Search Results (12,152)

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

Reliable estimates of aquifer properties are needed for groundwater resources management and for engineering applications. Pumping tests conducted in fractured aquifers using an open borehole may not produce a proper characterization of the aquifer properties leading to the failure of engineering solutions. In this work, we apply a radial flow model to reproduce the time drawdown curves recorded at an observation borehole instrumented with multi-level piezometers drilled in the Permo-Triassic sandstone, which is a complex fractured hydraulic unit. The radial flow model and the optimization code PEST are used to estimate the aquifer hydraulic parameter values. The model is then used to investigate the implications of replacing the multi-level piezometers with an open borehole. The results show that the open borehole does not only significantly alter the groundwater head and flow patterns around the borehole, but the analysis of the time drawdown curve obtained would produce estimates of aquifer properties that bear no relationship with the actual hydraulic properties of the aquifer. For engineering control studies, the pumping test must be carefully designed to account for the presence of fractures, and these must be represented in the analysis tools to ensure the correct characterization of the hydraulic system. Full article

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Background: Trichosporon spp. are opportunistic fungi, capable of causing infection, especially in critically ill individuals who often use broad-spectrum antibiotics, invasive devices, and have comorbidities. Objectives The aim of this study was to analyze individuals’ clinical characteristics, evaluate tolerance to biocides, as well as biofilm formation and efflux pump activity in isolates of Trichosporon asahii. Methods: Clinical isolates of T. asahii collected between 2020 and 2023 from both hospitalized and non-hospitalized individuals, of both sexes, regardless of age, were tested for tolerance to sodium hypochlorite, hydrogen peroxide, benzalkonium chloride, and ethyl alcohol. Efflux pump activity was also assessed using ethidium bromide, and biofilm formation was measured with the Safranin test. Clinical parameters such as outcomes, source, and length of hospitalization were analyzed through electronic medical records. Results: A total of 37 clinical isolates of T. asahii were identified. Thirty-three (83.8%) isolates were from hospitalized individuals, with 81.82% collected in ICUs, an average hospital stay of 35 days, and a mortality rate of 51.6%. The tested strains displayed the largest mean inhibition zone for 2% sodium hypochlorite, indicating lower tolerance. A high level of efflux pump expression was detected among clinical isolates. Biofilm formation was detected in 25/67.5% of the isolates. Conclusions: These findings highlight the clinical relevance of T. asahii, particularly in critically ill individuals, and underscore the pathogen’s ability to tolerate biocides, express efflux pumps, and form biofilms, all of which may contribute to its persistence and pathogenicity in hospital environments. Enhanced surveillance and effective microbial control measures are essential to mitigate the risks associated with T. asahii infections. Full article

Sodium p-perfluorous nonenoxybenzenesulfonate (OBS) has been proposed as a substitute for perfluorooctanesulfonic acid (PFOS), yet it has garnered increasing attention due to its environmental persistence and potential toxicity. Despite these concerns, the neurotoxic mechanisms of OBS remain unclear. This study investigates and compares the neurotoxic effects and mechanisms of OBS and PFOS in Caenorhabditis elegans. L4-stage worms were exposed to OBS (0.1–100 μM) or PFOS (100 μM) for 24 h. Neurobehavioral analysis showed that OBS exposure induced concentration-dependent neurobehavioral deficits, with 100 μM OBS significantly reducing pharyngeal pumping rate (29.8%), head swing frequency (23.4%), and body bending frequency (46.6%), surpassing the effects of PFOS. Both compounds decreased the fluorescence intensity of dopaminergic, glutamatergic, and γ-aminobutyric acid neurons and downregulated neurotransmitter-associated genes. They also increased ROS generation and inhibited antioxidant gene expression. Molecular docking revealed that OBS had a stronger binding affinity to p38 MAPK key protein (PMK-1) than PFOS. OBS and PFOS upregulated pmk-1 and skn-1, modulating oxidative stress and neuronal function. pmk-1 mutation differentially affected OBS-induced neurobehavioral changes and gene expression alterations. Our findings indicate that OBS exhibits stronger neurotoxicity than PFOS in Caenorhabditis elegans, mediated through the PMK-1 pathway. These results highlight the need for further investigation into the safety of OBS as a PFOS alternative. Full article

The regulation of calcium (Ca²⁺) homeostasis is a critical process in both plant and animal systems, involving complex interplay between various organelles and a diverse network of channels, pumps, and transporters. This review provides a concise overview of inter-organellar Ca²⁺ homeostasis, highlighting key regulators and mechanisms in plant and animal cells. We discuss the roles of key Ca²⁺ channels and transporters, including IP₃Rs, RyRs, TPCs, MCUs, TRPMLs, and P2XRs in animals, as well as their plant counterparts. Here, we explore recent innovations in structural biology and advanced microscopic techniques that have enhanced our understanding of these proteins’ structure, functions, and regulations. We examine the importance of membrane contact sites in facilitating Ca²⁺ transfer between organelles and the specific expression patterns of Ca²⁺ channels and transporters. Furthermore, we address the physiological implications of inter-organellar Ca²⁺ homeostasis and its relevance in various pathological conditions. For extended comparability, a brief excursus into bacterial intracellular Ca²⁺ homeostasis is also made. This meta-analysis aims to bridge the gap between plant and animal Ca²⁺ signaling research, identifying common themes and unique adaptations in these diverse biological systems. Full article

The stomach has been a highly conserved organ throughout vertebrate evolution; however, there are now over 20 lineages composed of monotremes, lungfish and teleost fish displaying a secondary loss of stomach function and morphology. This “agastric phenotype” has evolved convergently and is typified by a loss of gastric glands and gastric acid secretion and a near-to-complete loss of storage capacity of the stomach. All agastric species have lost the genes for gastric enzymes (Pga and Pgc) and proton pump subunits (Atp4a and Atp4b), and gastrin (Gast) has been lost in monotremes. As a key gastric hormone, the conservation of gastrin has not yet been investigated in the lungfish or agastric teleosts, and it is unclear how the loss of gastrin affects the evolution and selection of the native receptor (Cckbr), gastrin-releasing peptide (Grp) and gastrin-releasing peptide receptor (Grpr) in vertebrates. Furthermore, there are still many genes implicated in gastric development and function which have yet to be associated with the agastric phenotype. We analysed the evolution, selection and conservation of the gastrin pathway and a novel gastric gene repertoire (Gkn1, Gkn2, Tff1, Tff2, Vsig1 and Anxa10) to determine the correlation with the agastric phenotype. We found that the loss of gastrin or its associated genes does not correlate with the agastric phenotype, and their conservation is due to multiple pleiotropic roles throughout vertebrate evolution. We found a loss of the gastric gene repertoire in the agastric phenotype, except in the echidna, which retained several genes (Gkn1, Tff2 and Vsig1). Our findings suggest that the gastrin physiological pathway evolved differently in pleiotropic roles throughout vertebrate evolution and support the convergent evolution of the agastric phenotype through shared independent gene-loss events. Full article

With the increasing awareness of energy consumption issues, there has been a growing emphasis on energy-saving retrofits for central air-conditioning systems that constitute a significant proportion of energy consumption in buildings. Efficient energy utilization can be achieved by optimizing the modeling of the equipment within the chiller plants of central air-conditioning systems. Traditional modeling approaches have been static and have focused on modeling within narrow time frames when a certain amount of equipment operating data has accumulated, thus prioritizing the precision of the model itself while overlooking the fact that energy-saving retrofits are a long-term process. This study proposes a modeling scheme for the equipment within chiller plants throughout the energy-saving retrofit process. Based on the differences in the amount of available operating data for the equipment and the progress of retrofit implementation, the retrofit process was divided into three stages, each employing different modeling techniques and ensuring smooth transitions between the stages. The equipment within the chiller plants is categorized into two types based on the clarity of their operating characteristics, and two modeling schemes are proposed accordingly. Based on the proposed modeling scheme, chillers and chilled-water pumps were selected to represent the two types of equipment. Real operating data from actual retrofit projects was used to model the equipment and evaluate the accuracy of the model predictions. The results indicate that the models established by the proposed modeling scheme exhibit good accuracy at each stage of the retrofit, with the coefficients of variation (CV) remaining below 6.88%. Furthermore, the prediction accuracy improved as the retrofitting process progressed. The modeling scheme performs better on equipment with simpler and clearer operating characteristics, with a CV as low as 0.67% during normal operation stages. This underscores the potential application of the proposed modeling scheme throughout the energy-saving retrofit process and provides a model foundation for the subsequent optimization of the refrigeration system. Full article

Background: Compared to the conventional method of machining granite, abrasive water jet machining (AWJM) offers several benefits, including flexible cutting mechanisms and machine efficiency, among other possible advantages. The high-speed particles carried by water remove the materials, preventing heat damage and maintaining the granite’s structure. Methods: Three types of granite with different compressive strengths are investigated in terms of the effects of pump pressure (P), traverse speed (T), and abrasive mass flow (A) on the cutting depth. Results: The results of the study demonstrated that the coarse-grained granite negatively affected the penetration depth, while the fine-grained granite produced a higher cutting depth. The value of an optimal depth of penetration was also generated; for example, the optimum depth obtained for Black Galaxy Granite, M1 (32.27 mm), was achieved at P = 300 MPa, T = 100 mm/min, and A = 180.59 g/min. Conclusions: In terms of processing parameters, the maximum penetration depth can be achieved in granite with a higher compressive strength. Full article

The Union of the Comoros, located in the Indian Ocean, faces persistent energy challenges due to its geographic isolation, heavy dependence on imported fossil fuels, and underdeveloped electricity infrastructure. This study investigates the techno-economic optimization of a hybrid microgrid designed to supply electricity to a rural village in Grande Comore. The proposed system integrates photovoltaic (PV) panels, wind turbines, a diesel generator, and battery storage. Detailed modeling and simulation were conducted using HOMER Energy, accompanied by a sensitivity analysis on solar irradiance, wind speed, and diesel price. The results indicate that the optimal configuration consists solely of PV and battery storage, meeting 100% of the annual electricity demand with a competitive levelized cost of energy (LCOE) of 0.563 USD/kWh and zero greenhouse gas emissions. Solar PV contributes over 99% of the total energy production, while wind and diesel components remain unused under optimal conditions. Furthermore, the system generates a substantial energy surplus of 63.7%, which could be leveraged for community applications such as water pumping, public lighting, or future system expansion. This study highlights the technical viability, economic competitiveness, and environmental sustainability of 100% solar microgrids for non-interconnected island territories. The approach provides a practical and replicable decision-support framework for decentralized energy planning in remote and vulnerable regions. Full article

To address the limited flexibility of pumped storage power stations (PSPSs) under hierarchical clearing of energy and ancillary service markets, this study proposes a joint clearing mechanism for multi-level electricity markets. A bi-level optimization model based on the Stackelberg game is developed to characterize the strategic interaction between PSPSs and the market operator. Simulation results on the IEEE 30-bus system demonstrate that the proposed mechanism captures the dynamics of nodal supply and demand, as well as time-varying network congestion. It guides PSPSs to operate more flexibly and economically. Additionally, the mechanism increases PSPS profitability, reduces system costs, and improves frequency regulation performance. This game-theoretic framework offers quantitative decision support for PSPS participation in multi-level spot markets and provides insights for optimal storage deployment and market mechanism improvement. Full article

Modernizing irrigation systems (ISs) from traditional gravity methods to sprinkler and drip technologies has significantly improved water use efficiency. However, it has simultaneously increased electricity demand and operational costs. Integrating photovoltaic generators into ISs represents a promising solution, as solar energy availability typically aligns with peak irrigation periods. Despite this potential, photovoltaic pumping systems (PVPSs) often face reliability issues due to fluctuations in solar irradiance, resulting in frequent start/stop cycles and premature equipment wear. The IEC 62253 standard establishes procedures for evaluating PVPS performance but primarily addresses steady-state conditions, neglecting transient regimes. As the main contribution, the current paper proposes a non-intrusive, high-resolution monitoring system and a methodology to assess the performance of an isolated, high-power PVPS, considering also transient regimes. The system records critical electrical, hydraulic and environmental parameters every second, enabling in-depth analysis under various weather conditions. Two performance indicators, pumped volume efficiency and equivalent operating time, were used to evaluate the system’s performance. The results indicate that near-optimal performance is only achievable under clear sky conditions. Under the appearance of clouds, control strategies designed to protect the system reduce overall efficiency. The proposed methodology enables detailed performance diagnostics and supports the development of more robust PVPSs. Full article

Physiological levels of reactive oxygen species (ROS) play a crucial role as intracellular signaling molecules, helping to maintain cellular homeostasis. However, when ROS accumulate excessively, they become toxic to cells, leading to damage to lipids, proteins, and DNA. This oxidative stress can impair cellular function and lead to various forms of cell death, including apoptosis, necroptosis, ferroptosis, pyroptosis, paraptosis, parthanatos, and oxeiptosis. Despite their significance, the role of ROS in autosis (an autophagy-dependent form of cell death) remains largely unexplored. In this review, we gather current knowledge on autotic cell death and summarize how oxidative stress influences the activity of Beclin-1 and the Na⁺,K⁺-ATPase pump, both of which are critical effectors of this pathway. Finally, we discuss the theoretical potential for ROS to modulate this type of cell death, proposing a possible dual role for these species in autosis regulation through effectors such as HIF-1α, TFEB, or the FOXO family, and highlighting the need to experimentally address cellular redox status when working on autotic cell death. Full article

Heavy metal pollution represents a pervasive environmental challenge that significantly exacerbates the ever-increasing crisis of antimicrobial resistance and the capacity of microorganisms to endure and proliferate despite antibiotic interventions. This review examines the intricate relationship between heavy metals and AMR, with an emphasis on the underlying molecular mechanisms and ecological ramifications. Common environmental metals, including arsenic, mercury, cadmium, and lead, exert substantial selective pressures on microbial communities. These induce oxidative stress and DNA damage, potentially leading to mutations that enhance antibiotic resistance. Key microbial responses include the overexpression of efflux pumps that expel both metals and antibiotics, production of detoxifying enzymes, and formation of protective biofilms, all of which contribute to the emergence of multidrug-resistant strains. In the soil environment, particularly the rhizosphere, heavy metals disrupt plant–microbe interactions by inhibiting beneficial organisms, such as rhizobacteria, mycorrhizal fungi, and actinomycetes, thereby impairing nutrient cycling and plant health. Nonetheless, certain microbial consortia can tolerate and detoxify heavy metals through sequestration and biotransformation, rendering them valuable for bioremediation. Advances in biotechnology, including gene editing and the development of engineered metal-resistant microbes, offer promising solutions for mitigating the spread of metal-driven AMR and restoring ecological balance. By understanding the interplay between metal pollution and microbial resistance, we can more effectively devise strategies for environmental protection and public health. Full article

Nosocomial infections caused by ESKAPE pathogens represent a significant burden to global health. These pathogens may exhibit multidrug resistance (MDR) mechanisms, of which mechanisms such as efflux pumps and biofilm formation are gaining significant importance. Multidrug resistance mechanisms in ESKAPE pathogens have led to an increase in the effective costs in health care and a higher risk of mortality in hospitalized patients. These pathogens utilize antimicrobial efflux pump mechanisms and bacterial biofilm-forming capabilities to escape the bactericidal action of antimicrobials. ESKAPE bacteria forming colonies demonstrate increased expression of efflux pump-encoding genes. Efflux pumps not only expel antimicrobial agents but also contribute to biofilm formation by bacteria through (1) transport of molecules and transcription factors involved in biofilm quorum sensing, (2) bacterial fimbriae structure transport for biofilm adhesion to surfaces, and (3) regulation of a transmembrane gradient to survive the difficult conditions of biofilm microenvironments. The synergistic role of these mechanisms complicates treatment outcomes. Given the mechanistic link between biofilms and efflux pumps, therapeutic strategies should focus on targeting anti-biofilm mechanisms alongside efflux pump inactivation with efflux pump inhibitors. This review explores the molecular interplay between efflux pumps and biofilm formation, emphasizing potential therapeutic strategies such as efflux pump inhibitors (EPIs) and biofilm-targeting agents. Full article