Search Results (45,140)

Background/Objectives: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. Methods: This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). Results: The median age was 63.5 years (IQR: 57–68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age (p = 0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with p-values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, four patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. Conclusions: ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations. Full article

Skull base tumors such as meningiomas and schwannomas are often pathologically benign. However, surgery for these tumors poses significant challenges because of their proximity to critical structures such as the brainstem, cerebral arteries, veins, and cranial nerves. These structures are compressed or encased by the tumor as they grow, increasing the risk of unintended injury to these structures, which can potentially lead to severe neurological deficits. Preoperative imaging is crucial for assessing the tumor size, location, and its relationship with adjacent vital structures. This study reviews advanced imaging techniques that allow detailed visualization of vascular structures and cranial nerves. Contrast-enhanced computed tomography and digital subtraction angiography are optimal for evaluating vascular structures, whereas magnetic resonance imaging (MRI) with high-resolution T2-weighted images and diffusion tensor imaging are optimal for evaluating cranial nerves. These methods help surgeons plan tumor resection strategies, including surgical approaches, more precisely. An accurate preoperative assessment can contribute to safe tumor resection and preserve neurological function. Additionally, we report the MRI contrast defect sign in skull base meningiomas, which suggests cranial nerve penetration through the tumor. This is an essential finding for inferring the course of cranial nerves completely encased within the tumor. These preoperative imaging techniques have the potential to improve the outcomes of patients with skull base tumors. Furthermore, this study highlights the importance of multimodal imaging approaches and discusses future directions for imaging technology that could further develop preoperative surgical simulations and improve the quality of complex skull base tumor surgeries. Full article

Background: Esophageal cancer is a major public health issue, yet risk factors for its occurrence are still insufficiently known. This study aimed to estimate the global burden of esophageal cancer and its risk factors. Methods: This ecological study presented the incidence, mortality, and Disability-Adjusted Life Years (DALYs) of esophageal cancer in the world. This study collected the Global Burden of Disease study data from 1990 to 2019. Trends in esophageal cancer burden were assessed using the joinpoint regression analysis and calculating the average annual percent change (AAPC). Results: Globally, in 2019, in both sexes and all ages, the ASR for the incidence of esophageal cancer was 6.5 per 100,000 and for mortality, 6.1 per 100,000. The global proportion of DALYs for esophageal cancer attributable to selected behavioral, metabolic, and dietary risk factors was similar in males and females: chewing tobacco (3.8% vs. 5.1%), diet low in fruits (10.1% vs. 12.6%), diet low in vegetables (3.3% vs. 4.6%), and high body mass index (18.8% vs. 19.3%). However, the proportion of DALYs for esophageal cancer attributable to smoking and alcohol use was 4–5 times higher in males than in females (50.1% vs. 11.3%, and 29.6% vs. 5.1%, respectively). From 1990 to 2019, a significant decrease in global trends in rates of DALYs for esophageal cancer attributable to smoking (AAPC = −1.6%), chewing tobacco (AAPC = −0.5%), alcohol use (AAPC = −1.0%), a diet low in fruits (AAPC = −3.1%), and a diet low in vegetables (AAPC = −3.6%) was observed, while a significant increase in trends was observed in DALYs rates for esophageal cancer attributable to a high body mass index (AAPC = +0.4%). Conclusions: More epidemiological research is needed to elucidate the relationship between esophageal cancer and certain risk factors and guide prevention efforts. Full article

Training wheelchair skills are vital for enhancing independence and safety. Traditional training methods require significant time and resources, limiting accessibility. Virtual reality (VR) offers an innovative solution by simulating real-life environments for training, reducing risks and costs. However, the effectiveness of VR in complementing real-life training remains underexplored. This review investigates how VR can complement traditional wheelchair training by assessing the strengths and limitations of existing VR systems. A literature review of 28 studies on VR applications for wheelchair training from 2017 to 2024 was conducted, focusing on studies that detailed VR environments and training programs. It was found that most VR systems were designed for powered wheelchair users with joystick navigation. VR environments included tasks from basic navigation to complex real-world scenarios. While VR showed potential in improving skills and engagement, challenges included the lack of standard methods for evaluating effectiveness and cybersickness. Overall, VR can be a valuable complementary tool for wheelchair training, especially for powered users. Future research should standardise protocols, and address side effects. Full article

The objective of this work is to develop a qualitative new approach to assessing business and company value. For this purpose, two of the three income approach methods, CAPM and WACC, are modified. When modifying CAPM, a new model, CAPM 2.0, was created, within which business and financial risks were simultaneously taken into account. Moreover, for the first time, this was performed correctly and the inaccuracy, incorrectness and inconsistency of the popular Hamada model were shown. The developed approach corrects some of the shortcomings of the income approach. The new methodology significantly improves the accuracy of the assessment. The closeness of the results of the new methodology to the actual market value of Amazon company (AMZN) shows the importance and validity of this methodology, which should be used to evaluate the business and the value of the company. Full article

Climate change is leading modern society to seek innovative solutions for sustainable development and a zero-carbon economy. Nevertheless, new technologies strongly rely on precious raw materials and might suffer from supply chain risks. The European Union has identified a set of raw materials deemed to be critical or strategic because they appear essential for energy transition technologies. Consequently, long-term energy system planning must factor in the availability of these critical raw materials when selecting specific technologies, as their supply could be affected by global policies or conflicts. This paper provides a literature review on the assessment of critical raw materials in energy technologies comparing the main approaches on critical raw materials content assessment in technologies, long-term planning studies considering critical raw materials, and the development of indicators for critical raw materials content in energy technologies. The main findings of this review suggest that existing reliable databases with the bill of materials, such as life cycle inventories, should be exploited and that proper indicators to rank the criticality of materials and the importance of a specific technology should be developed. These findings are discussed and organized proposing a method for the optimal planning of an energy technologies mix in regional or national energy systems considering the availability and future supply of critical raw materials. Full article

Background/Objectives: The MTHFR^677C>T gene variant results in a thermolabile MTHFR enzyme associated with elevated plasma homocysteine in TT individuals. Health risks associated with the TT genotype may be modified by dietary and supplemental folate intake. Supplementation with methyltetrahydrofolate (methylTHF) may be preferable to folic acid because it is the MTHFR product, and does not require reduction by DHFR to enter one-carbon folate metabolism. In the Mthfr^677C>T mouse model for this variant, female 677TT (TT) mice have an increased incidence of hepatic steatosis. The objective of this study was to compare the effects of methylTHF and folic acid supplementation on hepatic steatosis and one-carbon metabolism in this model. Methods: Male and female C57BL/6J 677CC (CC) and TT mice were fed control (CD), 5xmethylTHF-supplemented (MFSD), or 5xfolic-acid-supplemented (FASD) diets for 4 months. Liver sections were assessed for steatosis by Oil Red O staining. One-carbon metabolites were measured in the liver and plasma. MTHFR protein expression was evaluated in the liver. Results: MFSD had no significant effect on plasma homocysteine, liver SAM/SAH ratios, or hepatic steatosis in males or females as compared to CD. MTHFR protein increased in MFSD TT female liver, but remained <50% of the CC. FASD had no effect on plasma homocysteine but it decreased the liver MTHFR protein and SAM/SAH ratios, and increased hepatic steatosis in CC females. Conclusions; MethylTHF and folic acid supplementation had limited benefits for TT mice, while folic acid supplementation had negative effects on CC females. Further investigation is required to determine if these effects are relevant in humans. Full article

Objective: Postoperative nausea and vomiting (PONV) was one of the common complications in patients with HCC who had undergone TACE. This study was a prospective analysis of patient data to investigate risk factors for PONV in patients after TACE. Material and Methods: Data were collected from 212 patients undergoing TACE in the interventional department between August 2022 and August 2023. Including: gender, age, education, BMI, operation time, concomitant underlying diseases and drugs, preoperative limosis, history of nausea and vomiting, history of kinetosis, history of smoking or drinking, and occurrence of PONV. A visual analog scale was used to measured pain. Neuropsychological status was also assessed, using the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the Patient Health Questionnaire-9(PHQ-9). To identify risk factors for PONV, multiple logistic regression analysis was used. The receiver operating characteristic (ROC) curve was plotted to assess the regression model. The clinical trial number did not apply in the study. Results: In this study, 212 out of a total of 904 patients with HCC undergoing TACE during their hospital stay were included for analysis. Among the included patients, the incidence of PONV was as high as 42% (89/212). Multiple logistic regression analysis showed that chronic gastritis (odds ratio [OR] = 10.350; p = 0.020), VAS (OR = 3.835; p = 0.003), epirubicin (OR = 26.685; p < 0.001), and the dosage of lipiodol (≥5 mL) (OR = 1.385; p < 0.001) were independent risk factors of PONV after TACE. The ROC curve demonstrated that the AUC was 0.902, the sensitivity was 84.3%, and the specificity was 87%. Conclusions: PONV is highly prevalent among patients with HCC after TACE. Chronic gastritis, pain, epirubicin, and the dosage of lipiodol were independent risk factors for PONV. The risk prediction model that was constructed according to the aforementioned factors demonstrated good discriminatory capacity for predicting the risk of post-TACE PONV, which can improve the recognition of medical providers, and has a good ability to prevent and treat nausea and vomiting. Full article

Abstract: Currently, land drought events have become a frequent and serious global disaster. How to address these droughts has become a major issue for researchers. Traditional response strategies for land drought events have been determined by experts based on the severity levels of the events. However, these methods do not account for temporal variations or the specific risks of different areas. As a result, they overlooked the importance of spatio-temporal multi-scale strategies. This research proposes a multi-scale response strategy recommendation model for land drought events. The model integrates characteristics of drought-causing factors, disaster-prone environments, and hazard-bearing bodies using case-based reasoning (CBR). Additionally, the analytic hierarchy process (AHP) and entropy weighting methods (EWMs) are introduced to assign weights to the feature attributes. A case retrieval algorithm is developed based on the similarity of these attributes and the structural similarities of drought cases. The research further classifies emergency strategies into long-term and short-term approaches. Each approach has a corresponding correction algorithm. For short-term strategies, a correction algorithm based on differential evolutions is applied. For long-term strategies, a correction algorithm based on drought risk assessment is developed. The algorithm considers factors such as drought risk, vulnerability, and exposure. It facilitates multi-scale decision-making for drought events. The candidate case obtained using the correction algorithm shows an overall attribute similarity of 94.7% with the real case. The emergency response levels match between the two cases. However, the funding required in the candidate case is CNY 327 million less than the actual expenditure. Full article

Amidst severe ecological challenges and resource constraints, realizing the value of ecological products—such as timber, non-timber forest products, and ecosystem services like carbon sequestration and biodiversity conservation—has emerged as an innovative approach within the realm of paying for ecosystem services. This study examines 35 cases of ecological product value realization in China, using a comprehensive analytical framework encompassing policy support, market participation, and resource endowment utilization. Utilizing a qualitative comparative analysis method (cs-QCA), the study explores the driving mechanisms behind ecological product value realization. These findings indicate that policy guidance and planning are indispensable for realizing ecological product value. Additional factors, such as fiscal and financial support, leadership from pioneering enterprises, product innovation and promotion, and the utilization of both natural and human resources, play varying roles across different grouping paths to varying degrees. The study uncovers the following three typical driving mechanisms: government-led; government–market hybrid; and integrated type. The study reveals that each region should choose an appropriate path based on its unique conditions. This research significantly enhances the theoretical understanding of ecological product value realization and provides a scientific foundation for policy formulation and practical applications. Full article

This paper explores the essential role of pre-pregnancy counselling for women with rheumatoid arthritis (RA), focusing on minimising risks and optimising pregnancy outcomes. RA, a prevalent inflammatory arthritis with onset during childbearing years, necessitates targeted preconception counselling to manage disease activity and comorbidities effectively. The counselling ensures medication compatibility and planning around disease flares, and it involves a multidisciplinary team comprising rheumatologists, obstetricians, and other specialists to develop individualised care plans. This literature review highlights the challenges women with RA face, including prolonged time to pregnancy, increased risks during pregnancy, such as hypertension and preeclampsia, and potential fertility issues related to medication and disease activity. Emphasis is placed on the importance of assessing autoantibody presence and managing specific joint involvements that may affect anaesthetic procedures during pregnancy. This paper underscores the importance of timing conception during periods of low disease activity and adopting a “Treat-to-Target” approach using acceptable medications to maintain disease remission. This study calls for routine family planning discussions and preconception evaluations to address reproductive health and treatment plans, thereby supporting women with RA in achieving favourable pregnancy outcomes comparable to the general population. The multidisciplinary approach and regular counselling are critical to navigating the complexities of RA and pregnancy successfully. Full article

Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p < 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations. Full article

Background/Objectives: Vitamin K deficiency in chronic kidney disease (CKD) could potentially occur due to multiple factors, leading to an increased risk of vascular and valvular calcifications. Vitamin K status can be indirectly assessed by measuring the blood levels of vitamin K-dependent proteins (VKDPs), such as matrix GLA protein (MGP). This study aims to examine the relationship between the levels of inactive MGP (dp-uc MGP) and the presence of valvular calcifications, as well as its association with mortality in hemodialysis patients. Methods: We conducted a single-center study that included 45 CKD G5D patients (hemodialysis for 6 months to 10 years) followed up for 24 months. All patients have been assessed at baseline regarding cardiovascular disease (medical history, echocardiography). Moreover, using standard methods, we determined blood biochemistry, complete blood count, and matrix GLA protein. At 24 months of follow-up, we assessed all-cause mortality and cardiovascular mortality. Results: In the studied hemodialysis patients, mean dp-uc MGP was 3285.93 +/− 2092.85 pmol/L. Patients with valvular calcifications had higher levels of dp-uc MGP compared to those without (4521.08 +/− 2263.82 vs. 2487.53 +/− 1446.94 pmol/L, however not statistically significant). The presence and severity of valvular calcifications were significantly associated with the history of treatment with vitamin K antagonists (p < 0.05). After 24 months of follow-up, we found an all-cause mortality rate of 24.4%. The level of dp-uc MGP was higher in the group of patients that died (3884.81 +/− 2439.20 vs. 3133.09 +/− 1925.26 pmol/L, p > 0.05). Patients with more than one valvular calcification on echocardiography had a significantly higher all-cause mortality risk (p = 0.04). In terms of traditional risk factors, we observed an increased risk of all-cause mortality in patients with a history of diabetes mellitus (p = 0.02) and aortic stenosis (p = 0.01). However, other cardiovascular markers, such as coronary heart disease and ejection fraction < 50%, did not have a statistically significant impact on mortality in our patients. Conclusions: In our study, we found that vitamin K deficiency, measured indirectly using the level of VKDP, especially dp-uc MGP, is a predictor of valvular calcifications. Severe valvular calcifications, aortic stenosis, and the presence of diabetes mellitus are risk factors for all-cause mortality in hemodialysis patients. Full article

Flood events pose significant risks to infrastructure and populations worldwide, particularly in Punjab, Pakistan, where critical infrastructure must remain operational during adverse conditions. This study aims to predict flood-prone areas in Punjab and assess the vulnerability of critical infrastructures within these zones. We developed a robust Flood Susceptibility Model (FSM) utilizing the Maximum Likelihood Classification (MLC) model and Analytical Hierarchy Process (AHP) incorporating 11 flood-influencing factors, including “Topographic Wetness Index (TWI), elevation, slope, precipitation (rain, snow, hail, sleet), rainfall, distance to rivers and roads, soil type, drainage density, Land Use/Land Cover (LULC), and the Normalized Difference Vegetation Index (NDVI)”. The model, trained on a dataset of 850 training points, 70% for training and 30% for validation, achieved a high accuracy (AUC = 90%), highlighting the effectiveness of the chosen approach. The Flood Susceptibility Map (FSM) classified high- and very high-risk zones collectively covering approximately 61.77% of the study area, underscoring significant flood vulnerability across Punjab. The Sentinel-1A data with Vertical-Horizontal (VH) polarization was employed to delineate flood extents in the heavily impacted cities of Dera Ghazi Khan and Rajanpur. This study underscores the value of integrating Multi-Criteria Decision Analysis (MCDA), remote sensing, and Geographic Information Systems (GIS) for generating detailed flood susceptibility maps that are potentially applicable to other global flood-prone regions. Full article

Cardiovascular disease continues to be a major contributor to global morbidity and mortality, with environmental and occupational factors such as air pollution, noise, and shift work increasingly recognized as potential contributors. Using a two-sample Mendelian randomization (MR) approach, this study investigates the causal relationships of these risk factors with the risks of unstable angina (UA) and myocardial infarction (MI). Leveraging single nucleotide polymorphisms (SNPs) as genetic instruments, a comprehensive MR study was used to assess the causal influence of four major air pollutants (PM_2.5, PM₁₀, NO₂, and NO_x), noise, and shift work on unstable angina and myocardial infarction. Summary statistics were derived from large genome-wide association studies (GWASs) from the UK Biobank and the FinnGen consortium (Helsinki, Finland), with replication using an independent GWAS data source for myocardial infarction. The inverse-variance weighted (IVW) approach demonstrated a significant positive correlation between shift work and the increased risk of both unstable angina (OR with 95% CI: 1.62 [1.12–2.33], p = 0.010) and myocardial infarction (OR with 95% CI: 1.46 [1.00–2.14], p = 0.052). MR-PRESSO analysis identified outliers, and after correction, the association between shift work and myocardial infarction strengthened (OR with 95% CI: 1.58 [1.11–2.27], p = 0.017). No notable causal associations were identified for air pollution or noise with either outcome. The replication of myocardial infarction findings using independent data supported a possible causal link between shift work and myocardial infarction (OR with 95% CI: 1.41 [1.08–1.84], p = 0.012). These results provide novel evidence supporting shift work as a likely causal risk factor for unstable angina and myocardial infarction, underscoring the need for targeted public health strategies to mitigate its cardiovascular impact. However, further investigation is necessary to elucidate the role of air pollution and noise in cardiovascular outcomes. Full article