Search Results (12,043)

Nowadays, two major pathways seem to be responsible for the development and progression of atherosclerosis, namely, high levels of low-density lipoprotein-cholesterol (LDL-C) and low-grade vascular inflammation. Indeed, the concentration of C-reactive protein (CRP), mirroring low-grade systemic inflammation, has been recognized as a more powerful determinant of recurrent cardiovascular (CV) events, death, and all-cause mortality than LDL-C levels. Gut microbiota (GM) dysbiosis is a causal factor for the development of different inflammatory-based pathologies, such as CV disease (CVD). In addition, pre/probiotics showed beneficial effects on GM dysbiosis, by influencing both inflammation and immunity. It has been well documented that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) exert triglyceride (TG)-lowering and antithrombotic effects and play a seminal role in the resolution of inflammatory processes. We showed the recent studies indicating the relationship between pharmacological reduction in inflammatory cytokines and CV outcomes. The principal aim of our review is to highlight the anti-inflammatory and immune-modulatory activities of GM, EPA, and DHA. Then, we pointed out how developing patient-specific pre/probiotic and EPA/DHA interventions alongside the standard of care (SOC) is needed in order to answer several of the questions raised, ranging from diminishing drug toxicity to including frailty individuals. Therefore, hypothetical tailored clinical studies are presented, aiming to treat all the patients at high-risk of CV events, as well as aged people. Full article

Flood inundation mapping (FIM), which is essential for effective disaster response and management, requires rapid and accurate delineation of flood extent and depth. Remote sensing FIM, especially using satellite imagery, offers certain capabilities and advantages, but also faces challenges such as cloud and canopy obstructions and flood depth estimation. This research developed a novel hybrid approach, named FLDSensing, which combines remote sensing imagery with the FLDPLN (pronounced “floodplain”) flood inundation model, to improve remote sensing FIM in both inundation extent and depth estimation. The method first identifies clean flood edge pixels (i.e., floodwater pixels next to bare ground), which, combined with the FLDPLN library, are used to estimate the water stages at certain stream pixels. Water stage is further interpolated and smoothed at additional stream pixels, which is then used with an FLDPLN library to generate flood extent and depth maps. The method was applied over the Verdigris River in Kansas to map the flood event that occurred in late May 2019, where Sentinel-2 imagery was used to generate remote sensing FIM and to identify clean water-edge pixels. The results show a significant improvement in FIM accuracy when compared to a HEC-RAS 2D (Version 6.5) benchmark, with the metrics of CSI/POD/FAR/F1-scores reaching 0.89/0.98/0.09/0.94 from 0.55/0.56/0.03/0.71 using remote sensing alone. The method also performed favorably against several existing hybrid approaches, including FLEXTH and FwDET 2.1. This study demonstrates that integrating remote sensing imagery with the FLDPLN model, which uniquely estimates stream stage through floodwater-edges, offers a more effective hybrid approach to enhancing remote sensing-based FIM. Full article

This study examines the effects of climate change on maize production in Romania between 2003 and 2024, focusing on yield dynamics, regional disparities, and economic losses. Maize, a key crop in Romanian agriculture, has become increasingly vulnerable to extreme weather events, particularly droughts, which remain the most frequent risk. The analysis highlights a marked decline in maize yields and cultivated area in recent years, strongly correlated with severe droughts in 2020, 2022, and 2024. The results show that western and northern counties display greater resilience, while southeastern regions face significant yield losses. The economic impact is substantial, with losses exceeding EUR 1 billion. These findings underscore the systemic nature of climate-related risks and call for region-specific adaptation strategies, expanded irrigation infrastructure, and index-based insurance schemes to strengthen resilience and ensure sustainable maize production under changing climatic conditions. Full article

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a life-threatening complication of cirrhosis, characterized by organ failures and high short-term mortality. Alcohol-related cirrhosis is one of the most frequent underlying etiologies of ACLF in Europe. Infections, particularly those leading to sepsis are recognized triggers; however, their relative contribution, clinical features, and prognostic impact in critically ill patients with alcohol-related cirrhosis remain incompletely defined. This study aimed to systematically identify and characterize precipitating events of ACLF in this population and to compare outcomes between sepsis- and non-sepsis-related cases. Methods: We conducted a retrospective cohort study including 188 ICU patients with alcohol-related cirrhosis who were treated for ACLF at a tertiary university medical center. ACLF was defined and graded according to the European Association for the Study of the Liver—Chronic Liver Failure Consortium (EASL-CLIF) criteria, and sepsis was diagnosed according to Sepsis-3 definitions. Clinical data, precipitating events, microbiological evidence, organ support requirements, and in-hospital outcomes were systematically analyzed. Results: Sepsis was the most frequent precipitating event, identified in 118 patients (62.8%), while 70 patients (37.2%) developed ACLF due to non-septic triggers such as gastrointestinal bleeding. Patients with sepsis-associated ACLF presented with more advanced disease (ACLF grade 2–3 in 80.5% vs. 57.1%, p = 0.004), higher Chronic Liver Failure Consortium—Acute-on-Chronic Liver Failure Score (CLIF-C ACLF) scores (median 55 vs. 50, p = 0.04), longer ICU stays (median 11 vs. 4.5 days, p < 0.001), and markedly higher in-hospital mortality (60.2% vs. 20.0%, p < 0.001) compared to patients without sepsis. Pneumonia (48.3%), urinary infections (17.8%) and spontaneous bacterial peritonitis (16.1%) were the leading infectious foci triggering sepsis. Microbiological evidence was obtained in 82.2% of sepsis cases, with frequent polymicrobial infections and opportunistic pathogens including Enterococcus faecium and Candida albicans. Conclusions: In critically ill patients with alcohol-related cirrhosis, infections leading to sepsis are the predominant precipitating event of ACLF and the strongest determinant of short-term prognosis. Compared with non-sepsis triggers, sepsis-associated ACLF is characterized by more severe disease, greater need for organ support, longer ICU stays, and substantially higher mortality. These findings highlight the urgent need for early recognition, rapid diagnostic strategies, and optimized infection management to improve outcomes in this high-risk population. Full article

Introduction: Atrial fibrillation (AF) is common in patients with Brugada syndrome (BrS). The impact and significance of AF in this patient population needs to be further clarified. Method: We performed a systematic review and meta-analysis of studies comparing the risks of developing major arrhythmic events (MAEs) in patients with BrS with and without AF. Databases including MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to July 2024, using appropriate search and MeSH terms. Data were sought on the comparison of patients with BrS with and without AF. The protocol was specified prior to the searches being performed, and standard meta-analytic techniques were used. Results: Thirteen observational studies were included (a total of 5413 patients). A significant increase in MAEs was observed in patients with both BrS and AF (20.6% vs. 7.8%; OR 2.81, 95% CI 1.82–4.34; p < 0.0001; I² = 46%). Significantly higher rates of syncope (33.3% vs. 23.4%; OR 1.97, 95% CI 1.04–3.76; p = 0.04, I² = 59%) and a significant increase in all-cause mortality (11.3% vs. 3.7%; OR 4.21, 95% CI 1.69–10.45; p = 0.002, I² = 0%) and sodium channel mutations (43.1% vs. 29.9%; OR 1.87, 95% CI 1.07–3.29; p = 0.028, I² = 0%) were observed for patients with BrS and AF. Conclusions: Patients with both BrS and AF seem to have a more severe disease phenotype. More research into the added role of AF in risk stratification of asymptomatic BrS patients is needed, but the prognostic implications of AF may need to be considered when developing future personalised medicine approaches in the BrS population. Full article

Rainfalls are the result of complex cloud microphysical processes. Trying to estimate their intensity and duration is a key task necessary for assessing precipitation magnitude. Across mountains, extreme rainfalls may cause several side effects on the ground, triggering severe geo-hydrological issues (floods and landslides) which impact people, human activities, buildings, and infrastructure. Therefore, having a tool able to reconstruct rainfall processes easily and understandably is advisable for non-expert stakeholders and researchers who deal with rainfall management. In this work, an evolution of the LUME (Linear Upslope Model Experiment), designed to simplify the study of the rainfall process, is presented. The main novelties of the new version, called LUME 2D, regard (1) the 2D domain extension, (2) the inclusion of warm-rain and cold-rain bulk-microphysical schemes (with snow and hail categories), and (3) the simulation of convective precipitations. The model was completely rewritten using Python (version 3.11) and was tested on a heavy rainfall event that occurred in Piedmont in April 2025. Using a 2D spatial and temporal interpolation of the radiosonde data, the model was able to reconstruct a realistic rainfall field of the event, reproducing rather accurately the rainfall intensity pattern. Applying the cold microphysics schemes, the snow and hail amounts were evaluated, while the rainfall intensity amplification due to the moist convection activation was detected within the results. The LUME 2D model has revealed itself to be an easy tool for carrying out further studies on intense rainfall events, improving understanding and highlighting their peculiarity in a straightforward way suitable for non-expert users. Full article

Rural landscapes are changing rapidly, yet many assessments remain descriptive and weakly connected to planning instruments. This study connects rural landscape analysis with planning and management by examining post-earthquake transformations in Topaktaş (Tuşba, Van), a village redesigned and relocated after the 2011 events. Using ArcGIS 10.8 and the Analytic Hierarchy Process (AHP), we integrate DEM, slope, aspect, CORINE land cover Plus, surface-water presence/seasonality, and proximity to hazards (active and surface-rupture faults) and infrastructure (Karasu Stream, highways, village roads). A risk overlay is treated as a hard constraint. We produce suitability maps for settlement, agriculture, recreation, and industry; derive a composite optimum land-use surface; and translate outputs into decision rules (e.g., a 0–100 m fault no-build setback, riparian buffers, and slope thresholds) with an outline for implementation and monitoring. Key findings show legacy footprints at lower elevations, while new footprints cluster near the upper elevation band (DEM range 1642–1735 m). Most of the area exhibits 0–3% slopes, supporting low-impact access where hazards are manageable; however, several newly designated settlement tracts conflict with risk and water-service conditions. Although limited to a single case and available data resolutions, the workflow is transferable: it moves beyond mapping to actionable planning instruments—zoning overlays, buffers, thresholds, and phased management—supporting sustainable, culturally informed post-earthquake reconstruction. Full article

Electricity price spikes are the most important characteristic of the electricity price time series. Operationally, they result from various stresses in the power system or the strategic bidding behavior of market participants. These high prices are important as they represent economic opportunities in the form of profits and savings. Theoretically, price spikes are defined as prices that exceed a threshold over a typically short duration. This definition serves as the basis for several established modeling approaches in the literature. In general, the threshold component determines the design of a price spike model, often overlooking the duration aspect. Therefore, this paper presents a simple yet informative model to quantify the duration of electricity price spikes using historical price data from different market jurisdictions. We approach the problem through the lens of survival analysis, a widely used technique for evaluating time-to-event data. Specifically, we use the Kaplan–Meier (KM) estimator, which enables a nonparametric evaluation of the survival (duration) of price spikes over time. We refer to this as the price spike duration model. Full article

An ascending aortic aneurysm is a localized dilation of the ascending aorta, which poses a high risk of aortic dissection or rupture, with surgery recommended at diameters > 5.5 cm. However, events also occur at smaller sizes, suggesting additional factors—such as stenosis—may significantly influence aneurysm severity. To investigate this, a computational fluid dynamics (CFD) analysis was conducted using a patient-specific ascending aortic model (aneurysm diameter: 5.28 cm) under three aortic stenosis severities: mild, moderate, and severe. Results showed that the severe stenosis condition led to the formation of prominent recirculation zones and increased peak velocities, 2.36 m·s⁻¹ compared to 1.53 m·s⁻¹ for moderate stenosis and 1.37 m·s⁻¹ for mild stenosis. A significantly increased pressure loss coefficient was observed for the severe case. Additionally, the wall shear stress (WSS) distribution exhibited higher values along the anterior region and lower values along the posterior region. Peak WSS values were recorded at 43.46 Pa in the severe stenosis model, compared to 21.98 Pa and 13.87 Pa for the moderate and mild cases, respectively. Velocity distribution and helicity analyses demonstrate that increasing stenosis severity amplifies jet-induced flow disturbances, contributing to larger recirculation zones and greater helicity heterogeneity in the ascending aorta. Meanwhile, WSS results indicate that greater stenosis severity is also associated with elevated WSS magnitude and heterogeneity in the ascending aorta, with severe cases exhibiting the highest value. These findings highlight the need to incorporate hemodynamic metrics, alongside traditional diameter-based criteria, into rupture risk assessment frameworks. Full article

Photogrammetry applied to sports provides precise data on athlete positions and time instants, especially with digital motion capture systems. However, detecting and identifying specific events in athletic movements such as discus throwing can be challenging when using only images. For example, with high-speed video, it is difficult to pinpoint the exact frame when events like foot touchdown or takeoff occur, as contact between shoe and ground may span several frames. Inertial measurement units (IMUs) can detect maxima and minima in linear accelerations and angular velocities, helping to accurately determine these specific events in throwing movements. As a result, comparing photogrammetry data with IMU data becomes challenging because of the differences in the methods used to detect events. Even if comparisons can be made with IMU data from other sports researchers, variations in methodologies can invalidate the comparison. To address this, the paper proposes a simple methodology for detecting the five phases of a discus throw using three IMUs located on the thrower’s wrist and on the instep or ankle of the feet. Experiments with three elite male discus throwers are conducted and the results are compared with existing data in the literature. The findings demonstrate that the proposed methodology is effective (100% of phases detected in the experiments without false positives) and reliable (results validated with professional coaches), offering a practical and time- and cost-effective solution for accurately detecting key moments in athletic movements. Full article

Alpha-synuclein (αsyn) misfolding and aggregation underlie several neurodegenerative disorders, including Parkinson’s disease. Early oligomeric intermediates are particularly toxic yet remain challenging to detect and characterize within cellular systems. Here, we employed the luminescent conjugated oligothiophene h-FTAA to investigate early aggregation events of human wildtype (huWT) and A53T-mutated αsyn (huA53T) both in vitro and in HEK293 cells stably expressing native human-αsyn. Comparative fibrillation assays revealed that h-FTAA detected αsyn aggregation with higher sensitivity and earlier onset than Thioflavin T, with the A53T variant displaying accelerated fibrillation. HEK293 cells stably expressing huWT- or huA53T-αsyn were exposed to respective pre-formed fibrils (PFFs), assessed via immunocytochemistry, h-FTAA staining, spectral emission profiling, and fluorescence lifetime imaging microscopy (FLIM). Notably, huA53T PFFs promoted earlier aggregation patterns and yielded narrower fluorescence lifetime distributions compared with huWT PFFs. Spectral imaging showed h-FTAA emission maxima (~550–580 nm) red-shifted and broadened in cells along with variable lifetimes (0.68–0.87 ns), indicating heterogeneous aggregate conformations influenced by cellular milieu. These findings demonstrate that h-FTAA is useful for distinguishing early αsyn conformers in living systems and, together with stable αsyn-expressing HEK293 cells, offers a platform for probing early αsyn morphotypes. Taken together, this opens for further discovery of biomarkers and drugs that can interfere with αsyn aggregation. Full article

Although liquefied natural gas (LNG) is already widely used as a marine fuel, its use on large cruise ships is a relatively new development. By the end of 2024, twenty-four LNG-fuelled cruise ships were in operation, each carrying several thousand passengers and making frequent port calls. These operational characteristics increase the potential risks compared to conventional cargo ships and require a rigorous safety assessment. In this study, the safety of LNG-fuelled cruise ships is assessed using the Formal Safety Assessment (FSA) framework prescribed by the International Maritime Organization (IMO). The assessment includes a hazard identification (HAZID), a risk analysis, an evaluation of risk control options, a cost–benefit analysis and recommendations for decision-making. Given the limited operational data on LNG-fuelled cruise ships, event trees are developed on the basis of LNG tanker incidents, adjusted to reflect passenger-related risks and cruise-specific operating conditions. A statistical overview of marine casualties involving cruise ships and LNG carriers of more than 20,000 GT over the last 35 years provides a further basis for the analysis. To ensure compliance, the study also analyses class requirements and regulatory frameworks, including risk assessments for ship design, bunker operations and emergency preparedness. These assessments, which are carried out at component, ship and process level, remain essential for safety validation and regulatory approval. The results provide a comprehensive framework for assessing LNG safety in the cruise sector by combining existing safety data, regulatory standards and probabilistic risk modelling. Recent work also confirms that event tree modelling identifies critical accident escalation pathways, particularly in scenarios involving passenger evacuation and port operations, which are under-researched in current practice. The results contribute to the wider debate on alternative fuels and support evidence-based decision-making by ship operators, regulators and industry stakeholders. Full article

Background: The 4CMenB vaccine (Bexsero^®) contains surface proteins from Neisseria meningitidis serogroup B and is recommended from 2 months of age. The most frequently reported adverse events are fever, injection site pain, and fatigue. Thus, this study aimed to estimate the incidence of local and systemic adverse events associated with the administration of the 4CMenB (Bexsero^®) vaccine. Methods: A systematic review and meta-analysis of clinical trials published up to 28 February 2025 were conducted using PubMed, ScienceDirect, and Web of Science. Human studies available in English, Spanish, French, German, or Italian were exclusively included. Adverse events following the first dose of the vaccine were analyzed. Pooled proportions with 95% confidence intervals were calculated, and heterogeneity across studies was assessed using the I² statistics. Results: Ten clinical trials comprising 13,345 participants were included. The most common adverse event was local pain (occurring in up to 94% of cases), followed by induration, erythema, and edema, with frequencies ranging from 25% to 45%. The most frequently reported systemic events were irritability (up to 75%), fatigue (51–59%), fever (up to 60%), headache (42–49%), and persistent crying (50–65%). Most adverse events were mild and self-limiting. Conclusions: The 4CMenB (Bexsero) vaccine exhibits a favorable safety profile, characterized by a predominance of mild and transient local adverse events. Although several systemic events were reported, their overall frequency was generally low. These findings support the continued inclusion of Bexsero^® in routine childhood immunization programs. Full article

Objective: This study evaluates the efficacy of a novel approach to oral appliance therapy (“OAT”) for the treatment of obstructive sleep apnea (“OSA”). This novel approach utilizes a systemized, oximetry-informed, treatment protocol and a precision-custom oral appliance. Methods: Sixty consecutive patients diagnosed with OSA were treated at Sleep Better Austin (“SBA”) using a structured, multi-step protocol and a precision-custom oral appliance (ProSomnus EVO). Baseline and post-treatment apnea–hypopnea index (“AHI”) values were compared using a matched-pair design. The primary outcome was the percentage of patients achieving a residual AHI of <10 events/h. Secondary outcomes included severity classification improvement. Results: In total, 90% of patients achieved the primary endpoint, and 87% improved by at least one severity classification. The mean AHI improved by 63% from baseline with the precision-custom OAT in situ (p < 0.001). In the moderate-to-severe subgroup, AHI improved by 70%, with 100% of severe patients achieving a residual AHI of <20 and a ≥50% improvement, without patient preselection. No serious adverse events were reported, and all patients continued therapy at follow-up. Conclusions: Precision-custom OAT, when delivered through a standardized clinical protocol informed by oximetry, can be a highly effective and well-tolerated treatment for OSA. These findings support its broader adoption as a non-invasive alternative to continuous positive airway pressure (“CPAP”) and surgical interventions, particularly for patients seeking personalized, high-compliance solutions. Full article

Extreme rainfall events characterized by small catchments with high-velocity flows pose critical challenges to infrastructure resilience, particularly the rail infrastructure, due to its partial location near rivers and in mountainous regions, and the limited availability of alternative routes. This can lead to severe damages, often resulting in long-term route closures. To mitigate flash flood damage, detailed information about affected structures and damage processes is necessary. Therefore, this study presents a newly developed multi-criteria flash flood damage assessment framework for the rail infrastructure and a QGIS-based analysis of the most frequent damages. Applying the framework to Eifel route damages in Western Germany after the July 2021 flood disaster shows that nearly 45% of the damages affected the track superstructure, especially tracks and bedding. Additionally, power supply systems, sealing and drainage systems, as well as railway overpasses or bridges, were impacted. Approximately 30% of the railway section showed washout of ballast, gravel and soil. In addition, deposit of wood or stones occurred. Most damages were classified as minor (47%) or moderate (34%). Furthermore, damaged track sections were predominantly located within a 50 m distance to the Urft river, whereas undamaged track sections are often located at a greater distance to the Urft river. These findings indicate that the proposed framework is highly applicable to assess and classify damages. Critical elements and relations could be identified and can help to adapt standards and regulations, as well as to develop preventive measures in the next step. Full article