Search Results (241)

Insulin resistance (IR), a core component in the development of type 2 diabetes mellitus (T2DM), is increasingly recognized for its role in cardiovascular and pulmonary complications. This review explores the relationship between IR, right ventricular dysfunction (RVD), and decreased lung volume in patients with T2DM. Emerging evidence suggests that IR contributes to early structural and functional alterations in the right ventricle, independent of overt cardiovascular disease. The mechanisms involved include oxidative stress, inflammation, dyslipidemia, and obesity—factors commonly found in metabolic syndrome and T2DM. These pathophysiological changes compromise right ventricular contractility, leading to reduced pulmonary perfusion and respiratory capacity. RVD has been associated with chronic lung disease, pulmonary hypertension, and obstructive sleep apnea, all of which are prevalent in the diabetic population. As RVD progresses, it can result in impaired gas exchange, interstitial pulmonary edema, and exercise intolerance—highlighting the importance of early recognition and management. Therapeutic strategies should aim to improve insulin sensitivity and cardiac function through lifestyle interventions, pharmacological agents such as SGLT2 inhibitors and GLP-1/GIP analogs, and routine cardiac monitoring. These approaches may help slow the progression of RVD and its respiratory consequences. Considering the global burden of diabetes and obesity, and the growing incidence of related complications, further research is warranted to clarify the mechanisms linking IR, RVD, and respiratory dysfunction. Understanding this triad will be crucial for developing targeted interventions that improve outcomes and quality of life in affected patients. Full article

The increasing pressure for environmental, social, and governance (ESG) accountability in publicly funded institutions has raised concerns about the authenticity and efficiency of ESG implementation. This study investigates the relationship between public ESG funding, disclosure quality, and organizational efficiency across Greek public and financial entities. Using a mixed-methods approach—data envelopment analysis (DEA), qualitative ESG content scoring, and bibliometric mapping—we reveal that symbolic compliance remains prevalent, often decoupled from actual sustainability outcomes. Our DEA findings show that technical efficiency is strongly associated with reporting clarity, the use of verifiable metrics, and governance integration, rather than the mere volume of funding. The qualitative analysis further confirms that many disclosures reflect reputational signaling rather than impact-oriented transparency. Bibliometric results highlight a systemic underrepresentation of the public sector in ESG scholarship, particularly in Southern Europe, underscoring the need for regionally grounded empirical studies. This study provides practical implications for improving ESG accountability in publicly funded institutions and contributes a novel approach that integrates efficiency, content, and bibliometric analysis in the ESG context. Full article

Background: While timely blood transfusion is critical for restoring oxygen-carrying capacity after coronary artery bypass grafting (CABG), allogeneic blood product transfusions are independently associated with increased long-term mortality, necessitating a risk-stratified approach to balance oxygen delivery against immunological complications and infection risks. Methods: We retrospectively analyzed 3376 patients undergoing isolated CABG between 2005 and 2023 at a single tertiary center. Patients who died during their perioperative hospital stay within 30 days were excluded. Transfusion burden was assessed both as the absolute number of blood product units (packed red blood cells, platelet transfusion, fresh frozen plasma) and as a percentage of calculated patient blood volume. The primary outcome was all-cause mortality at 5 years. Flexible Cox regression with penalized smoothing splines, adjusted for EuroSCORE II, was used to model dose–response relationships. Results: From our cohort of 3376 patients, a total of 137 patients (4.05%) received >10 units of packed red blood cells (PRBC) perioperatively. These patients were older (median 71 vs. 68 years, p < 0.001), more often female (29% vs. 15%, p < 0.001), and had higher preoperative risk (EuroSCORE II: 2.53 vs. 1.41, p < 0.001). After 5 years, mortality was 42% in the massive transfusion group versus 10% in controls. Spline regression revealed an exponential increase in mortality with transfused units: 14 units yielded a 1.5-fold higher hazard of death (HR 1.46, 95% CI 1.31–1.64), rising to HR 2.71 (95% CI 2.12–3.47) at 30 units. When transfusion was indexed to blood volume, this relationship became linear and more tightly correlated with mortality, with lower maximum hazard ratios and narrower confidence intervals. Conclusions: Indexing transfusion burden to the percentage of patient blood volume replaced provides a more accurate and clinically actionable predictor of 5-year mortality after CABG than absolute unit counts. Our findings support a shift toward individualized, volume-based transfusion strategies to optimize patient outcomes and resource stewardship in a time of limited availability of blood products. Full article

Objectives: To employ artificial intelligence (AI) to automatically measure bone mineral density (BMD) and intramuscular fat in computed tomography (CT) images of patients with fractures and explore the association between these parameters and fracture healing. Methods: This retrospective study included patients who underwent baseline CT scans for rib fracture diagnosis and follow-up CT scans for fracture healing assessment at our hospital between 2012 and 2023. The volumetric BMD of the entire first lumbar vertebra (L1) and the paraspinal intramuscular fat area (PIFA) at the midsection of L1 in the baseline CT were extracted using AI. The primary outcomes, including callus formation, volume increase, and poor healing, and logistic regression were used to analyze the relationships between BMD and PIFA with primary outcomes. Results: Overall, 297 fractures from 53 patients (24 males; mean age: 53.83 ± 10.86 years) were included in this study. In multivariate regression analysis, a 1 standard deviation (SD) decrease in BMD was identified as an independent prognostic factor for reduced callus formation (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.50–0.97), diminished volume increase (OR = 0.70, 95% CI = 0.51–0.96), and elevated poor fracture healing at follow-up (OR = 2.08, 95% CI = 1.38–3.13). Similarly, a 1 SD increase in PIFA was an independent prognostic factor for reduced callus formation (OR = 0.24, 95% CI = 0.16–0.37), diminished volume increase (OR = 0.33, 95% CI = 0.23–0.49), and elevated poor fracture healing at follow-up (OR = 2.09, 95% CI = 1.50–2.93). Therefore, a model combining BMD, PIFA, and clinical characteristics significantly outperformed a model that included only clinical characteristics in predicting callus formation, volume increase, and poor fracture healing, with areas under the curve of 0.790, 0.749, and 0.701, respectively (all p < 0.001). Conclusions: BMD and PIFA can be used as early predictors of fracture healing outcomes and can help clinicians select appropriate interventions to prevent poor healing. Full article

The management of end-stage kidney disease (ESKD) poses a substantial clinical and economic challenge, characterized by a growing patient burden, rising healthcare costs, and persistent unmet needs to enhance survival outcomes and quality of life. Background/Objectives: Conventional high-flux hemodialysis (HD) remains the dominant form of renal replacement therapy for ESKD but is still associated with substantial morbidity and mortality. High-volume post-dilution online hemodiafiltration (HVHDF) offers a promising alternative by enhancing the convective removal of uremic toxins. Methods: We conducted a narrative review of randomized controlled trials, meta-analyses, real-world cohort studies, and registry analyses published between 2010 and 2024. Evidence was categorized into short-term, medium-term, and long-term outcomes, including hemodynamic stability, inflammation, anemia, infection risk, cardiovascular events, cognitive decline, quality of life, and survival. Results: HVHDF improves short-term outcomes by enhancing toxin clearance, stabilizing blood pressure, reducing inflammation and oxidative stress, and improving anemia management. Medium-term benefits include improved nutritional status, reduced hospitalizations related to infections, and improved neurological and immune function. Long-term data from major trials (e.g., ESHOL, CONVINCE) and large real-world studies show consistent reductions in all-cause and cardiovascular mortality, particularly with convection volumes ≥ 23 L/session. A clear dose–response relationship supports the clinical relevance of convection volume targets. HVHDF has also shown benefits in preserving cognitive function and enhancing health-related quality of life. Conclusions: Strong and converging evidence supports HVHDF as a superior dialysis modality. Given its survival benefits, better tolerance, and broader impact on patient outcomes, HVHDF should be considered the new standard of care in dialysis, especially in light of the recent regulatory approval of the machine that provides the ability to perform HDF in the United States. Full article

Background and Objectives: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with diverse subtypes. Recent evidence has suggested a link between vitamin D deficiency and IBS; however, the associations between vitamin D levels, IBS subtypes, and hematological–biochemical parameters remain unclear. The aim of this research was to investigate the associations between vitamin D status, IBS subtypes, and sex, along with their relationships with biochemical and hematological parameters. Materials and Methods: This retrospective study included 240 patients diagnosed with IBS according to the Rome IV criteria at Van Yüzüncü Yıl University Medical Faculty Hospital. The patients were classified as diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or mixed-type (IBS-M). The patients’ serum vitamin D levels and hematological (hemoglobin, white blood cell and platelet counts, and mean corpuscular volume) and biochemical (ferritin, iron, calcium, magnesium, and vitamin B12 levels) parameters were evaluated at baseline and after vitamin D supplementation. Sex-related differences were assessed. Results: Baseline vitamin D levels were low in all IBS subtypes, with no significant differences between the groups. Vitamin D supplementation resulted in a significant increase in serum vitamin D levels across all subtypes (p = 0.001). No significant correlations were identified between vitamin D levels and hematological or biochemical parameters. Sex differences in vitamin D levels were only significant in the IBS-M group, both at baseline and post-treatment (p < 0.05). Conclusions: Vitamin D deficiency is prevalent among all IBS subtypes and significantly improves with supplementation, independently of the subtype. Although no associations were found between vitamin D levels and laboratory parameters, the observed sex differences in patients with IBS-M highlight the need for further research into potential sex-related pathophysiological mechanisms. These findings support the integration of routine vitamin D assessment and supplementation into the clinical management of IBS, especially in patients with the IBS-M subtype and female sex, to potentially improve patient outcomes. Full article

Background/Objectives: Isocitrate dehydrogenase (IDH) mutations are hallmark features in subsets of gliomas, producing the oncometabolite D-2-hydroxyglutarate (2HG). Although IDH mutations are associated with better clinical outcomes, their relationship with tumor progression is complex. This study aimed to investigate, in vitro and in vivo, the phenotypic consequences of IDH mutation and 2HG exposure in glioblastoma (GBM) under normoxic and hypoxic conditions and under temozolomide (TMZ) and radiation exposure. Methods: Experiments were conducted using IDH-wildtype (IDH-wt) and IDH-mutant (IDH-mut) glioma cell lines under controlled oxygen conditions. Functional assays included cell viability, cell cycle analysis, apoptosis profiling, migration, and surface marker expression via flow cytometry. Orthotopic xenografts were established in immunocompromised mice to assess in vivo tumor growth and morphology, followed by MRI and histological analysis. Treatments included TMZ, radiation, and 2HG at varying concentrations. Statistical analyses were performed using SPSS and RStudio. Results:IDH-wt cells exhibited faster proliferation and greater adaptability under hypoxia, while IDH-mut cells showed cell cycle arrest and limited growth. 2HG recapitulated IDH-mut features in IDH-wt cells, including increased apoptosis under TMZ, reduced proliferation, and altered CD24/CD44 expression. In vivo, IDH-wt tumors were larger and more infiltrative, while 2HG administration reduced tumor volume and promoted compact morphology. Notably, migration was initially similar across genotypes but increased in IDH-mut and 2HG-treated IDH-wt cells over time, though suppressed under therapeutic stress. Conclusions: IDH mutation and 2HG modulate glioma cell biology, including cell cycle dynamics, proliferation rates, migration, and apoptosis. While the IDH mutation and its metabolic product confer initial growth advantages, they enhance treatment sensitivity and reduce invasiveness, highlighting potential vulnerabilities for targeted therapy. Full article

The impact of urbanization on the agricultural economy has long attracted scholarly attention. Taking China as a case, this study investigates the relationship between urbanization and agricultural development under the dual progress of urbanization and the rural revitalization strategy. Based on panel data from 31 mainland provinces, this paper measures agricultural economic efficiency using the global slack-based measure (SBM) model and employs quantile regression to systematically analyze the influence of various urbanization factors across different levels of agricultural efficiency. A Tobit regression model is further adopted for robustness checks. The results show that representative urbanization factors, such as the proportion of urban population and the prevalence of higher education, exert significant negative impacts on agricultural efficiency, particularly in regions with higher efficiency levels. Freight volume has a significantly negative effect in regions with medium and low efficiency, while freight turnover negatively impacts medium- to high-efficiency areas. In contrast, improvements in healthcare services and digital infrastructure are found to consistently enhance agricultural efficiency. Although the corporatization of agriculture is often regarded as a key outcome of urbanization, its efficiency-improving effect is not statistically significant in most models and is mainly concentrated in high-efficiency regions. Overall, the improvement in China’s agricultural economic efficiency relies more on direct support from the rural revitalization strategy, while rapid urbanization has failed to bring substantial benefits and has even led to structural negative effects. These adverse outcomes may stem from the rapid occupation of suburban farmland, increased logistics costs due to the relocation of agricultural activities, and the ineffective absorption of surplus rural labor. This study highlights the need for future urbanization policies in China to pay greater attention to the coordinated development of the agricultural economy. The methods and findings of this research also provide reference value for other developing regions facing similar urbanization-agriculture dynamics. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by systemic manifestations, including altered body composition, reduced quality of life, and psychological distress. Despite its significance, the relationship between body composition parameters and symptoms of fatigue, anxiety, and depression in patients with COPD remains underexplored. This study aimed to examine the association between detailed body composition metrics and quality of life, fatigue, and anxiety and depression symptoms in male patients with COPD compared to healthy controls. Methods: This cross-sectional study included 49 men with COPD and 51 age-matched healthy controls aged 50–80 years. Body composition was assessed using bioelectrical impedance analysis (BIA). Pulmonary function, dyspnea, activities of daily living, and psychological status were evaluated using spirometry, the Medical Research Council Dyspnea Scale, the London Chest Activity of Daily Living Scale (LCADL), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Compared to the controls, patients with COPD exhibited significantly lower forced expiratory volume in one second (FEV₁: 1.1 vs. 2.16 L; p < 0.001), lower fat mass (15.0 vs. 24.3 kg; p < 0.001), and higher muscle mass (53.8 vs. 42.0 kg; p < 0.001). They also reported significantly greater fatigue (Borg scale: 4 vs. 0; p < 0.001), higher anxiety (8 vs. 5; p = 0.006), and depression scores (11 vs. 5; p < 0.001), along with more pronounced limitations in their daily activities. Conclusions: COPD is associated with profound impairments in body composition, physical function, and mental health. Detailed body composition analysis using BIA provides valuable clinical insights and may aid in tailoring individualized interventions to improve quality of life and psychological outcomes in COPD management. Full article

Background: Matrix metalloproteinase 9 (MMP9) has recently emerged as a risk predictor in patients with cardiovascular diseases (CVD). However, little is known regarding the significance of elevated plasma MMP9 levels in patients during the long-term period following myocardial revascularisation. We aimed to investigate the role of MMP9 in relation to myocardial status before and after myocardial revascularisation and to assess its long-term prognostic value. Methods: This prospective observational study included 200 male patients with ischaemic heart disease. All patients underwent direct myocardial revascularisation on a beating heart (off-pump surgery). Plasma MMP9 levels were analysed preoperatively, at 48 h postoperatively, and during the long-term follow-up period (one year postoperatively). Key echocardiographic parameters, specifically left ventricular ejection fraction (LVEF) and Left Ventricular End-Diastolic Volume (LVEDV), were also assessed. Results: MMP9 levels decreased significantly at 48 h postoperatively (p < 0.0001). During the long-term postoperative period, a clear relationship was demonstrated: higher 1-year MMP9 levels were associated with lower 1-year LVEF, whilst lower 1-year MMP9 levels were associated with higher 1-year LVEF. No significant correlation was observed between preoperative MMP9 levels and age or most other baseline laboratory parameters. Conclusions: Our study established an association between 1-year postoperative MMP9 levels and key parameters of left ventricular function during the long-term follow-up period. This suggests that MMP9 may serve as a novel biomarker for predicting outcomes following myocardial revascularisation. Full article

Background: Orbital floor blowout fractures (OFBF) can have serious consequences for the patient. Selecting the right treatment method and materials is essential. Krenkel’s maxillary sinus implant has been used successfully for more than 40 years in clinical practice. The aim of this study was to evaluate the long-term outcome of this implant compared to polydioxanone (PDS) sheets. Material and methods: This retrospective study examined a cohort of 82 OFBF patients over a seven-year period. Clinical and geometric data were collected. Defect size, location, and the volume of the herniated tissue were measured from conventional computer tomography (CT) or cone beam computer tomography (CBCT) scans. The relationship between ophthalmologic rehabilitation and treatment modality was analyzed using logistic regression. Results: The study included 82 patients, 28% female and 72% male, with a median age of 45.2 years. Defect size and hernia volume correlated with preoperative ophthalmological symptoms. At follow-up, 14.8% in the implant group and 28.6% in the PDS group showed mild visual impairment, with no severe diplopia. Conclusions: Our results suggest this method is a reliable and effective solution for repairing OFBFs and ophthalmologic rehabilitation. However, further research in a clinical controlled trial is needed. Full article

In today’s fast-paced technological environment, spotting emerging trends and anticipating future developments are important tasks in strategic planning and business decision-making. However, the volume and complexity of unstructured data containing relevant information make it very difficult for humans to effectively monitor, analyze, and identify inflection points by themselves. In this paper, we aim to prove the potential of integrating large language models (LLMs) with a novel finite state chain machine (FSCM) with output and graph databases to extract insights from unstructured data, specifically from earnings call transcripts of 40 top Technology Sector companies. The FSCM provides a modular, state-based approach for processing texts, enabling entity and relationship recognition. The extracted information is stored in a knowledge graph, further enabling semantic search and entity clustering. By leveraging this approach, we identified over 20,000 hidden (overlapping) trends and topics across various types. Our experiment on real-world datasets confirms the scalability and effectiveness of the method in extracting valuable knowledge from large datasets. The present work contributes to the field of Natural Language Processing (NLP) by showcasing the proposed method in addressing real-world business problems. The findings shed new light on current trends and challenges faced by tech companies, highlighting the potential for further integration with other NLP methods, leading to more robust and effective outcomes. Full article

Background/Objectives: Pheochromocytomas and paragangliomas (PPGLs) are rare tumors of neural crest origin that secrete varying levels of catecholamines. [¹⁸F]Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a valuable tool for the detection of metastases and the prediction of prognoses. However, varying FDG avidities in PPGLs raise concerns regarding cost-effectiveness and unnecessary radiation exposure. Catecholamine secretion patterns are associated with metastasis and clinical outcomes. This study aimed to explore the relationships among FDG avidity, catecholamine levels, and clinical factors in patients with PPGLs. Methods: This retrospective study included 25 patients with unresectable or metastatic PPGLs scheduled for [¹³¹I]metaiodobenzylguanidine therapy with FDG-PET data available within 40 days of urine catecholamine measurements. FDG avidity was assessed using semiquantitative parameters such as the maximum standardized uptake value (SUVmax), total metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Urine catecholamine levels were quantified. Logistic regression and Spearman’s correlation were performed to evaluate the relationship between FDG parameters and urinary catecholamine levels. Results: Urinary noradrenaline levels were significantly higher in patients with FDG-avid lesions than in those without (726.25 μg/day vs. 166.3 μg/day, p = 0.001). Noradrenaline levels showed significant positive correlations with SUVmax, MTV, and TLG (ρ = 0.527, 0.541, and 0.557, respectively; all p < 0.01). Urinary noradrenaline levels predicted FDG avidity with an AUC of 0.849; a cutoff value of 647.5 μg/day achieved 55.6% sensitivity and 100% specificity. Conclusions: Urinary noradrenaline levels were significantly associated with FDG avidity in PPGLs, suggesting their potential utility in predicting FDG-PET outcomes. Therefore, FDG-PET may be unnecessary in PPGL patients with low urinary noradrenaline levels. These findings may help optimize imaging strategies for patients with PPGLs. Full article

Mechanical ventilation, a lifesaving intervention for critically ill patients, can also cause ventilator-induced lung injury (VILI), which is related to its interplay with immune system. To explore this relationship, we established a model consisting of two subsystems: a lung immune response system (LIRS), elucidating the interactions between immune cells and epithelial cells within the pulmonary environment, and a tidal volume damage system (TVDS), quantifying alveolar epithelial damage by simulating the detrimental effects of mechanical ventilation across varying tidal volumes. The integrated framework presents a novel lens for examining the interplay between heterogeneous immunological capabilities and tidal volume. The model reveals distinct responses among the individuals with varying immune capacities when subjected to identical tidal volumes, manifesting in diverse outcomes for healthy epithelial cells (eh). Analysis of simulation results shows a weak correlation between initial immune cell variables and eh, and a stronger correlation between eh and baseline repair capacity. Furthermore, while the initial immune state of lung tissue moderately influences epithelial health, the heterogeneous and inherent immunological competence of the tissue plays a pivotal role in shaping the diverse patterns observed in the development and severity of VILI. This insight highlights the importance of tailoring therapeutic strategies to individual immunological profiles, thereby optimizing patient outcomes. Full article

Since its inception in 1987, in vitro fertilization (IVF) has constituted a significant medical achievement in the field of fertility treatment, offering a viable solution to the challenge of infertility. The continuous evolution of assisted reproductive technology (ART) has brought its relationship with the rapidly developing field of artificial intelligence (AI), in particular with techniques such as machine learning (ML), a rapidly evolving area of specialization. In fact, it is responsible for significant developments in the field of precision medicine, as well as in preventive and predictive medicine. The analysis focuses on a large volume of clinical data and patient characteristics of those who underwent assisted reproduction treatments. Concurrently, the utilization of machine learning algorithms has facilitated the development and implementation of predictive models. The objective is to predict the success of treatments for external fertilization based on processed clinical data. This study encompasses statistical analysis techniques and artificial intelligence algorithms for the correlation of variables, such as patient characteristics, the history of pregnancies, and the clinical and embryological parameters. The analysis and creation of prognostic models were compared with the objective of identifying factors that influence the outcome of IVF treatments. The potential for implementing a predictive model in routine clinical practice was also investigated. The findings revealed trends and factors that warrant attention. Such findings may prompt questions regarding the impact of the patient’s age on treatment efficacy. Moreover, the value of developing a predictive model based entirely on patient data prior to the commencement of treatment was also investigated. This approach to the processing and utilization of clinical data demonstrates the potential for optimization and documentation of therapeutic procedures. The objective is to reduce costs and the emotional burden while increasing the success rate of IVF treatments. Full article