Search Results (343)

Background: The first 1000 days of life, from conception to 2 years of age, represent a critical window during which nutrition can exert long-lasting effects on neurodevelopment, immune maturation, and susceptibility to prematurity-related morbidity. Docosahexaenoic acid (DHA) is a key structural n-3 long-chain polyunsaturated fatty acid of the brain and retina, characterized by rapid fetal accretion during the third trimester. Methods: We conducted a narrative review of studies published from March 2015 up to December 2025, including randomized controlled trials, follow-up studies, and systematic reviews/meta-analyses about DHA supplementation during pregnancy, lactation, infancy and early childhood, and its role on development. Results: Across the first 1000 days, DHA supplementation improves biochemical DHA status, particularly in populations with low baseline levels (moderate to high level of evidence), while clinical outcomes remain heterogeneous. During pregnancy, some benefits in specific cognitive and behavioral domains have been demonstrated, whereas effects on global cognition and long-term behavior are frequently null (moderate evidence). Visual outcomes appear favorable, with improvements in visual acuity (moderate evidence). In preterm infants, enteral DHA—often combined with arachidonic acid (ARA)—is feasible and well tolerated. DHA may reduce inflammatory markers and necrotizing enterocolitis risk when in equilibrium with ARA (low to moderate evidence), while no evidence supports the link between DHA and reduced risk of bronchopulmonary dysplasia and retinopathy of prematurity (moderate evidence). Neurodevelopmental outcomes are mixed: neuroimaging studies suggest enhanced white matter maturation with DHA + ARA, whereas most trials show no clear benefit regarding standardized developmental scores (moderate evidence). Conclusions: DHA is biologically essential during the first 1000 days, but its clinical impact depends on timing, dose, baseline status, and prematurity-related context. The balance between DHA and ARA, rather than DHA supplementation alone, emerges as a key determinant of clinical efficacy, supporting a shift toward precision-based nutritional strategies in early life. Full article

For irregularly shaped 820CrMnTi carburizing and nitriding parts, the challenges of high reflectivity-induced overexposure, low surface contrast, and interference from minute burrs in industrial online inspection are addressed in this paper. An innovative precision detection method integrating adaptive imaging and a dual-drive heterogeneous coupling model (RGFCN) is proposed. Such parts, due to surface photovoltaic characteristic changes caused by carburizing and nitriding heat treatment and the complex on-site lighting environment, are prone to local overexposure and “false out-of-tolerance” measurements caused by outlier sensitivity in traditional inspections. First, an innovative programmatic adaptive exposure control algorithm based on grayscale histogram feedback is introduced, which dynamically adjusts imaging parameters in real time to effectively suppress high-brightness overexposure under specific working conditions. Second, a novel adaptive main-axis scanning strategy is designed to construct a dynamic follow-up coordinate system, eliminating projection errors introduced by random positioning from a geometric perspective. Additionally, Gaussian gradient energy fields are combined with the Huber M-estimation robust fitting mechanism to suppress thermal noise while automatically reducing the weight of burrs and oil stains, achieving “immunity” to non-functional defects. Meanwhile, a data-driven innovative compensation approach is introduced. Based on sample training, gradient boosting decision trees (GBDTs) are integrated to explore the nonlinear mapping relationship between multidimensional feature spaces and system residuals, achieving implicit calibration of lens distortion and environmental coupling errors. By simulating factory conditions with drastic 24 h day–night lighting fluctuations and strong oil stain interference, statistical analysis of over 1000 mass-produced parts shows that this method exhibits excellent robustness in complex environments. It reduces the false out-of-tolerance rate caused by burrs by over 90%, and the standard deviation of repeated measurements converges to the micrometer level. This effectively addresses the visual inspection challenges of irregular, highly reflective parts on dynamic production lines. Full article

This study experimentally evaluates the thermal performance of a compact parabolic trough solar collector (PTSC) operating under actual solar conditions in Chachapoyas, a high-Andean city in northern Peru characterized by frequent cloud cover and variable irradiance. Despite the growing interest in solar thermal systems, few studies have assessed PTC behavior under high-altitude, diffuse radiation conditions typical of Andean regions. The PTSC, aligned along the north–south axis and equipped with a manual solar tracking system, was monitored for 30 consecutive days. Solar irradiance, ambient temperature, and water inlet/outlet temperatures were recorded at 30 min intervals using a DAVIS Vantage Pro Plus weather station and infrared thermometers (±0.5 °C accuracy). Thermal efficiency was determined from the ratio of useful heat gain to incident solar energy, based on instantaneous irradiance data. Results showed peak irradiance values of 1000 W m⁻² and maximum outlet water temperatures of 85 °C, achieving an average efficiency of 68 ± 2.5%. The collector maintained stable operation even under fluctuating radiation, confirming its suitability for domestic hot-water and low-temperature industrial applications. These findings provide the first experimental evidence of efficient solar-thermal conversion in cloudy highland environments of Peru, supporting the deployment of decentralized renewable energy systems in the Andean region. Full article

Background: The first 1000 days of life represent a critical window for developmental programming, during which specific nutritional exposures, such as vitamin D levels, may influence long-term health trajectories. Vitamin D plays a central role in skeletal development, but increasing evidence also supports its possible involvement in immune, metabolic, and neurodevelopmental processes during early life. In this narrative review, we summarize current evidence on the biological functions of vitamin D across the first 1000 days, focusing on its roles in skeletal, immune, metabolic, and neurodevelopmental processes, and its potential role as a programming factor. Methods: We conducted our research using the PubMed, Scopus, and Cochrane databases. We included systematic reviews, randomized controlled trials, and high-quality observational studies published from 2015 onward, focusing on pregnancy, neonatal life, and early childhood. Results: Vitamin D acts through placental, epigenetic, skeletal, immune, metabolic, and neurodevelopmental pathways that are particularly active during early development. Low maternal or early-life vitamin D status has been associated with adverse birth outcomes and impaired bone health. It has also been linked to increased susceptibility to infections and allergic diseases, altered metabolic trajectories, and mild neurodevelopmental differences. Evidence from supplementation trials remains heterogeneous, with benefits appearing more consistent in populations with baseline deficiency. Conclusions: Vitamin D fulfills several biological plausibility criteria for a potential early-life programming factor, although current human evidence remains heterogeneous. Full article

This study addresses the dual challenges of low copper recovery and persistent arsenic pollution in the bioleaching of low-grade, high-arsenic copper ores containing enargite (Cu₃AsS₄). Through integrated electrochemical, chemical, and biological investigations, a selective and environmentally sustainable two-stage hybrid leaching process was developed. Electrochemical analysis identified a critical oxidation threshold of ~750 mV governing enargite dissolution. Chemical leaching and X-ray Photoelectron Spectroscopy (XPS) analysis revealed a temperature-dependent sulfur transformation pathway, enabling a staged thermal strategy: flotation below 40 °C to maximize hydrophobic elemental sulfur (S⁰) formation, and bioleaching at 40–55 °C to promote complete sulfur oxidation to sulfate. Optimization produced a two-stage process comprising 10-day chemical pre-leaching with FeSO₄ (10.0 g/L Fe²⁺) followed by bioleaching, achieving 78.3% copper extraction while suppressing arsenic dissolution to approximately 10%. The use of FeSO₄ instead of Fe₂(SO₄)₃ reduces reagent costs by ~70%, saving an estimated CNY 47,250 daily at 1000 t/d scale. Leaching toxicity tests confirm residue As < 0.10 mg/L, meeting non-hazardous waste standards (GB5085.3-2007). This work provides the first integrated demonstration of electrochemical threshold control combined with temperature-dependent sulfur speciation for selective copper extraction from arsenic-bearing enargite ores, offering a scalable, reagent-economical, and environmentally sustainable metallurgical route. Full article

Introduction: High-output stoma (HOS) is a frequent and morbid complication following ileostomy formation. Proton pump inhibitors (PPIs) may reduce intestinal secretions, but no randomized trial has yet tested whether intensified intravenous omeprazole treatment prevents or mitigates early postoperative HOS. We aim to determine whether intensified PPI dosing reduces early postoperative ileostomy output compared with standard dosing. Methods and Analysis: STOP-HOS-1 is a randomized, parallel-group, open-label, superiority trial conducted at two academic centers in Poland. The target sample size is 100 adults undergoing the formation of a loop or end ileostomy. Participants will be randomized 1:1 to receive either: intensified omeprazole group—80 mg IV loading dose, followed by 40 mg IV twice daily through postoperative day (POD) 10, or standard omeprazole group—40 mg IV once daily through POD 10. The primary outcome is mean ileostomy output (mL/24 h) across POD 1–3. A ≥250 mL/day reduction is prespecified as clinically meaningful. Key secondary outcomes include: incidence of HOS (≥1000 mL/day for ≥3 consecutive days or ≥1400 mL on any single day), time to output stabilization (<1400 mL/day for 3 consecutive days), dehydration-related complications (hyponatremia, hypokalemia, acute kidney injury), length of hospital stay and 30-day readmission rate. The primary analysis will follow the intention-to-treat principle. One interim safety analysis is planned after enrollment of the first 20 patients. Discussion: Although PPIs are commonly used to reduce ileostomy output, high-quality evidence in the early postoperative setting is lacking. STOP-HOS-1 targets the critical period when output is most variable, and complications are most frequent, using a pragmatic randomized design and an objective, clinically meaningful primary endpoint. Conclusions: STOP-HOS-1 will provide the first randomized evidence on whether intensified postoperative PPI therapy reduces early ileostomy output and HOS-related morbidity, informing future standards of care. Full article

This second part of this expert panel review explores the broader impact of vaccines across the lifespan, emphasizing their role beyond immediate infection control. Vaccines not only extend life expectancy but also influence long-term health trajectories, particularly during the critical first 1000 days of life, where they prevent severe infections, disability, and mortality. They contribute to cancer prevention through vaccination against human papillomavirus and hepatitis B, reduce cardiovascular events and complications in individuals with chronic diseases, and protect against late-life functional decline. Furthermore, vaccines exert lasting effects on healthy aging by modulating inflammation and preserving independence, while proposed vaccination schemes illustrate the need for a comprehensive, life-course approach. Together with Part 1, which focused on immunosenescence and immune modulation, this closing installment underscores vaccination as a cornerstone of sustainable health policy, reinforcing its pivotal role in extending both lifespan and healthspan for future generations. Full article

Achievement of optimal nutritional status within the first 1000 days of life for a child with cystic fibrosis (CF) is of paramount importance, with an emphasis on favorable early life growth trajectories that best optimize pulmonary and extrapulmonary health. The ‘first 1000 days’ framework emphasizes that environmental, sociocultural and nutritional exposures during this period can have life-long consequences for physical, cognitive, social and emotional health and development. Optimal nutrition encompasses not just physical growth, but the provision of nutrients and optimal feeding throughout the preconception, pregnancy and first 1000-day period to ensure lifelong healthy development and aging. For children with CF (cwCF), the first 1000 days is marred by a myriad of complications, exposing a unique nutritional fragility within this critical developmental window. Conversely, as life expectancy increases for people with CF (pwCF), overnutrition is becoming increasingly prevalent and the widespread uptake of disease-modifying drugs challenges clinicians to take a nuanced and personalized approach to lifelong nutritional care. This review explores early disease manifestations of CF and their impact on early life growth and nutrition in the modern era of CF. This review also considers how we might theoretically view early life nutrition in CF from a lens which takes into consideration well-known frameworks such as ‘the first 1000 days’ and ‘developmental origins of health and disease’. Full article

Background/Objectives: Neonatal esophageal perforation (EP) is a rare but potentially life-threatening condition, primarily affecting preterm and very low birth weight infants. Iatrogenic injury—most commonly related to malpositioned naso- or orogastric tubes—represents the leading cause. Methods: We conducted a comprehensive review of EP cases diagnosed within the first 28 days of life and reported between 2004 and October 2025 in PubMed and Scopus databases. The analysis focused on clinical presentation, risk factors, diagnostic modalities, management strategies, and outcomes. Only English-language case reports, case series, and observational studies (retrospective, cross-sectional and multicenter analyses) were included. Previously published narrative and systematic reviews were screened for relevant primary studies and contextual comparison, but were not included as primary data sources. Additionally, the emotional impact of iatrogenic complications on neonatal teams was also explored, through a focus on the importance of safety culture, reflective practice, and professional learning. Results: A total of 84 neonatal EP cases, were identified across 11 publications. The literature consistently indicates that iatrogenic EP predominantly affects infants born <28 weeks of gestational age and weighing <1000 g. Conservative management is effective in the majority of cases, whereas surgical intervention is reserved for complicated or refractory presentations. Prevention relies on standardized tube insertion techniques and early imaging verification. Conclusions: Although rare, neonatal EP demands high clinical vigilance, timely imaging-based diagnosis, and cautious conservative treatment. This review aims to consolidate available evidence while emphasizing the role of preventive strategies, safety culture, and team awareness in neonatal intensive care. By integrating clinical findings with reflections on iatrogenic risk, it seeks to support standardized practices, multidisciplinary learning, and continuous improvement in patient safety. Full article

This paper presents a modeling framework for large-capacity lithium-ion battery energy storage systems (BESSs), developed within the Modelica LIBSystems library and focused on system-level integration. The framework builds on a combined analysis of the electrical, thermal and degradation behavior at the cell level to model the BESS interconnection to the electrical grid. A semi-empirical aging model was incorporated following its validation at the cell level against capacity loss experimental measurements. Two case studies were conducted for a 10.5 MW/15 MWh BESS installed in the isolated power system of Terceira Island. The first analyzed the short-term response to a 5% load step decrease under 60% and 80% renewable penetration scenarios, yielding a frequency nadir improvement of 3 mHz and 21 mHz, respectively. The second projected long-term degradation under two dispatch strategies: one derived from historical time series, and another synthetically constructed to induce more frequent and deeper cycling. After 1000 days of operation, the state of health declined to 95.2% in the historical-based case and to 93.5% under the aggressive profile. The proposed framework establishes a unified, cross-domain modeling workbench for Li-ion BESS applications, enabling evaluation of the system design, control strategies, operation conditions, and system-level performance across both dynamic and long-term horizons. Full article

Background: Surgical site infections (SSIs) are healthcare-associated infections that can occur following surgical procedures, either at admission or within 30 days post-discharge. This study aimed to assess the incidence and associated risk factors for superficial SSI at a Tertiary Hospital in Ethiopia. Methods: A longitudinal study was conducted among patients undergoing surgery at Jimma University Specialized and Comprehensive Hospital (JUSCH) from 1 June to 30 September 2022. Pus, wound swab, or abscess samples were inoculated on Blood and MacConkey Agar for culture. Bacterial isolates were identified using MALDI-TOF, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method, and the results were interpreted according to EUCAST 2022 breakpoints. Incidence rates, Kaplan–Meier analysis, extended Cox regression, and violin plots were utilized to analyze and present the findings. Results: Among 1205 participants, 629 (52.2%) were male, and the median age was 27 years (IQR: 16–40). The incidence of SSI was 9.2 per 1000 person-days. Most SSIs occurred during hospitalization (81.1%), and the remaining primarily developed within the first week post-discharge. The culture positivity rate was 72.7%, yielding 252 isolates comprising 36 bacterial species. The most frequently identified organisms were E. coli (22.2%), Acinetobacter (20.2%), and Klebsiella (14.7%). Over 67% of Gram-negative bacteria were ESBL producers. Age, gender, residence, hospital ward, surgery area, emergency surgery, longer hospitalization, and the number of staff attending the surgery were identified as important risk factors. Conclusions: This study revealed a high incidence of SSI during hospitalization, with significant proportion identified post-discharge. The high rates of multidrug-resistant Gram-negative pathogens underscore the urgent need for comprehensive infection prevention and control measures. Full article

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common and serious complication after coronary artery bypass grafting (CABG), leading to increased morbidity and healthcare utilization. Although systemic inflammation is a well-established driver of POAF pathogenesis, no composite preoperative inflammatory biomarker has been validated for risk stratification in this population. This study aimed to evaluate the novel Inflammatory Burden Index (IBI)—the first composite biomarker combining acute-phase (C-reactive protein, CRP) and chronic cellular (neutrophil-to-lymphocyte ratio, NLR) inflammation—as a preoperative predictor of POAF after CABG. Methods: In this large retrospective cohort study, we included 3481 consecutive patients who underwent isolated CABG at a high-volume cardiac center between 2019 and 2024. Preoperative IBI was calculated as CRP (mg/dL) × NLR. The primary outcome was new-onset POAF within the first 7 postoperative days, confirmed by continuous telemetry on 12-lead ECG. Predictive performance was assessed using multivariable logistic regression, receiver operating characteristic (ROC) curve analysis (area under the curve, AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and internal validation via bootstrapping (1000 resamples). Results: POAF developed in 866 patients (24.9%). Patients with POAF exhibited significantly higher preoperative IBI levels (39.4 ± 18.6 vs. 26.3 ± 16.7, p < 0.01). In multivariable analysis adjusted for age, hypertension, left atrial diameter, and other clinical covariates, IBI emerged as a strong independent predictor of POAF (adjusted OR 1.041, 95% CI 1.036-1.046, p < 0.01). The IBI alone demonstrated moderate-to-good discriminative performance (AUC 0.72, 95% CI 0.70–0.74), significantly outperforming the Systemic Immune/Inflammation Index (SII; AUC 0.61, DeLong test p < 0.001) and providing superior reclassification (NRI 0.150, IDI 0.032) and model fit (lower AIC). Combining IBI with established clinical risk factors further improved predictive accuracy (combined AUC 0.74, specificity 72.4%). Tertile-based stratification revealed a clear graded relationship with POAF incidence (low IBI: 16.6%, medium: 21.3%, high: 35.1%; p = 0.02). Notably, the medium IBI stratum (11.18-25.44) displayed the highest discriminative power (AUC 0.87, 95% CI 0.85-0.88), with bootstrap validation confirming model stability (minimal bias, robust 95% CI). Conclusions: This study establishes the preoperative Inflammatory Burden Index (IBI) as the first validated composite inflammatory biomarker independently associated with POAF following CABG. Its superior performance over existing indices (SII), graded risk stratification, and peak accuracy in the moderate inflammation window highlight its potential for personalized preoperative risk assessment and targeted perioperative intervention strategies. Full article

The first 1000 days of life, from conception through the second year, represents a uniquely sensitive period for neurodevelopment. During this time, multiple physiological systems undergo rapid and coordinated maturation. Among these, the brain, gut, and sleep system form a tightly interconnected triad, exerting reciprocal influences on each other and playing a pivotal role in shaping lifelong cognitive, emotional, and behavioral trajectories. Disruptions in any one of these domains can reverberate across the others, amplifying developmental vulnerabilities. A key modifiable factor that can modulate this gut–brain–sleep triad is nutrition. In this review, we synthesize current evidence on the interconnected development of the brain, gut, and sleep systems and examine the role of key nutrients in shaping these pathways. We also identify critical gaps in the literature and highlight opportunities for future research to better understand how early-life nutritional interventions can optimize neurodevelopmental outcomes. Full article

The first 1000 days of life, starting from conception to a child’s second birthday, constitute a pivotal period for fetal lung and pulmonary vascular development. Maternal nutrition during this period plays an important role in fetal growth, immune programming and organ development, including that of the pulmonary system. This narrative review consolidates evidence linking maternal nutrition and early-life nutrient intake during this period with the development of pulmonary hypertension in the newborn. We examine the influence of both nutrient deficiencies and excesses on fetal lung and vascular development. We performed a structured search of PubMed and Embase (conducted from February 2025 to March 2025) and screened reference lists. Twenty-eight peer-reviewed studies were included, comprising human clinical and observational evidence and studies on animal models. The findings suggest that imbalances in maternal diet can disrupt placental function, induce inflammation, and trigger epigenetic alterations, all contributing to pulmonary vascular dysfunction and increased pulmonary hypertension susceptibility in neonates. Notably, maternal undernutrition and thiamine deficiency during lactation have been directly linked to pulmonary hypertension in infants. Conversely, high-fat diets and excessive polyphenol intake have been associated with adverse fetal cardiovascular remodeling. While current evidence is primarily derived from animal models and observational studies, it highlights the urgent need for targeted nutritional strategies and clinical trials during pregnancy. Although human causality is unproven for most exposures, studying maternal nutrition in the first 1000 days could offer a cost-effective method for reducing the burden of pediatric pulmonary hypertension and its long-term consequences and for prospective trials aimed at preventing early-life pulmonary vascular disease. Full article

Background/Objectives: Cervical cancer outcomes based on geographic location of residence reveal inconsistent patterns, and most of the evidence is from the United States. This retrospective study aimed to investigate whether there existed a difference in overall survival (OS) and recurrence-free survival (RFS) between individuals living within a Canadian city with a tertiary care centre versus those living remotely within a large catchment area (up to >1000 km travel distance), including a sizeable rural component. Methods: Surgically treated cervical cancer patients from 2000 to 2016 were included. Patients were treated with either radical hysterectomy, trachelectomy, or simple hysterectomy. Adjuvant treatment was provided depending on surgical pathology. OS and RFS were estimated using Kaplan–Meier curves and cumulative incidence curves. Results: Two hundred and eighty-two patients with surgically treated cervical cancer were included: 185 patients living within urban city limits and 97 patients living rurally. There were no significant baseline differences between groups. No significant difference in OS or RFS was found, even after adjusting for death as a competing risk for RFS. The median time to surgery for residents living within versus outside the city was 84 vs. 66 days, respectively, although this difference was not statistically significant (p = 0.3179). Conclusions: This is the first Canadian study to examine an association between survival and distance to care for cervical cancer. Full article