fracture care, yet in patients using Direct Oral Anticoagulants (DOACs), surgery is frequently delayed due to concerns about increased intraoperative bleeding. Despite the increasing prevalence of hip fracture patients on DOACs, no consensus exists on optimal surgical timing. This has led to substantial practice variation between hospitals, with some operating within 24 h of last DOAC intake and others delaying surgery beyond 24 h. This study hypothesizes that early surgery within 24 h results in a non-inferior blood transfusion risk compared to delayed surgery 24 h or more after last DOAC intake in hip fracture patients on DOACs. This protocol describes the design and methodological rationale of a natural experiment. Methods and analysis: A multicenter cohort study designed as a natural experiment will be conducted across seven Dutch level 2 trauma centers, using predefined and standardized prospectively collected variables from electronic health records. Centers will adhere to distinct local surgical timing protocols, forming two cohorts: early surgery within 24 h and delayed surgery 24 h or more after last DOAC intake. Patients presenting with an isolated hip fracture who are using a DOAC and have taken their last dose within 24 h before admission will be included. The primary endpoint is postoperative blood transfusion. Secondary endpoints include additional bleeding-related outcomes, thrombotic and postoperative complications, and hospital length of stay. The primary analysis will be conducted on a per-protocol basis, with an intention-to-treat analysis performed as a supplementary assessment. Non-inferiority will be established if the upper bound of the one-sided 95% confidence interval for the risk difference does not exceed the predefined margin of 5%. Ethics and dissemination: Ethical approval was obtained from the Medical Ethics Committee United, Utrecht, The Netherlands. As this is a cohort study without altering clinical care, individual informed consent is not required. All data will be pseudonymized, and findings will be disseminated through peer-reviewed journals and scientific conferences. Registration details: Medical Ethics Committee United, Utrecht, The Netherlands, registration number W25.034. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article

Background/Objectives: Food cravings are common with high-palatability foods that are high in sugar and/or fat. Food cues can strongly induce food craving, and heightened food cue reactivity is associated with eating disorders and obesity. Sweet taste signalling is suggested to be an important regulator of appetite and food intake, with sensory-metabolic mismatch potentially relevant for the food craving experience. This study investigated the interaction between taste and food cues and food craving in healthy people with and without ingestion of a sugary drink. Methods: This study had a randomised crossover design with 47 healthy individuals who participated in two experimental trials. Fasted individuals were exposed to food cues, and food craving pre- and post-exposure was measured via a newly validated method using handgrip force as a response modality. This was followed either by ingestion (ingestion trial) or mouth rinse (mouth rinse trial) of a sugary drink and reassessment of food cue craving responses. Continuous interstitial glucose monitoring was performed using a glucose sensor inserted into the upper arm, and a blood sample for leptin levels was taken. Results: A strong food craving response to food cues was bound to the fasted state, while ingestion of a sugary drink blunted food cue reactivity and reduced craving levels. Mouth rinse induced a stable increase in food craving, which reached a maximum after food cues. Interstitial glucose levels over the after-trial periods (incremental area under the curve, iAUC) were significantly higher for the rinse trial day than for the ingestion trial day, which may suggest higher carbohydrate/sugar intake after the rinse trial, while craving levels were associated with iAUC in the rinse trial. Conclusions: Outcomes indicate that taste/flavour in connection with food cues may generate an error signal experienced as food craving, whereas receipt of sugars, with concomitant physiological responses, reduces the signal and diminishes food craving. These results highlight the importance of sensory-metabolic mismatch in the food craving experience. Full article

Background/Objectives: Iodine intake influences thyroid-related and metabolic diseases that have important public health implications. However, longitudinal evidence of the association between iodine intake and mortality remains scarce and limited to Western populations. Given the markedly high iodine intake among Asians and possible ethnic or regional differences in iodine sensitivity, population-based data from Asian cohorts are needed. Methods: We analyzed 5497 adults from the Korean National Health and Nutrition Examination Survey (2013–2015) linked with mortality follow-up through 2021. Urinary iodine concentration (UIC) was quantified from spot urine samples using inductively coupled plasma mass spectrometry. Iodine intake was estimated from UIC and categorized into four groups: below the estimated average requirement, low-normal, high-normal, and above the tolerable upper level (UL). The primary outcome was all-cause mortality. Cardiovascular disease-specific and cancer-specific mortality were also assessed. Multivariable Cox proportional hazards models accounting for the complex survey design were used to estimate hazard ratios and 95% confidence intervals. Sensitivity analysis excluded participants with thyroid disease or early death, and subgroup analyses by age and sex were also conducted. Results: During a median 8.4-year follow-up, 139 deaths occurred. Compared with the low-normal intake group, excessive iodine intake (above UL) was not associated with all-cause mortality (HR 1.09, 95% CI 0.36–3.27), cardiovascular mortality (HR 1.27, 95% CI 0.21–7.61), or cancer mortality (HR 1.71, 95% CI 0.40–7.29). No significant trends were observed across intake categories (p > 0.2), and similar findings were obtained when UIC levels were analyzed. Excluding participants with thyroid disease or early death did not change the results, and no significant interaction was observed by age or sex. Conclusions: In this first population-based Asian study on iodine intake to mortality, neither estimated iodine intake nor UIC was associated with all-cause mortality. These results suggest that the relationship between iodine exposure and mortality may differ across populations, underscoring the need for further large-scale studies. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder affecting almost 10% of the general population, characterized by recurrent abdominal pain and altered bowel habits. Its pathophysiology is incompletely understood, but it is established that symptoms result from an interplay between several environmental- and patient-related factors. This study aimed to analyze the influence of a widespread shift in lifestyle habits and multidimensional stress on IBS manifestations. Methods: An online survey was administered during the COVID-19 lockdown in 2020 to three groups of people representative of the general population. The survey contained questions regarding socio-demographic data, dietary habits, alcohol, smoking, physical activity, sleeping, working activities, stress level, and the characteristics of gastrointestinal symptoms related to both the pre-pandemic period and the lockdown period. The definition of IBS was based on the Rome IV criteria. Multivariate analyses were used to evaluate the association between environmental variables and the occurrence/resolution of IBS. Results: A total of 2735 participants were enrolled. Among them, 122 patients (46.2%) reported symptoms’ improvement during the observation period, while 118 previously healthy subjects (4.8%) developed IBS symptoms. Reduced general stress (OR = 2.2, 95%CI 1.1–4.6, p = 0.029), increased fiber intake (OR = 2.8, 95%CI 1.6–5.0, p < 0.001), and increased hours of sleep (OR = 2.0, 95%CI 1.1–3.8, p = 0.031) were associated with a high probability of IBS resolution, while increased anxiolytic pill intake (OR = 0.14, 95%CI 0.04–0.46, p = 0.001) showed a low likelihood of IBS resolution. Reduced physical activity (OR = 2.0, 95%CI 1.3–3.2, p = 0.002), increased anti-inflammatory effects (OR = 2.4, 95%CI 1.4–4.1, p = 0.002), anxiolytic pill intake (OR = 3.5, 95%CI 2.1–5.9, p < 0.001), and increased work-related stress (OR = 1.8, 95%CI 1.2–2.8, p = 0.009) were risk factors for IBS symptoms’ occurrence. Reduced alcohol consumption was a protective factor (OR = 0.5, 95%CI 0.3–0.8, p = 0.006). The resolution of IBS did not affect upper gastrointestinal functional symptoms (OR = 0.2, 95%CI 0.1–0.3, p < 0.001). Conclusions: The widespread lifestyle change forced by the pandemic created a protective “Cocoon Effect”, resulting in a beneficial effect in almost half of patients with IBS. Our findings provide large-scale evidence that environmental factors play a pivotal role in the pathophysiology of IBS. Specifically, stress levels, fiber intake, sleep patterns, and alcohol consumption are key modifiable drivers of symptom occurrence and resolution. Full article

Cereal-based complementary foods are widely consumed by children, yet limited data exist on their elemental composition and potential health risks. This study quantified As, Cd, Co, Cr, Cu, Fe, K, Mn, Mg, Mo, Ni, P, Pb, Se, Si, V, and Zn in eight commercial cereal-based products collected in Campo Grande, Brazil, using inductively coupled plasma optical emission spectrometry (ICP OES). Arsenic, cadmium, cobalt, and chromium were consistently below the detection limit. Phosphorus and potassium were the predominant elements across brands, followed by Fe, Mg, and Zn, with significant inter-brand variability (Kruskal–Wallis, p < 0.05). Lead was detected in Brands 1–5 (0.11–0.41 mg/kg), but it was below the limit of detection (LOD = 0.003 mg/L) in the other samples. Estimated daily intake (DI) values at 30 g/day and 90 g/day showed that Fe, Zn, Mn, and Se frequently met or exceeded dietary reference intakes for children aged 1–3 years, while Cu, Ni, and P remained below tolerable levels. Comparison with tolerable upper intake levels and ATSDR minimal risk levels indicated that higher consumption (90 g/day) could result in excess intake of Mn, Zn, and Se, with Pb contributing to cumulative hazard indices above the safety threshold (HI > 1). These findings emphasize the dual role of cereal-based foods as important nutrient sources and potential contributors to excessive trace element exposure in young children. Full article

Breastfeeding based on the use of follow-on milk may contain traces of xenobiotic elements that could pose a risk to the health of the vulnerable population for which it is intended. Fluorine is a non-essential element that, at high concentrations, can produce adverse health effects such as dental fluorosis, decreased IQ (intelligence quotient), thyroid alterations, and kidney damage. Given the vulnerability of infants and the possible presence of fluoride in this type of product, the content of this anion was determined in a total of 46 samples of follow-on milk from different brands and types (starter, follow-on, and hydrolysate formulas) using a fluoride ion-selective electrode (EWI). The highest mean concentration of fluoride was recorded in the hydrolysate formulas (3.38 ± 2.78 mg/L). The dietary intake assessment indicated that some brands of hydrolyzed formulas could pose a health risk, providing up to 94.1% of the UL (upper level) with only one 90 mL serving in the 0–6-month age group. It is recommended that consumers be aware of the fluoride content in the water used to prepare bottles, as it can further increase total fluoride intake and therefore pose a risk to the health of infants. Full article

Aim: The recently updated steatotic liver disease (SLD) nomenclature provides a refined classification accounting for both metabolic dysfunction and alcohol exposure. However, the relationship between SLD subtypes and upper gastrointestinal (UGI) cancer risk remains unclear. Methods: We analyzed 456,367 UK Biobank participants, categorizing them into non-SLD, metabolic dysfunction-associated steatotic liver disease with no alcohol (MASLD1), MASLD with minimal alcohol use (MASLD2), metabolic dysfunction-associated alcohol-related liver disease (MetALD), and alcohol-associated liver disease (ALD) groups. Cox proportional hazards models estimated cancer risks over a median 13-year follow-up, with histologic subtype-specific analyses. Results: Compared to non-SLD, esophageal cancer risk was significantly elevated in all SLD groups with any alcohol consumption (MASLD2, MetALD, and ALD), but not in purely metabolic SLD without alcohol (MASLD1). This association was driven by adenocarcinoma subtype, with hazard ratios ranging from 1.67 to 1.80 in alcohol-exposed SLD groups. For gastric cancer, elevated risk was observed primarily in ALD and MetALD groups, affecting intestinal-type cancers. Squamous cell esophageal cancer and non-intestinal gastric cancer showed no significant associations. Conclusions: Upper GI cancer risk in SLD patients is significantly modified by alcohol consumption, with combined metabolic dysfunction and alcohol exposure conferring the highest risks for esophageal adenocarcinoma and intestinal-type gastric cancer. Clinically, these findings suggest that SLD patients with any level of alcohol consumption require heightened cancer surveillance. Even minimal alcohol intake substantially increases cancer risk in metabolically compromised individuals, supporting alcohol reduction as a key preventive strategy. Full article

This study provides a comprehensive evaluation of naturally occurring radionuclides—radium-226 (²²⁶Ra), thorium-232 (²³²Th), and potassium-40 (⁴⁰K)—in groundwater systems across the Nile Valley regions of Upper Egypt, based on the analysis of 85 groundwater wells. Measured mean activity concentrations were 0.74 ± 0.3 Bq/L for ²²⁶Ra, 0.24 ± 0.1 Bq/L for ²³²Th, and 13 ± 4 Bq/L for ⁴⁰K, with ²²⁶Ra displaying low correlations with salinity indicators including chloride (Cl⁻), sodium (Na⁺), electrical conductivity (EC), and total dissolved solids (TDS). Notably, approximately 30% of sampled wells exceeded the World Health Organization (WHO) guidance level of 1 Bq/L for ²²⁶Ra, primarily in central and eastern zones influenced by elevated salinity and evaporite dissolution processes. Geospatial mapping combined with multivariate statistical analysis identified four principal components accounting for over 85% of total data variability, demonstrating that depth-dependent processes, including prolonged water–rock interaction and redox evolution, are the primary controls on ²²⁶Ra mobilization, with salinity-driven ion exchange as a secondary factor. Minor anthropogenic influences, potentially linked to agricultural activities in shallow aquifers, were also detected. Radiological risk assessment confirmed that calculated annual effective doses remain well within international safety limits (<1 mSv/year), although infants and children demonstrated relatively higher exposure levels due to increased water intake per unit body weight. Lifetime cancer risk estimates via ingestion pathways yielded values below 1 × 10⁻⁴, aligning with global health organization benchmarks and reinforcing the general safety of groundwater use in the region. The study highlights potential risks posed by saline groundwater to ancient monuments and archaeological sites, as the cycles of salt forming and breaking down might speed up damage to buildings made of limestone and sandstone. These findings establish a robust scientific foundation for future groundwater quality management and cultural heritage conservation efforts in the Nile Valley region of southern Egypt. Full article

Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care. Full article

Taking a composite goaf in goaf-side entry retaining as our research focus, a kilogram-level spontaneous combustion experiment was carried out, and limit parameters for coal spontaneous combustion characteristics were assessed. Combined with the key parameters of the site, a numerical model of a multi-area composite goaf was constructed, and the distribution features of the dangerous area for coal spontaneous combustion in the lower layer of in goaf-side entry retaining were determined by means of the upper and lower layer composite superposition division method. The results show that at a floating coal thickness in the goaf of 1.9 m, the lower limit of oxygen concentration C_min, upper limit of air leakage intensity, and corresponding seepage velocity are 6%, 0.282 cm⁻³·s⁻¹·cm⁻², and 11.28 × 10⁻³ m/s respectively. The dangerous area regarding residual coal on the intake side is 23~38 m away from the working face, while that on the return air side is concentrated amid the goaf at 23~75 m, and that on the flexible formwork wall is concentrated at 0~121 m. The research results are of crucial practical importance for the prevention and control of coal spontaneous combustion within a composite goaf. Full article

Background/Objectives: High sodium consumption increases the risk of hypertension and cardiovascular disease. Although food remains the primary source of intake, elevated sodium levels in drinking water can further contribute to excessive intake, particularly in populations already exceeding recommendations. This review examines the extent to which national drinking water standards account for sodium-related health risks and aims to inform discussion on the need for enforceable, health-based sodium limits. Methods: National standards for unbottled drinking water in 197 countries were searched for using the WHO 2021 review of drinking water guidelines, the FAOLEX database, and targeted internet and AI searches. For each country, data were extracted for the document name, year, regulatory body, regulation type, sodium limit (if stated), and rationale. Socio-geographic data were sourced from World Bank Open Data. A descriptive analysis was conducted using Microsoft Excel. Results: Standards were identified for 164 countries. Of these, 20% (n = 32), representing 30% of the global population, had no sodium limit. Among the 132 countries with a sodium limit, 92% (n = 121) adopted the WHO’s palatability-based guideline of 200 mg/L. Upper limits ranged from 50 to 400 mg/L. Only twelve countries (9%) cited health as a rationale. Three countries—Australia, Canada, and the United States—provided a separate recommendation for at-risk populations to consume water with sodium levels below 20 mg/L. Conclusions: Globally, drinking water standards give inadequate attention to sodium’s health risks. Most either lack sodium limits or rely on palatability thresholds that are too high to protect health. Updating national and international standards to reflect current evidence is essential to support sodium reduction efforts. Health-based sodium limits would empower communities to better advocate for safe water. Amid rising water salinity, such reforms must be part of a broader global strategy to ensure universal and equitable access to safe, affordable drinking water as a basic human right. Full article