Search Results (127)

Background: High-voltage electrical injuries (HVEIs) represent a complex and life-threatening entity, frequently involving multi-organ damage. While traditionally linked to occupational hazards, train surfing—riding on moving trains—and train climbing—scaling stationary carriages—have emerged as increasingly common causes among adolescents. Popularized via social media, these behaviors expose individuals to the invisible danger of electric arcs from 15,000-volt railway lines, often resulting in extensive burns, cardiac complications, and severe trauma. This study presents a 30-year retrospective analysis comparing cardiac biomarkers and clinical outcomes in train-surfing injuries versus work-related HVEIs. Methods: All patients with confirmed high-voltage injury (≥1000 volts) admitted to a Level 1 burn center between 1994 and 2024 were retrospectively analyzed. Exclusion criteria comprised low-voltage trauma, suicide, incomplete records, and external treatment. Clinical and laboratory parameters—including total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), electrocardiogram (ECG) findings, intensive care unit (ICU) and hospital stay, mortality, and cardiac biomarkers (creatine kinase [CK], CK-MB, lactate dehydrogenase [LDH], aspartate transaminase [AST], troponin, and myoglobin)—were compared between the two cohorts. Results: Of 81 patients, 24 sustained train-surfing injuries and 57 were injured in occupational settings. Train surfers were significantly younger (mean 16.7 vs. 35.2 years, p = 0.008), presented with greater TBSA (49.9% vs. 17.9%, p = 0.008), higher ABSI scores (7.3 vs. 5.1, p = 0.008), longer ICU stays (53 vs. 17 days, p = 0.008), and higher mortality (20.8% vs. 3.5%). ECG abnormalities were observed in 51% of all cases, without significant group differences. However, all cardiac biomarkers were significantly elevated in train-surfing injuries at both 72 h and 10 days post-injury (p < 0.05), suggesting more pronounced cardiac and muscular damage. Conclusions: Train-surfing-related high-voltage injuries are associated with markedly more severe systemic and cardiac complications than occupational HVEIs. The significant biomarker elevation and critical care demands highlight the urgent need for targeted prevention, public awareness, and early cardiac monitoring in this high-risk adolescent population. Full article

Background: Biosimilar versions of rituximab have similar safety and efficacy as the reference product across all indications based on the extrapolation principle. Our organization replaced intravenous (IV) rituximab (Mabthera) with IV rituximab (Truxima-Biosimilar) in 2021. Hence, our practice changed to providing first cycles of IV rituximab (Truxima-Biosimilar) instead of rituximab (Mabthera), and if the first cycle was completed without severe infusion-related reactions (IRRs), then subsequent cycles were given with subcutaneous (SC) rituximab as per institutional guidelines. However, the safety of this approach has not been evaluated. Methods: A retrospective study was conducted at the Princess Nourah Oncology Center in Saudi Arabia. The primary objective was to assess IRRs after using IV rituximab (Truxima-Biosimilar) in the first cycle followed by SC rituximab in subsequent cycles. Results: Of the 71 patients reviewed, 35 patients met the eligibility criteria. Only one (3%) patient developed an IRR. However, it was a Grade 1 IRR, as per CTCAE.V5, and the patient was able to complete the remaining IV infusion successfully. Hence, all patients transitioned from IV rituximab biosimilar to SC rituximab Mabthera. Conclusions: This real-world study demonstrates that transitioning from IV rituximab biosimilar to SC Mabthera is a well-tolerated and safe practice, confirming the extrapolation principle of biosimilars. Full article

Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s pre-existing conditions influence requirements. Methods: We analysed outcomes and influencing factors of fluid regimes in a retrospective cohort study including 90 severely burnt patients resuscitated with the same protocol. Results: The mean amount of fluids in the first 24 h was 6.5 mL/kg bodyweight (BW)/% total burn surface area (TBSA). A total of 14% received restrictive (<4), 34% received liberal (4–6) and 51% received excessive (>6) mL/kgBW/%TBSA fluids. There was no difference regarding mortality, age, complications, organ failure, inhalation injury or full-thickness burns in the groups. Patients with excessive fluid therapy had a significantly lower ABSI score (9 vs. 11, p = 0.05) and TBSA (35 vs. 51%, p < 0.001), while patients with a restrictive fluid therapy needed fewer incidences of surgery to cover burn wounds (3.5 vs. 9.0 vs. 7.0, p = 0.008). History of liver disease or alcohol abuse tended to indicate excessive fluid administration. Patients with pre-existing heart failure received restrictive fluid therapy (23 vs. 3 vs. 4%, p = 0.03). Conclusions: Individualised, timely therapy monitoring is as essential as identifying patients with a higher or lower fluid requirement. Excessive fluid resuscitation had fewer deleterious consequences in complications than expected but seems to influence wound healing. Awareness of circumstances that prompt deviations from recommended fluid rates remains elementary. Full article

Background/Objectives: Obesity is a key driver of cardiovascular disease (CVD), with central adiposity directly involved in adverse cardiac remodeling. Body mass index (BMI) is limited in capturing fat distribution and associated cardiovascular risk. Novel anthropometric indices, including A Body Shape Index (ABSI) and Body Roundness Index (BRI), may offer greater clinical value, but their relationship with electrocardiographic markers of left ventricular hypertrophy (LVH) remains underexplored. This study aims to assess the correlation between novel adiposity indices (ABSI and BRI) and electrocardiographic evidence of LVH, as measured by the Sokolow-Lyon Index (SLI), in individuals with arterial hypertension. Methods: 274 hypertensive patients were recruited, and BMI, ABSI, and BRI were calculated. LVH was assessed via SLI on 12-lead ECG. Participants were stratified by the SLI (≤35 mm vs. >35 mm) for statistical analyses. Results: Patients with a lower SLI showed significantly higher values of ABSI and BRI compared to those in higher SLI group, without differences in BMI. In the entire population, SLI was significantly and inversely correlated with both ABSI (r = −0.296, p < 0.001) and BRI (r = −0.238, p < 0.01), but not with BMI. Multivariate regression analysis confirmed ABSI (p = 0.013) and BRI (p = 0.038) as independent predictors of SLI, even after adjusting for age, blood pressure, renal function, and metabolic parameters. Conclusions: ABSI and BRI are inversely and independently associated with ECG-derived SLI in hypertensive individuals, suggesting that central adiposity may attenuate ECG voltages and obscure LVH detection. Incorporating novel adiposity indices into ECG interpretation may enhance diagnostic accuracy and risk stratification in obese and hypertensive populations. Longitudinal studies are needed to validate these findings and refine clinical algorithms. Full article

Background/Objectives: Obesity is a major contributor to cardiovascular disease, yet traditional risk assessment methods may overlook behavioral and circadian influences that modulate metabolic health. Chronotype, physical activity, sleep quality, eating speed, and breakfast habits have been increasingly associated with cardiometabolic outcomes. This study aims to evaluate the associations between these behavioral factors and both anthropometric and biochemical markers of cardiovascular risk among obese candidates for bariatric surgery. Methods: A cross-sectional study was conducted in a sample of 286 obese adults (78.3% females, mean 44.3 years, SD = 10.8, mean BMI = 42.5 kg/m², SD = 6.2) followed at a central Portuguese hospital. Chronotype (reduced Morningness–Eveningness Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), physical activity (Godin–Shephard Questionnaire), eating speed, and breakfast skipping were assessed. Cardiovascular risk markers included waist-to-hip ratio (WHR), waist-to-height ratio, A Body Shape Index (ABSI), Body Roundness Index, atherogenic index of plasma (AIP), triglyceride–glucose index (TyG), and homeostatic model assessment for insulin resistance (HOMA-IR). Results: Men exhibited significantly higher WHR, ABSI, HOMA-IR, TyG, and AIP. Eveningness was associated with higher insulin (r = −0.168, p = 0.006) and HOMA-IR (r = −0.156, p = 0.011). Poor sleep quality was associated with higher body fat mass (r = 0.151, p = 0.013), total cholesterol (r = 0.169, p = 0.005) and LDL cholesterol (r = 0.132, p = 0.030). Faster eating speed was associated with a higher waist circumference (r = 0.123, p = 0.038) and skeletal muscle mass (r = 0.160, p = 0.009). Conclusions: Male sex, evening chronotype, and poor sleep quality were associated with more adverse cardiometabolic profiles in individuals with severe obesity. These findings support the integration of behavioral and circadian factors into cardiovascular risk assessment strategies. Full article

Brain tumours (BTs) are among the most dangerous and life-threatening cancers in humans of all ages, and the early detection of BTs can make a huge difference to their treatment. However, grade recognition is a challenging issue for radiologists involved in automated diagnosis and healthcare monitoring. Recent research has been motivated by the search for deep learning-based mechanisms for segmentation and grading to assist radiologists in diagnostic analysis. Segmentation refers to the identification and delineation of tumour regions in medical images, while classification classifies based on tumour characteristics, such as the size, location and enhancement pattern. The main aim of this research is to design and develop an intelligent model that can detect and grade tumours more effectively. This research develops an aggregated architecture called LGCNet, which combines a local context attention network and a global context attention network. LGCNet makes use of information extracted through the task, dimension and scale. Specifically, a global context attention network is developed for capturing multiple-scale features, and a local context attention network is designed for specific tasks. Thereafter, both networks are aggregated, and the learning network is designed to balance all the tasks by combining the loss functions of the classification and segmentation. The main advantage of LGCNet is its dedicated network for a specific task. The proposed model is evaluated by considering the BraTS2019 dataset with different metrics, such as the Dice score, sensitivity, specificity and Hausdorff score. Comparative analysis with the existing model shows marginal improvement and provides scope for further research into BT segmentation and classification. The scope of this study focuses on the BraTS2019 dataset, with future work aiming to extend the applicability of the model to different clinical and imaging environments. Full article

Background: Gender differences in dietary patterns and lifestyle behaviours may influence abdominal adiposity and cardiometabolic risk, but comprehensive analyses integrating these factors remain limited. Methods: We conducted a cross-sectional study including 1631 adults recruited from a centre specialising in nutrition and metabolic health. Food intake was assessed by 7-day food diaries and lifestyle behaviours were assessed by structured questionnaires. Z scores of a body shape index (zABSI) were calculated as a marker of abdominal adiposity. zABSI represents the standardised value of ABSI, an index specifically designed to assess abdominal adiposity independently of BMI Multivariable linear regression models, stratified by sex and adjusted for age, examined associations between dietary patterns, physical activity and zABSI. Results: Higher intake of plant-based protein was significantly associated with lower zABSI values in women (β = −0.052, p = 0.0053) but not in men (β = −0.015, p = 0.2675). Stratified analyses revealed that women in the middle tertile of plant-based protein intake showed significantly lower zABSI values than men. Combined analyses showed that women classified as physically active and high consumers of plant-based protein had the most favourable abdominal adiposity profiles (p = 0.0036). Participation in endurance and strength sports was associated with lower zABSI values in both sexes, whereas women engaged in team sports had the lowest zABSI values. No significant interaction terms between sex and lifestyle were identified; however, male sex remained an independent predictor of higher zABSI values. Conclusions: In this cross-sectional study, plant-based dietary patterns and physical activity were associated with lower abdominal adiposity, especially among women. These findings suggest the importance of gender-specific strategies to address cardiometabolic risk and emphasise the need for prospective studies to confirm these associations and clarify the underlying mechanisms. Full article

Background: High-voltage injuries associated with train surfing are a distinct subset of electrical injuries, yet detailed analyses remain limited. This study retrospectively reviewed train-surfing injuries admitted between 1994 and 2024, comparing their characteristics and outcomes to work-related high-voltage injuries. Methods: Medical records of 102 patients admitted for high-voltage injuries were analyzed, including 32 train-surfing and 70 work-related cases. Demographics, injury patterns, and clinical outcomes were assessed. Results: Train surfers were predominantly young males (median age 19 years), while work-related injuries involved slightly older males (median age 34 years). Train surfers sustained more severe burns (%TBSA: 47.6% vs. 25.4%, p < 0.0001) and higher ABSI scores (6.7 vs. 5.3, p < 0.01). Vertical electrical flow was predominant in train surfing (65.6%), reflecting contact with overhead lines, while work-related injuries showed varied flow patterns, with diagonal flow being most frequent (58.6%). Train surfers had longer ICU stays (38.7 vs. 17.9 days, p < 0.001) and underwent more surgeries per patient (5.3 vs. 2.8, p < 0.01). Fasciotomy rates were significantly higher among train surfers (84.4% vs. 55.7%, p < 0.01), as were amputations (53.1% vs. 25.7%, p < 0.001). Mortality rates were similar in both groups (25%). Conclusions: Train-surfing injuries represent a distinct and highly severe subgroup of high-voltage trauma, marked by greater burn extent, predominantly vertical electrical flow due to contact with overhead lines, and significantly higher surgical complexity—including increased rates of fasciotomies and amputations. Despite comparable mortality, the clinical burden for train-surfing victims is substantially higher, reflected in longer ICU stays and more operations per patient. These findings underscore the urgent need for targeted prevention strategies addressing youth engagement in train surfing. Public health campaigns, railway infrastructure modifications (e.g., deterrent systems or physical barriers), and early educational interventions could play a critical role in reducing these preventable injuries. Furthermore, trauma centers should be prepared for the specific reconstructive and critical care demands posed by this high-risk group, emphasizing the importance of specialized multidisciplinary management protocols. Full article

This paper presents the kinetic study of titanium carbide (TiC)-supported, platinum-doped tetrahedral amorphous carbon (taC:Pt) referred to as TiC-taC, for the hydrogen evolution reaction (HER). This study employs the Volmer–Heyrovsky–Tafel (VHT) mechanism. A theoretical approach was utilized to investigate the kinetic properties of these materials for an HER in 0.5 M H₂SO₄. TiC-taC exhibited Volmer-dominated reactions with a Tafel slope of 40 mV/dec and the overpotential at 10 mA/cm² was 185 mV. In contrast, isolated TiC and taC:Pt recorded significantly higher Tafel slopes with 60–110 mV/dec and overpotentials of 871 mV and 1009 mV, respectively. The developed model was tested in one dimension (1D) for individual TiC and taC:Pt. The simulated kinetics parameters were determined for both TiC and taC:Pt, revealing that TiC follows the VHT steps, while taC:Pt follows the VH steps. The simulation results show excellent coherence with the experimental results. Further simulation of the hybrid TiC-taC electrocatalyst was conducted considering surface diffusion and edge effects in two (2D) and three dimensions (3D). To the best of our knowledge, this FEM simulation approach is the first to be reported due to the unique geometry of the TiC-taC catalyst enabling the assumption of surface diffusion and edge effect. The introduction of edge effects on the taC:Pt side of the TiC support significantly enhanced the current output, aligning closely with experimental results. The edge exhibited distinct kinetic properties compared to both TiC and taC:Pt. The kinetic parameters determined from the simulation demonstrated strong agreement with experimental findings. Adding the edge effects was essential to explaining the higher current output from the TiC-taC electrode. It exhibited unique kinetic properties not observed in either TiC or taC:Pt alone, acting as a pump where it absorbs c_Hs from neighbouring sites due to surface diffusivity and releases H2 via the Heyrovsky reaction. While surface diffusion had a lesser effect, the simulation indicated its positive influence on the HER. Full article

Digital Twin (DT) technology is emerging as a powerful tool for optimizing energy efficiency and industrial sustainability. By creating virtual replicas of physical systems, DTs enable real-time monitoring, predictive maintenance, and resource optimization, offering new opportunities to meet growing energy demands. Despite its potential, the comprehension of DT technology’s applications, benefits, and challenges remains limited. This systematic review explores the role of Digital Twins in energy efficiency across various industries. A structured literature search was conducted in IEEE Xplore, Elsevier, Springer, MDPI, and Google Scholar, following PRISMA 2020 guidelines. After applying the predefined inclusion criteria, 50 studies were selected for in-depth analysis. The findings highlight that DT implementation can lead to energy savings of up to 30%, reduce operational costs, and improve predictive maintenance strategies. Their impact is particularly notable in smart buildings, manufacturing, and industrial processes, where real-time data analytics contribute to better energy management. However, significant barriers remain, including high implementation costs, data security risks, and the complexity of integrating DTs with existing infrastructures. By synthesizing the current research, this review underscores the transformative potential of Digital Twins while identifying key challenges that need to be addressed for their wider adoption. Future efforts should focus on developing standardized methodologies, reducing implementation costs, and enhancing cybersecurity measures to maximize their benefits in energy efficiency and sustainability. Full article

Background and Objectives: Various adiposity indicators have been used to predict metabolic syndrome (MetS). The aim of the present study was to evaluate the predictive ability of known adiposity indicators, such as abdominal girth, girth/height and fat percentage, as well as less commonly used indicators, such as the conicity index (CI), body roundness index (BRI), visceral adiposity index (VAI) and body shape index (ABSI), to predict MetS. Materials and Methods: A total of 261 participants, including family members and graduates of a flagship school in the city of Trujillo, Peru, participated. Metabolic syndrome was assessed according to the harmonised ATP III criteria. ROC curves were analysed for each of the adiposity indicators using SPSS 26.0 statistical software. Results: The prevalence of MetS was found to be 43.4%, with a higher proportion in men (25.8%). The area under the curve (AUC) for the prediction of MetS exceeded a value of 0.8 for VAI, abdominal circumference, circumference/height and relative fat mass in both men and women, with VAI showing the highest values of 0.858 and 0.875 in women and men, with cut-off points for MetS of 2.57 and 1.73, respectively. Conclusions: VAI can be used in the diagnosis of metabolic syndrome during lipid profile and anthropometric assessment. Full article

Background/Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a significant global burden, attributed to its increasing prevalence and strong correlation with metabolic syndrome and related conditions. Timely diagnosis and intervention are essential for minimizing the impact of MASLD. This study sought to analyze the efficacy of advanced anthropometric indices and non-invasive steatosis markers in diagnosing MASLD. Methods: This cross-sectional retrospective study evaluated the data from 578 Turkish patients admitted to our gastroenterology clinic. MASLD was diagnosed based on internationally recognized criteria. The evaluated parameters included body mass index (BMI); waist–hip ratio (WHR); waist–height ratio (WHtR); body roundness index (BRI); conicity index (CI); a body shape index (ABSI); visceral adiposity index (VAI); abdominal volume index (AVI); lipid accumulation product (LAP); fatty liver index (FLI); hepatic steatosis index (HSI); and triglyceride–glucose index (TyG) and its variants TyG–waist circumference(WC) and TyG–BMI. Results: Among 215 men, 103 (56.9%) met the criteria for MASLD, while 260 out of 363 women (65.5%) fulfilled the criteria. In the receiver operating characteristic (ROC) analysis for identifying MASLD, TyG–WC (0.826), TyG–BMI (0.820), and FLI (0.830) achieved the highest area under the curve (AUC) values, with statistically significant differences observed in their pairwise comparisons against the other parameters. Conclusions: TyG–WC and TyG–BMI are comparable to FLI in terms of simplicity of calculation and superior diagnostic accuracy, making them valuable non-invasive alternatives for MASLD screening and diagnosis. Full article

Background/Objectives: Enzymatic debridement with bromelain is a treatment option for deep partial thickness and full thickness burns. This procedure is associated with significant pain, necessitating the use of anesthesia techniques. However, there is limited evidence on the optimal strategy to achieve effective pain control. To detail the anesthetic approach in patients undergoing bromelain-based enzymatic debridement for burn injuries. Methods: A retrospective observational study was conducted by analysing the medical records of burn patients treated with enzymatic debridement using bromelain. The study included patients admitted to the Burn Unit of Vall d’Hebron University Hospital between January 2015 and December 2019. Results: A total of 112 patients met the inclusion criteria. The average burned total body surface area (TBSA) was 10.7% ± 11.4, and the median Abbreviated Burn Severity Index (ABSI) was 5 (range: 2–12). The most commonly burned and treated regions were the upper limbs (73%), followed by the lower limbs (30%) and the abdomen (8%). Regional anesthesia was the predominant technique, utilised in 96% of cases. Among these, axillary nerve block was performed in 47% of patients, with continuous catheter placement in 31%. Pain control was achieved in 61% of patients during the first 48 h following enzymatic debridement. Opioids were required for post-procedure pain relief in 12.5% of cases, and repeat anesthesia was necessary in 2.7%. There was no significant difference in pain management outcomes between single nerve blocks and catheter-based approaches (p = 0.809). Complications were reported in nine patients and included hypotension, nausea, and urinary retention. Conclusions: Bromelain-based enzymatic debridement is a painful intervention requiring specialised anesthetic management. Regional anesthesia techniques offer a safe and effective strategy for pain control, though achieving optimal analgesia during the initial 48 h remains a clinical challenge. Full article

Vegetable proteins derived from legumes, cereals or pseudocereals have increased in popularity in recent years, becoming very interesting for the food industry. In addition to their nutritional interest, these products have techno-functional properties that allow them to be used in the production of a wide variety of foods. This research has studied the nutritional and mineral composition of 12 samples of rice, pea and soy concentrates. The objective was to investigate the influence of this nutritional composition, mainly mineral components, on the techno-functional properties (water- and oil-binding capacity, swelling, emulsifying, gelling and foaming capacities) of these concentrates. For this purpose, a Pearson correlation matrix and a GH biplot method were applied. The results showed that there is a correlation between mineral content and functional properties. Mg, K and Ca were positively correlated with protein solubility index, oil absorption capacity and swelling capacity. Na and P contents were positively related to water absorption capacity and emulsifying capacity. Gelling capacity was positively correlated with Mg contents and negatively correlated with Cu and Fe contents. The preliminary results reported in this study highlight the necessity to further assess the influence of non-protein components on the techno-functionality of protein concentrates. Full article

Background/Objectives: Metabolic syndrome (MetS) is a cluster of risk factors that significantly increase the risk of cardiovascular disease, including type 2 diabetes, etc. Assessing the predictive diagnostic power of anthropometric indicators for MetS is crucial for the early identification and prevention of related health issues. This study focuses on the Korean adult population while providing insights that may be applicable to broader global contexts. Therefore, this study aimed to compare the predictive diagnostic capabilities of various anthropometric indicators, including body mass index (BMI), waist-to-height ratio (WHtR), muscle mass-to-fat mass ratio (MFR), muscle mass-to-waist ratio (MWR), and body shape index (ABSI), in relation to MetS in Korean adults. Methods: Data from 13,725 participants of the Korea National Health and Nutrition Examination Survey (2008–2011) were analyzed. The diagnostic power of each indicator was assessed using the receiver operating characteristic (ROC) curve analysis, and the area under the curve (AUC) values were compared. Participants were classified into normal (NG) and abnormal (AG) groups based on established cutoff values, and logistic regression analysis was performed to evaluate the odds of MetS in each group. Results: WHtR showed the highest AUC values (0.792 for men and 0.768 for women), indicating superior diagnostic accuracy compared to the other indicators (p < 0.001). Logistic regression analysis indicated that both the unadjusted and adjusted odds ratios (OR) for MetS were significantly higher in the AG than in the NG across all indicators (p < 0.001). Specifically, the adjusted OR (95% confidence interval) for WHtR in the AG was 6.793 (5.929–7.784) for men and 4.665 (4.151–5.423) for women, representing the highest values among all indicators (p < 0.001). Conclusion: Among the various anthropometric indicators, WHtR is the most reliable and practical for predicting MetS in Korean adults. It is useful for early intervention and prevention in both clinical and public health settings. Full article