Search Results (3,072)

Background: Fluid management is a critical aspect of care for neurocritically ill patients, yet the optimal approach remains unclear. The relationship between fluid balance and clinical outcomes in these patients requires further investigation, particularly regarding the timing and volume of fluid administration. Methods: This retrospective observational study analyzed 2186 adult patients admitted to the neurosurgical intensive care unit (ICU) from January 2013 to December 2022. We employed a generalized additive model (GAM) with cubic spline smoothing to examine non-linear relationships between fluid balance and mortality. The maximally selected rank statistics method was used to determine the optimal cutoff value for fluid balance. Associations between fluid balance patterns and 28-day mortality were analyzed using a multivariable logistic regression model. Results: Initial analysis identified fluid balance on day 1 as the most significant predictor of mortality; patients with positive fluid balance showed a higher 28-day mortality. Non-survivors showed significantly higher fluid input throughout the 7-day observation period, particularly during the first 24 h (4444 mL vs. 3978 mL, p = 0.007). Multivariable analysis confirmed that fluid balance on day 1 remained independently associated with 28-day mortality after adjusting for confounders (adjusted odd ratio 1.705, 95% confidence interval: 1.001–2.905, p = 0.049). Additionally, the relationship between fluid input day 1 and mortality demonstrated a progressively increasing probability of 28-day mortality with higher fluid volumes. Early fluid balance, particularly during the first 24 h of ICU admission, shows a significant association with mortality in neurocritically ill patients. Conclusions: These findings emphasize the crucial importance of careful fluid management in the early phase of neurocritical care and suggest that implementation of strict fluid monitoring protocols, especially during the initial period of care, may improve patient outcomes. Full article

This study aims to clarify how different types of motivation influence employee retention by identifying the distinct roles of intrinsic and extrinsic factors in shaping job satisfaction, particularly under varying levels of urban stress and generational identity. Drawing on Herzberg’s Two-Factor Theory and Self-Determination Theory, we distinguish between intrinsic drivers (e.g., autonomy, achievement) and extrinsic hygiene factors (e.g., pay, stability). Using survey data from 356 Chinese employees and applying PLS-SEM with a moderated mediation design, we investigate how urbanization and Generation Z moderate these relationships. Results show that intrinsic motivation enhances satisfaction, especially in urban settings, while extrinsic factors negatively affect satisfaction when perceived as insufficient or unfair. Job satisfaction mediates the relationship between motivation and retention, although this effect is weaker among Generation Z employees. These findings refine motivational theories by demonstrating how environmental pressure and generational values jointly shape employee attitudes. The study contributes a context-sensitive framework for understanding retention by integrating individual motivation with macro-level moderators, offering practical implications for managing diverse and urbanizing labor markets. Full article

Bioinspired soft adhesive systems capable of stable and intelligent object manipulation are critical for next-generation robotics. In this study, a soft gripper combining an octopus-inspired suction mechanism with a frog-inspired hexagonal friction pattern was developed to enhance adhesion performance under diverse surface conditions and orientations. The hexagonal pattern, inspired by frog toe pads, contributed to improved stability against tilting and shear forces. The integrated strain gauge enabled real-time monitoring of gripping states and facilitated the detection of contact location and changes in load distribution during manipulation. The system demonstrated robust adhesion under both dry and wet conditions, with adaptability to various object geometries and inclinations. These results suggest broad potential for bioinspired gripping platforms in fields such as collaborative robotics, medical tools, and underwater systems. Full article

Background/Objectives: The association between chronic kidney disease (CKD) and body size phenotypes in metabolically diverse but apparently healthy adult populations remains inadequately understood. This study investigated the association between CKD and body size phenotypes in a nationally representative sample of healthy Korean adults. Methods: Data from 8227 participants in the 2019–2021 Korean National Health and Nutrition Examination Survey were analyzed. Participants were categorized into four body size phenotypes by combining BMI status (normal weight or obese) with metabolic health status (healthy or abnormal)—MHNW (Metabolically Healthy Normal Weight), MANW (Metabolically Abnormal Normal Weight), MHO (Metabolically Healthy Obese), or MAO (Metabolically Abnormal Obese). CKD was defined based on the urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR). To assess the association between CKD and body size phenotypes, multivariable logistic regression analyses were performed. Results: CKD prevalence was 4.4%. MANW and MAO made up 12.6% and 26.4% of the CKD group, compared to 5.0% and 13.2% of the non-CKD group. CKD prevalence by phenotype was observed as follows: MHNW, 3.2%; MANW, 10.5%; MHO, 4.0%; and MAO, 8.5%. CKD odds were highest in the MAO group (OR: 3.770, 95% CI: 2.648–5.367), followed by the MANW (OR: 2.492, 95% CI: 1.547–4.016) and MHO (OR: 1.974, 95% CI: 1.358–2.870) groups. MAO individuals carried a higher CKD risk than MHO individuals (OR: 1.897, 95% CI: 1.221–2.945). Conclusions: Among apparently healthy adults, body size phenotypes—particularly those with metabolic abnormalities—were significantly associated with the presence of CKD. These findings highlight the need to assess both metabolic health and body composition for effective CKD prevention and management. Full article

Wound healing is a complex and dynamic process involving several stages of tissue repair. This study has shown that extracellular vesicles (EVs) derived from the callus of Camellia japonica L. and their associated microRNAs (miRNAs) possess significant wound healing activities. In human fibroblasts, EVs from C. japonica L. stimulated wound healing and upregulated collagen gene expression. The EVs also decreased inflammation levels in human keratinocytes, supporting wound healing. Among the miRNAs identified, miR408, one of the abundant miRNAs in the EVs, also showed similar wound healing efficacy. These findings suggest that both EVs and miR408 from the callus of C. japonica L. play a pivotal role in promoting wound healing. Additionally, this study shows that the regulation of miRNAs between different kingdoms can be achieved and suggests a new direction for the utilization of plant-derived components. Full article

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients. Full article

Background and Objectives: Patients with hip fractures have a high mortality rate, highlighting the need for a reliable prognostic tool. Although the prognostic nutritional index (PNI) is a well-established predictor in patients with cancer, its utility has not been thoroughly investigated in patients with hip fractures. Therefore, this study aims to evaluate the association between PNI and mortality in patients undergoing hip fracture surgery. Materials and Methods: A retrospective review was conducted on all patients aged ≥65 years who underwent surgery for hip fracture between January 2014 and February 2018. Quartile stratification was chosen because no universally accepted clinical cut-off exists for PNI; this approach enables comparison of equally sized groups and exploration of potential non-linear risk patterns. The primary endpoints were 1-year and overall mortality in older adults undergoing hip fracture surgery. Multivariable Cox proportional-hazards models adjusted for age, sex, ASA class and comorbidities. Results: A total of 815 patients were analyzed. One-year and overall mortality rates were highest in the Q1 group (26.6%, 14.2%, 6.9%, 6.4% [p < 0.001] and 56.7%, 36.3%, 27.0%, 15.2% [p < 0.001], respectively). In Cox regression analysis, a lower preoperative PNI was significantly associated with an increased risk of overall mortality (Q1: HR 3.25, 95% confidence interval [CI] 2.11–5.01, p < 0.001; Q2: HR 1.85, 95% CI 1.19–2.86, p = 0.006; Q3: HR 1.52, 95% CI 0.97–2.38, p = 0.065; Q4 as reference), indicating a stepwise, dose–response increase in mortality risk as PNI decreases. Conclusions: The findings demonstrate that a lower preoperative PNI is significantly associated with higher 1-year and overall mortality in older adults undergoing hip fracture surgery. Although further prospective validation is needed, preoperative PNI may help predict mortality in frail patients undergoing hip fracture surgery and identify those who could benefit from nutritional assessment and optimization before surgery. Full article

Chamaecyparis obtusa (Siebold & Zucc.) Endl. (C. obtusa) is an evergreen conifer native to temperate regions such as South Korea and Japan, traditionally used for its anti-inflammatory properties. However, the molecular mechanisms underlying the anti-inflammatory effects of C. obtusa bark extracts remain poorly understood. In this study, I compared the biological activities of C. obtusa bark extracts prepared using boiling water (COWB) and 70% ethanol (COEB), and investigated their anti-inflammatory mechanisms in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. COEB significantly suppressed both mRNA and protein expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), along with decreased production of their respective inflammatory mediators, nitric oxide (NO) and prostaglandin E₂ (PGE₂). Additionally, COEB selectively downregulated interleukin (IL)-1β expression, without affecting tumor necrosis factor-α (TNF-α), and unexpectedly upregulated IL-6. Notably, COEB did not inhibit the LPS-induced activation of major inflammatory signaling pathways, including mitogen-activated protein kinase (MAPK), nuclear factor-kappa B (NF-κB), and Janus kinase/signal transducer and activator of transcription (JAK/STAT). These findings suggest that COEB exerts anti-inflammatory effects by modulating key inflammatory mediators independently of canonical signaling pathways and may offer a novel therapeutic strategy for controlling inflammation. Full article

Central nervous system (CNS) insulin signaling is involved in a broad array of cardiometabolic physiology, including glucose and lipid metabolism, feeding, energy expenditure, and blood pressure regulation. A key role for hypothalamic neuroendocrine and autonomic centers in regulating insulin-associated cardiovascular and metabolic physiology has been highlighted. However, it is still unclear which CNS site(s) initiate insulin-dependent neural cascades. While some investigations have suggested that circulating insulin can access hypothalamic regions by crossing the blood-brain barrier, other studies point to a necessity of other brain areas upstream of the hypothalamus to initiate central insulin actions. In this context, accumulating evidence points to a possible involvement of the sensory circumventricular organs (CVOs), unique areas located outside of the blood-brain barrier, in insulin-dependent cardiometabolic homeostasis. Here, the multifaceted roles for the sensory CVOs in cardiovascular and metabolic regulation, with a special emphasis on insulin receptor pathways, are discussed. Full article

Grid-forming (GFM) converters have been critical in DER-dominant power systems, ensuring stability, but their performance is highly sensitive to grid conditions such as system strength. Testing GFM converters under a wide range of grid strengths (from strong high-inertia systems to very weak grids) and fault scenarios is challenging, as traditional test facilities and static grid simulators have limitations. To address this problem, this paper proposes a converter-based power line emulator that provides a flexible, programmable grid environment for GFM converter testing. The emulator uses power electronic converters to mimic transmission line characteristics, allowing for the adjustment of effective grid strength (e.g., short-circuit ratio changes). The proposed approach is validated through detailed PSCAD simulations, demonstrating its ability to provide scalable weak-grid emulation and comprehensive validation of GFM converter control strategies and stability under various grid conditions. This research highlights that the converter-based emulator offers enhanced flexibility and cost-effectiveness over traditional testing setups, making it an effective tool for GFM converter performance test. Full article

Heat shock protein 90 (HSP90) is a molecular chaperone that plays a pivotal role in the stabilization and functional activation of numerous oncoproteins and signaling molecules essential for cancer cell survival and proliferation. Despite the extensive development and clinical evaluation of HSP90 inhibitors, their therapeutic potential as monotherapies has been limited by suboptimal efficacy, dose-limiting toxicity, and the emergence of drug resistance. Recent studies have demonstrated that combination therapies involving HSP90 inhibitors and other anticancer agents such as chemotherapeutics, targeted therapies, and immune checkpoint inhibitors can enhance anticancer activity, overcome resistance mechanisms, and modulate the tumor microenvironment. These synergistic effects are mediated by the concurrent degradation of client proteins, the disruption of signaling pathways, and the enhancement of antitumor immunity. However, the successful clinical implementation of such combination strategies requires the careful optimization of dosage, administration schedules, toxicity management, and patient selection based on predictive biomarkers. In this review, we provide a comprehensive overview of the mechanistic rationale, preclinical and clinical evidence, and therapeutic challenges associated with HSP90 inhibitor-based combination therapies. We also discuss future directions leveraging emerging technologies including multi-omics profiling, artificial intelligence, and nanoparticle-mediated delivery for the development of personalized and effective combination regimens in oncology. Full article

Climate change disrupts lives globally and poses significant challenges to mental health. Although several scales assess climate anxiety, many either conflate symptoms with coping responses or fail to adequately capture the core symptomatology of anxiety. Hence, this study aimed to develop and validate the Brief Anxiety Scale for Climate Change (BACC), a self-report measure designed to assess symptoms of climate anxiety. A preliminary pool of 21 items was generated based on the diagnostic criteria for generalized anxiety disorder and climate-related stress. Study 1 (n = 300) explored the factor structure via an exploratory factor analysis while Study 2 (n = 400) independently validated the structure via a confirmatory factor analysis (CFA). Analyses of the internal consistency, content validity, and discriminant validity helped refine the scale to a final 13-item version with two factors: cognitive and functional impairment. The CFA results indicated that all the fit indices met the recommended thresholds, and the final version demonstrated excellent internal consistency (Cronbach’s α = 0.92). Additionally, latent correlations revealed that climate anxiety was moderately associated with generalized anxiety and depression. The BACC was developed to identify individuals in the community who experience climate anxiety beyond an adaptive level, thereby promoting sustainable mental health in the context of climate change. These findings suggest that the BACC is a promising tool for assessing climate anxiety. With better identification, mental health professionals, community practitioners, and policymakers can utilize the scale to develop climate-sensitive public health programs and tailored intervention strategies. Full article

In novels, readers encounter a variety of characters with distinct personalities, and their satisfaction tends to increase when each character’s utterances consistently reflect their unique traits. Recent advances in large language model (LLM) technology have made it possible to perform complex tasks such as generating long-form narratives and adapting writing styles. However, research on generating character utterances that reflect individual personalities remains limited. In this paper, we identify a key challenge in this task, namely the unconscious influence of the author’s writing style, and propose a novel clustering-based method to mitigate this problem by tuning large language models. We manually annotated Big Five personality trait scores for characters appearing in selected novels and designed prompts to generate examples for instruction-tuning. Experimental results demonstrate that language models trained using our proposed method produce utterances that more consistently reflect character personalities compared to untuned models. Full article

This study examines the factors that influence individuals’ intentions to create socially oriented ventures, emphasizing the joint role of social and technical systems. Grounded in Socio-Technical Systems Theory, the research investigates how perceptions of social legitimacy and technological infrastructure shape social entrepreneurial intention (SEI) and how these effects are conditioned by generational cohort, familiarity and intent to use artificial intelligence (AI), and social proximity to entrepreneurial peers. Based on survey data from 388 respondents in China who expressed interest in both entrepreneurship and social problem-solving, the study applies a conditional process structural equation model to capture the complex interplay between external systems and individual-level readiness. The results show that both social and technical systems significantly and positively influence SEI, particularly among younger generations (Millennials and Generation Z). Furthermore, AI familiarity and social proximity operate as moderated mediators, differentially transmitting and shaping systemic influences on SEI. These findings advance the theoretical understanding of socio-technical determinants of social entrepreneurship and offer practical insights for fostering inclusive, generationally responsive entrepreneurial ecosystems. Full article