Search Results (14,364)

With global supply chains being reshaped and costs surging, China’s manufacturing sector faces mounting pressure to retain its position as the world’s largest manufacturing center. Meeting this challenge demands the full mobilization of digital factors, which has attracted increasing academic attention. However, limited research has examined how the effective integration of digital factors with traditional production factors can improve corporate performance. With data on Chinese manufacturing enterprises from the A-share market, this study employs a fixed effect model and a mediating effect model to analyze how the synergies between digital and traditional factors enhance corporate performance. Further, it illustrates the heterogeneous impacts across different types of enterprises. The results reveal three key findings. First, the synergies between digital and traditional factors significantly enhance corporate performance, with digital–capital synergy proving more effective than digital–labor synergy. Second, this synergy promotes performance improvement through three primary mechanisms: strengthening internal control quality, fostering business model innovation, and increasing product differentiation. Third, the performance effects of multi-factor synergies vary considerably across enterprise types, being more pronounced in non-state-owned enterprises, firms with strong digital attributes, and firms without political connections. Overall, this study offers valuable insights for manufacturing firms seeking a competitive edge in high-end and intelligent manufacturing within an increasingly globalized competitive landscape. Full article

Background/Objectives: Emerging evidence suggests the critical role of diet in shaping mental health outcomes, which are increasingly prevalent among children and adolescents worldwide. This study aims to investigate whether the dietary habits of children in the Italian multicenter Piccolipiù birth cohort at four years of age were associated with anxiety and depression symptoms. This analysis was conducted within the framework of the Global burden of disease Lifestyle And mental Disorder (GLAD) Project (DERR2-10.2196/65576). Methods: Data from 1726 children were analyzed. Emotional symptoms were assessed with the Child Behavior Checklist (CBCL), and diet was assessed using a food frequency questionnaire. Sociodemographic data, including per capita income, were also collected. Associations between food intake (grams per day) and clinical anxiety/depression (T-scores > 70) or total symptom scores were examined using univariate and multivariable logistic and robust linear regressions adjusted for sex and income. Results: In 1726 children (median age 4.4 years; 50% female), 3% exhibited clinical anxiety and 2% clinical depression. Higher grain intake was associated with increased odds of clinical anxiety (OR = 1.004; 95% CI: 1.001–1.007), while greater fish consumption reduced odds of clinical depression (OR = 0.946; 95% CI: 0.903–0.992). Vegetable intake was associated with lower anxiety and depression scores. Multivariable analyses confirmed that grain intake is positively associated with anxiety, while fish consumption is inversely associated with depression. Conclusions: Higher intake of vegetables, fruits, and fish may be associated with better emotional health in preschoolers, although effect sizes were modest. Early dietary interventions may offer a practical approach to improving children’s long-term mental health. Longitudinal studies are needed to confirm these associations and clarify underlying mechanisms. Full article

Background: Few data are available on the outcomes of patients with venous thromboembolism (VTE) on long-term reduced dose of direct oral anticoagulants (DOACs). We evaluated the effectiveness and safety of reduced dose of DOACs for the extended treatment of VTE. Methods: In this monocenter, ambispective cohort study, 140 patients receiving a reduced dose of DOACs for VTE were included. The primary outcomes were recurrent VTE, major bleeding and clinically relevant non-major bleeding. The secondary outcomes were arterial events and minor bleedings. The incidence of the primary outcomes was calculated. The rate for secondary outcomes was descriptively reported. Results: The mean age of the overall cohort was 72 years. Half of the patients were female, 51.4% had a persistent risk factor, 40.0% an unprovoked VTE, and 8.6% a minor transient risk factor. Most patients had lower extremity deep vein thrombosis with or without pulmonary embolism (55.0%) and received apixaban (73.6%) or rivaroxaban (14.3%) for a mean duration of 2.7 years. Regarding the primary outcomes, there was one recurrent VTE (0.7%), four major bleedings (2.9%) and two clinically relevant non-major bleedings (1.4%). Regarding the secondary outcomes, there were four acute ischemic strokes (2.9%) and two minor bleedings (1.4%). Conclusions: Reduced dose of DOACs was associated with a low rate of recurrent VTE and an acceptably low rate of bleeding complications. The rate of arterial events during follow-up suggests the need for an assessment of cardiovascular risk factors in this study population. Full article

Background: Today, in Western countries, patients with allo-antibodies to high-frequency antigens or with complex antibody mixtures represent one of the most significant challenges in transfusion medicine. Another important aspect is the prevention of allo-immunization of patients who lack high-frequency antigens. In these conditions, the availability of a bank of a rare red blood cell group, supported by a database of donors subjected to extensive erythrocyte typing (preferably using erythrogenomic study), can constitute a resource of great value. Materials and Methods: Repeat Caucasian blood donors of group A or O, with selected Rh phenotypes (CCDee, ccDEE, ccdee, ccDee), aged under 52 years, were considered for typing. Moreover, we selected all non-Caucasian repeat blood donors for typing. For extended phenotyping and genotyping we adopted commercial methods supplied by Grfols and Werfen, respectively. For cryopreservation, we selected a high glycerol method in −80 °C electric freezer; blood unit processing was performed using a Haemonetics ACP 215 automated cell processor with close circuit devices. Results: We considered the five patients as follows: PA was massively transfused for a road trauma, developed multiple allo-antibodies (anti-D, anti-k), and required compatible blood units for an elective cardiac surgery; PB was a pregnant woman with anti-Coa (a high frequency antigen) monitored during pregnancy and in which it was necessary to proceed with the transfusion of the newborn; PC was a poly-transfused patient with myelo dysplastic syndrome who developed multiple allo-antibodies (anti-k, anti-CW, anti-Lea) and required continuous supportive therapy, including the procurement of compatible units and the implementation of therapeutic actions in an attempt to reduce the transfusion requirement using luspatercept; PD was a patient with sickle cell disease. They had a Fy (null) genotype, making it very difficult to find compatible units; and PE was interesting for the complexity of the immunohematological and erythrogenomic study performed to characterize a recipient with a rare phenotype and thus allow the transfusion of compatible units, preventing allo-immunization. Discussion: In this report, we have maintained a narrative approach. Starting with five patients representing as many clinical situations as possible, we have illustrated the approach followed for the immune-hematological study and the choices made to try to guarantee effective and safe transfusion therapy. Full article

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or “real SCIWORA”), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating “real” SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children. Full article

The circadian rhythm controls the sleep/wake cycle and a wide variety of metabolic and physiological functions. Clock genes regulate it in response to both external and endogenous stimuli, and their expression may change because of aging, leading to an increased risk of health problems. Despite the well-described benefits of physical exercise as a circadian synchronizer, there is a lack of literature regarding the role of chronic exercise intensity in clock gene expression during aging. This article aims to analyze the differential expression of genes that regulate the biological clock under the effects of variable-intensity aerobic swimming training in aging mice, determining whether these exercise regimens interfere with the genomic regulation of the circadian rhythm. For this purpose, the mice were exposed to low- and high-intensity exercise and had their heart and gastrocnemius tissues molecularly analyzed by cDNA synthesis and qPCR to determine the expression levels of the selected genes: Clock, Arntl, Per1, Per2, Cry1, Cry2, and Nr1d1. The results showed that low-intensity exercise, performed at workloads below the anaerobic threshold, significantly changed their expression in the gastrocnemius muscle (p < 0.05), while high-intensity exercise had no statistically significant effects (p > 0.05), with the heart being immune to exercise influence except when it comes to the Per1 gene, for which expression was increased (p = 0.031) by low-intensity exercise. Additionally, both body weight and lactate thresholds had no change during the experiment (p > 0.05), while the maximum supported workload was maintained for high-intensity exercise (p > 0.05) and increased for low-intensity exercise (p < 0.01), with the control group experiencing a decay instead (p < 0.05). Thus, the present study highlights the importance of chronic exercise in modulating clock genes and opens exciting possibilities for circadian medicine, such as improvements in exercise capacity, heart condition, and lipid metabolism for subjects of low-intensity regimens. Full article

This study aimed to evaluate mortar performance by substituting part of standard sand with recycled fine aggregates sourced from concrete waste, aiming to assess mechanical properties and durability. Moreover, this study examined the use of crystallizing agents to understand their impact on mortar properties. Four mortar series were prepared with sand substitution percentages ranging from 25% to 100% while adhering to the diverse fraction proportions within the standardized sand particle size distribution. Mechanical results indicate that incorporating recycled concrete sand significantly enhances mechanical properties with respect to standard sand. The study showed the technical feasibility of producing mortars with up to 100% recycled fine concrete aggregate with enhanced compressive strength, albeit requiring higher superplasticizer dosages. The addition of crystallizing agents provided an increase in flexural strength in specific conditions, while they did not provide a significant improvement to compressive strength. Full article

Background/Objectives: A disruption of eating habits is related to obesity and obesity-related complications (ORCs), including diabetes and cardiovascular disease. We previously described chrono-nutritional profiles considering the eating habits of patients with severe obesity during the 24 h cycle. Our present study aims to determine, first, whether belonging to a specific eating profile is associated with greater or lesser weight loss in patients with obesity who have undergone bariatric surgery, and second, whether chrono-nutritional profiles are associated with the remission of ORCs after surgery. We also investigated whether there were differences between the original baseline profile and the new profile derived from the 24 h recall on dietary patterns. Methods: The study included 75 patients with obesity who had undergone bariatric surgery and were followed up for a period of 36 ± 11 months. Data were collected from patients’ medical records and telephone interviews. R software (v4.4.0; R Core Team, 2024) was used. Results: Significant weight loss from baseline was observed at follow-up for all profiles (p < 0.0001); however, there were no significant differences in weight loss % among profiles. Using a linear regression model, Profile 3 (characterized by irregular eating patterns) demonstrated less weight loss at follow-up compared to other profiles (p = 0.0487). There was a significant remission of ORCs from baseline to follow-up, but there were no significant differences among profiles. Conclusions: Chrono-nutritional profiles may play a role in weight regulation in patients with severe obesity who are candidates for bariatric surgery. Further studies with a larger sample size are needed. Full article

The decarbonization and automation of port operations are emerging as key strategies to enhance the sustainability and efficiency of maritime logistics. This study proposes a simulation-based framework to assess the operational and environmental impacts of transitioning from traditional Internal Combustion Engine (ICE) tractors to Battery Electric Tractors (BET) and Automated Electric Guided Tractors (e-AGT) in Roll-on/Roll-off (Ro–Ro) port terminal operations. The proposed framework is applied to simulate a full vessel turnaround at the Ro–Ro terminal of the Port of Ravenna (Italy). A set of Key Performance Indicators (KPIs) is defined to evaluate turnaround time, vehicle productivity, energy consumption and CO₂ emissions across three scenarios. The results indicate that both BET and e-AGT configurations significantly reduce emissions compared to ICE, with reductions up to 40%. However, the e-AGT scenario reveals operational drawbacks, including increased unloading time and reduced fleet availability due to charging constraints and routing limitations. These findings highlight the environmental potential of automation and electrification but also emphasize the need for integrated planning of fleet size, charging infrastructure and circulation specifications. The proposed framework provides a replicable decision-support tool for port authorities and logistics operators to evaluate alternative handling technologies under realistic conditions. Full article

In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic therapy (TAT), and clopidogrel alone during the subsequent 6- to 12-month period of double antithrombotic therapy (DAT). Both direct and indirect data support the recommendation to avoid the more potent P2Y12 inhibitors—ticagrelor and prasugrel—as part of TAT, owing to the increased risk of bleeding. There is less and inconclusive data available regarding the safety and efficacy of DAT when ticagrelor or prasugrel are used instead of clopidogrel. Also, there is very limited evidence for the use of aspirin instead of clopidogrel in a DAT regimen. While acknowledging the safety and effectiveness of the recommended strategies above, it would, nonetheless, be valuable to have alternative options in the choice of antiplatelet agents. In case of very high thrombotic risk, especially when stents are positioned in potentially risky sites (such as the left main or last remaining vessel) a more potent P2Y12 inhibitor than clopidogrel may be warranted. Moreover, non-responsiveness to, or pharmacological interactions of, clopidogrel may hamper its efficacy. In this review, we aim at presenting and discussing the evidence supporting the current recommendations for the use of the various antiplatelet agents in AF patients on OAC undergoing PCI, as well as at giving a glimpse at future perspectives. Full article

Background: Atopic dermatitis (AD) in elderly patients presents unique clinical challenges due to comorbidities, polypharmacy, and an increased risk of adverse events. Janus kinase inhibitors (JAKis) have emerged as effective oral treatments, but limited data are available for their use in older adults. Methods: A narrative review was conducted through a comprehensive search of PubMed/MEDLINE, Ovid, Scopus, Embase, Cochrane Library, Web of Science, and Google Scholar up to July 2025. Only English-language studies evaluating abrocitinib, baricitinib, or upadacitinib in elderly patients (≥65 years) with moderate-to-severe AD were included. Results: RCTs enrolled few elderly patients and lacked dedicated subgroup analyses. Abrocitinib showed similar efficacy in older and younger adults, but higher rates of adverse events, especially at the 200 mg dose. Real-world studies, mainly on upadacitinib, demonstrated rapid and sustained clinical improvements, including in difficult-to-treat areas. Safety outcomes were generally favorable; most adverse events were mild and manageable. Herpes zoster and hematological changes were more frequent in elderly patients, while serious cardiovascular events were rare. Conclusions: JAK inhibitors are effective therapeutic options for elderly patients with moderate-to-severe AD. Careful patient selection, dose tailoring, and close monitoring are essential. Further age-specific RCTs and long-term real-world data are needed to guide clinical practice. Full article

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice. Full article

This work presents a novel time-to-digital converter based on the analog sampling of dual-phase periodic signals generated from a free-running oscillator. A proof-of-concept ASIC, implemented in 130 nm CMOS technology, achieves an average single-shot precision of 0.9 ps-rms for time intervals up to 3 ns, with a best performance of 0.79 ps-rms. It maintains a precision below 3.7 ps-rms for intervals up to 25 ns. The design demonstrates excellent linearity, with a peak-to-peak differential nonlinearity of 0.56 LSB and a peak-to-peak integral nonlinearity of 1.43 LSB. The free-running oscillator is shareable across multiple channels, enabling power consumption of approximately 4.1 mW per channel and efficient area utilization. These features make the design highly suitable for detection systems requiring picosecond-level precision and high channel density, such as silicon pixel sensors, SPADs, LiDARs, and time-correlated single-photon counting systems. Furthermore, the architecture shows strong potential for use in high-count-rate applications, reaching up to 22 Mcps. Full article