Search Results (1,390)

Background/Objective: Ovarian hyperstimulation syndrome (OHSS) is a severe complication during controlled ovarian hyperstimulation. Ascites and consecutive hemoconcentration may lead to potentially life-threatening complications like thromboembolic events and the need for intensive care. The use of diuretics is widely used to treat ascites in non-OHSS patients. The aim of this study was to assess whether the use of furosemide in the treatment of OHSS was associated with a higher rate of complications compared to the literature. Methods: In this retrospective cohort study, 502 cases treated from January 2005 to June 2023 for OHSS at the Medical University of Vienna were evaluated regarding the distribution of OHSS severity, average duration of treatment, types and frequency of complications associated with antidiuretic treatment, and predictive factors for paracentesis. Results: The median AMH levels were 5.7 ng/mL. An antagonist protocol was used in 80% of stimulations. Human Chorionic Gonadotropin trigger was used in 80% of stimulations, with 71.7% of cases being early-onset. The incidence dropped from 8.4% (2006 to 2016) to 3.3% (from 2015 to 2023). The median duration of inpatient treatment was seven days, with about 75% of patients receiving furosemide as a diuretic treatment. Ascites drainage was necessary in 27.9%. None of our patients developed a thromboembolic complication following the furosemide treatment. Conclusions: During the study period, the incidence of OHSS declined, most probably as a result of advances in ovarian stimulation protocols and freezing strategies. In moderate to severe OHSS, standardized diuretic treatment with furosemide was not associated with additional thromboembolic complications as long as patients remain normovolemic. Full article

Background/Objectives: Interventional endoscopic ultrasound (I-EUS) has evolved from a diagnostic imaging modality into a transformative therapeutic platform encompassing biliary drainage, pancreatic interventions, luminal bypass, pain management, and ablative therapies. Despite the rapid proliferation of I-EUS research, a comprehensive bibliometric analysis characterizing the global intellectual architecture of this field is lacking. Methods: A Web of Science Core Collection search identified 4340 records, of which 2237 were included (2001–2024), analyzed with R bibliometrix (version 5.0) and VOSviewer (version 1.6.20). Results: Publication output demonstrated three distinct phases with pronounced acceleration from 2017. The United States led global output (n = 625, 27.9%), followed by Japan (n = 435, 19.4%) and Italy (n = 166, 7.42%). At the continental level, Asia collectively produced the largest share of output (n = 884, 39.5% of the total corpus), exceeding the Americas (n = 687, 30.7%) and Europe (n = 492, 22.0%). Gastrointestinal Endoscopy was the most productive journal (n = 173). Tokyo Medical University was the most productive institution (n = 93, 4.16%). Four thematic clusters were identified: EUS-guided biliary and pancreatic ductal drainage; diagnostic, ablative, and injection EUS for pancreatic tumors; LAMS-enabled luminal bypass and gallbladder drainage; and pancreatic fluid collections and necrotizing pancreatitis. Temporal overlay confirmed EUS-guided gastroenterostomy, EUS-guided gallbladder drainage, and EUS-guided radiofrequency ablation as the leading research frontiers. Annual output showed no discernible contraction during the COVID-19 pandemic period (2020–2021). Conclusions: The United States led global I-EUS research output with higher rates of international collaboration compared with East Asian nations, although Asia as a continent generated the largest aggregate volume of publications. EUS-guided biliary drainage and pancreatic fluid collection management constitute the established, high-volume core of the field, while EUS-guided gastroenterostomy and novel ablative technologies represent the most dynamic investigative frontiers. Full article

Coal-bearing tight gas and deep coalbed methane (CBM) widely co-occur in China, and integrated commingled production outperforms separate development. Conventional separated simulation fails to capture coupled reservoir–wellbore gas–water flow. This study develops an integrated geomechanical coupled numerical model with multi-scale fractures and multi-phase wellbore flow: tight gas reservoirs use a stress-sensitive single-porosity model, deep CBM adopts a dual-porosity model for matrix desorption, and EDFM characterizes non-Darcy flow in hydraulic fractures. The Gray gas column and liquid column methods calculate layered bottomhole pressure according to reservoir vertical distribution, and matrix bordering solves the whole coupled system. Validated by field data of Well C-1 in Shanxi, the model yields average relative errors of 8.76% for daily gas output and 2.92% for daily water output. Sensitivity analysis on Well C-2 indicates vertical reservoir stacking controls interlayer pressure difference, and commingled gas curves show dual peaks with shifting dominant gas sources over production stages. A 3.9% rise in deep coalbed methane gas content significantly boosts mid-term peak production and cumulative gas output, making reservoir gas content the dominant geological factor governing commingled production performance. A 120.0% increase in tight gas saturation only delivers a slight uplift in cumulative production under low-porosity conditions. Elevated reservoir stress sensitivity triggers a cumulative gas production reduction of over 50%. Cumulative gas output varies proportionally with hydraulic fracture length, while fracture network width brings mismatched production improvement due to pressure drawdown funnel effects. Therefore, hydraulic fracturing operations should prioritize extending artificial fractures to expand the drainage area of commingled wells. Schemes with constant bottomhole flowing pressure and constant gas rate exert marginal influences on ultimate cumulative production and can be flexibly switched on site. To stabilize daily gas deliverability throughout the early, middle and late production stages, a bottomhole pressure drawdown rate of 0.05 MPa/d or a fixed daily gas rate of 4000 m³/d is recommended. This work provides theoretical support for optimizing commingled development of superimposed tight gas and deep CBM reservoirs. Full article

Background/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness. Full article

High-volume, long-duration flowback in ultra-deep fractured wells couples pressure, rate, water production, fracture conductivity, and stress-sensitive reservoir properties, making it difficult for pressure transient analysis (PTA), flowing material balance (FMB), and rate transient analysis (RTA) to maintain parameter continuity across flowback stages. This study proposes a physics-constrained artificial-intelligence (AI)-assisted workflow centered on FMB. PTA provides permeability, fracture half-length, and fracture-conductivity priors; RTA, Blasingame, and Agarwal–Gardnerdiagnostics provide production-dynamic constraints; and machine-learning models perform anomaly screening, stage recognition, time-series correction, type-curve discrimination, and multi-method fusion. The workflow was applied to Well Baitan 1, an ultra-deep fractured gas well with eight-stage fracturing and multi-regime flowback data. Isolation forest preprocessing removed 32 abnormal records, random forest (RF) drainage-type classification reached 93% accuracy, and long short-term memory (LSTM) correction improved production-forecast fitting from 87% to 95%. Neural-network fusion yielded matrix permeability of 0.49 mD and dynamic reserves of 1.93 × 10⁴ m³, reducing static geological-volume validation error to 2.8%. The results show that AI improves productivity evaluation when constrained by diagnostic flow models and geological validation, providing a traceable basis for optimizing flowback intensity, monitoring frequency, and stabilized deliverability estimation. Full article

Acidic mine drainage (AMD) rich in heavy metals and sulfates causes severe environmental hazards. SRB and SOB are ideal remediation strains, yet their microaerophilic symbiotic metabolism and metabolite characteristics remain ambiguous. This study explores their symbiotic metabolic mechanisms, optimizing culture parameters via response surface methodology and multi-objective genetic neural network algorithms. The optimal conditions are 32.60 °C, pH = 7.20, strain ratio at 1:1 and DO = 0.3–0.5 mg/L, achieving 80.27% sulfate removal and 60.60% elemental sulfur production. Under optimized microaerobic symbiosis, Cu²⁺, Zn²⁺ and sulfate removal rates reach 90.16%, 80.59% and 63.97%, with a S⁰ yield of 64.67%. SEM-EDS, XRD, XPS, and microbial diversity analysis verify that heavy metals are eliminated as metal sulfide precipitates, and most of the sulfate transforms into recyclable elemental sulfur. Full article

Siphon vertical axial-flow pump systems are widely used in large-scale low-head pumping stations, irrigation and drainage projects, urban flood control, and water diversion engineering, where safe and stable operation is essential for hydraulic system reliability. Compared with steady operating conditions, the startup process involves rapid variations in impeller speed, flow rate, pressure distribution and hydraulic energy transfer, resulting in highly transient hydraulic behavior and obvious instability in the internal flow field. To clarify the transient hydraulic response of a siphon vertical axial-flow pump system during startup, an unsteady numerical model was established by coupling the impeller speed control equation with a dynamic boundary condition implemented through a user-defined function. The time-dependent evolution of flow rate, head, blade loading, pressure distribution, internal flow pattern and energy conversion characteristics was then investigated during the whole startup process. The results show that the pump system undergoes a distinct transition from an initially unstable flow state to a quasi-steady operating condition. At the early startup stage, the flow passage is not fully established, and the pump operates under a low-flow transient condition, leading to strong flow disorder, uneven blade loading and a sharp fluctuation in head. With the increase in rotational speed and flow rate, the internal flow gradually becomes organized, the pressure distribution on the blade surface tends to be more uniform, and the hydraulic energy transfer process becomes progressively stable. The pump head first exhibits an abnormal transient peak, then decreases rapidly, and finally recovers to a stable value as the flow field is fully established. The study reveals the transient evolution mechanism of hydraulic performance and energy conversion during startup, providing a theoretical basis for improving startup control strategy and operational stability of siphon vertical axial-flow pump systems. Full article

Rift Valley fever (RVF) is a climate-sensitive mosquito-borne zoonosis long regarded as a rural, pastoral disease, yet accelerating tropical urbanization and intensifying climate variability may be reshaping its epidemiology at the urban–peri-urban interface. This narrative review examines how global climate change and urban-specific climatic conditions jointly shape RVF virus (RVFV) vector habitats, transmission, and burden in tropical and subtropical cities, synthesizing 51 of 412 English-language records identified by a structured, non-systematic search of PubMed, Scopus, Web of Science, and Google Scholar (2009–2026) and selected for relevance to urban and peri-urban RVF. This research draws on human, livestock, and vector evidence from Sub-Saharan Africa, the Arabian Peninsula, and Indian Ocean islands across epidemic and inter-epidemic periods. The synthesis indicates that impervious surfaces, poor drainage, and open water storage can recreate the water-retaining function of rural dambos, sustaining a year-round larval habitat, and that Culex quinquefasciatus dominance together with peri-urban cattle may form an amplification bridge to humans. Direct evidence remains scarce, anchored by a single peri-urban serosurvey and limited urban slaughterhouse entomology. Critical gaps include urban primary-vector ecology, infection-rate data, urban-heat effects, city-specific exposure studies, and coupled climate–urban burden models. We conclude that RVF is a plausible emerging urban threat warranting proactive inter-epidemic surveillance and integration of RVF into urban planning and One Health systems. Full article

Objectives: Factors influencing outcomes of endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction remain unclear. We evaluated clinical factors associated with surgical success. Methods: We retrospectively reviewed patients who underwent endoscopic DCR for this indication (2012–2022). Allergic rhinitis, obstruction level and type, canalicular intubation stent (CIS) insertion, and adjunctive procedures were analyzed against surgical success, epiphora scores, and SNOT-22 change using multivariate logistic regression. Results: Among 300 eyes (259 patients), the success rate was 82.0%. Epiphora scores improved from 7.6 ± 1.3 to 4.0 ± 2.3 and SNOT-22 from 17.3 ± 19.1 to 11.1 ± 14.2 (both p < 0.001). Sac-level and duct–sac junction obstructions had higher success than canalicular obstruction, and allergic rhinitis was associated with less epiphora improvement. CIS insertion was associated with lower success; however, this was confined to functional (42.0% vs. 92.0%) and canalicular-level (53.3% vs. 77.6%) obstruction—where CIS was selectively used—and absent in drainage-level obstruction (85.3% vs. 85.7%), indicating confounding by indication. Conclusions: Endoscopic DCR yields favorable outcomes with significant epiphora and quality-of-life improvement. Obstruction level, allergic rhinitis, and CIS insertion were associated with surgical outcomes; the CIS association, however, likely reflects confounding by indication rather than a direct adverse effect, as CIS was selectively used in functional and canalicular-level obstruction. Full article

Background: Based on the demonstrated survival benefits of gemcitabine plus cisplatin (GemCis) therapy in the TOPAZ-1 and KEYNOTE-966 trials, GemCis plus immune checkpoint inhibitor (ICI) therapy has become a standard first-line treatment for unresectable biliary tract cancer. However, its safety and efficacy in elderly patients and those requiring biliary drainage remain insufficiently evaluated in real-world practice. We aimed to evaluate the efficacy and safety of GemCis plus ICI therapy, with a focus on elderly patients and those requiring biliary drainage. Methods: We retrospectively analyzed the clinical characteristics of patients with unresectable biliary tract cancer treated with GemCis plus ICI at our institution between April 2022 and September 2025. Progression-free survival (PFS) was analyzed using the Kaplan–Meier method, and prognostic factors were examined using Cox proportional hazards models. PFS and immune-related adverse events (irAEs) were compared between durvalumab and pembrolizumab. Results: Of the 51 patients diagnosed with unresectable biliary tract cancer during the observation period, 26 (51.0%) received GemCis plus ICI therapy. The median age was 73 years (range, 46–83 years), and 15 (57.7%) patients were male. Distant metastases were present in 22 patients (84.6%), and biliary drainage was performed in 15 (57.7%). The primary tumor sites were intrahepatic cholangiocarcinoma (n = 8), perihilar cholangiocarcinoma (n = 6), gallbladder cancer (n = 11), and cancer of unknown primary origin (n = 1). The ICIs used were durvalumab in 18 patients and pembrolizumab in eight patients. The median follow-up period was 214 days (range, 30–1114). The response rate was 28.6%, the disease control rate was 90.5%, and the transition rate to ICI maintenance therapy was 29.2%. IrAEs occurred in six patients (23.1%), with a significantly higher frequency in the pembrolizumab group than in the durvalumab group (50.0% vs. 11.1%). The median PFS was 8.2 months in the durvalumab group and 8.9 months in the pembrolizumab group, with no significant difference (p = 0.88). Multivariate analysis incorporating age, performance status, metastatic burden, and liver function confirmed that age ≥ 75 years remained the only independent predictor of shorter PFS (HR 5.62; 95% CI, 1.35–23.4; p = 0.02), whereas ICI regimen and biliary drainage were not significant prognostic factors. Conclusions: In clinical practice, GemCis plus ICI therapy showed no statistically significant difference in efficacy between ICI regimens in this small cohort, although this comparison was not statistically powered. Given the exploratory nature of these findings, the lower incidence of immune-related adverse events (irAEs) observed in the durvalumab group should be interpreted with caution. Age ≥ 75 years was associated with shorter PFS. Careful patient selection is warranted when considering GemCis plus ICI therapy in elderly patients with biliary tract cancer. Full article

This study investigates the mechanisms and performance of oxygen-reduced air flooding (ORAF) and oxygen-reduced air gravity drainage (ORAGF) through laboratory experiments on crude oil and cores from the Kunbei Oilfield. PVT experiments show that injecting N₂ or oxygen-reduced air (5% and 10% O₂) increases saturation pressure and reduces oil viscosity comparably. Low-temperature oxidation (LTO) tests reveal that oxygen consumption rate declines exponentially with decreasing initial O₂ concentration; at 5% O₂, oxidation products are nearly indistinguishable from the original crude oil. Long-core displacement experiments demonstrate that vertical (gravity-assisted) injection significantly outperforms horizontal injection, with oil recovery reaching 39.8% (10% O₂) versus 26.2% horizontally, owing to gravity segregation suppressing gas fingering and enhancing oil–gas contact. Among injection strategies, gas-assisted gravity drainage (GAGD) and water-alternating-gas (WAG) improve recovery by 7.7% and 7.2% over continuous waterflooding, respectively, with GAGD being more suitable for high water cut reservoirs. Reservoir rhythm and permeability contrast affect performance and gravity-driven injection mobilizes low-permeability layers more effectively than horizontal injection, exhibiting good adaptability to heterogeneous reservoirs. Fracture orientation relative to injection direction plays a critical role—horizontal fractures achieve the highest recovery (~50%), whereas through-going fractures impair performance. These findings provide experimental guidance for optimizing oxygen-reduced air gravity flooding in tight and heterogeneous oil reservoirs. Full article

Child-well stimulation design has become a central challenge in mature unconventional reservoirs, where infill wells are commonly completed in reservoirs that have already been modified by parent-well production. Prior depletion changes pore pressure, stress distribution, and fracture-propagation pathways, causing child-well treatments to behave differently from parent-well completions. As a result, increasing fluid volume, proppant loading, stage density, or pump rate does not necessarily produce proportional gains in recovery. This review synthesizes the comprehensive literature on child-well stimulation intensity with emphasis on well performance, fracture-driven interactions, pad-scale economics, diagnostics, and resource-use considerations. The analysis shows that the production response is highly conditional: larger treatments can enhance reservoir contact when fractures access underdrained rock; however they may lose effectiveness when depletion-induced stress changes redirect fracture growth toward parent-well drainage areas or pre-existing fracture networks. In such cases, higher nominal intensity can increase interwell communication, reduce completion efficiency, impair parent-well performance, and weaken pad-level economic value. A key outcome of this review is the distinction between nominal stimulation intensity, represented by the treatment pumped, and effective stimulation intensity, represented by the fraction of that treatment that creates incremental productive fracture area. This distinction reframes child-well optimization from a treatment-size problem to a depletion-aware fracture-placement problem. Diagnostics, coupled modeling, production analysis, and mitigation strategies are therefore necessary to determine whether added stimulation intensity improves recovery or primarily redistributes production within the pad. From an economic perspective, the pad rather than the individual child well is the correct unit for evaluating stimulation-intensity decisions, since pad-level net present value integrates incremental child-well recovery, parent-well degradation, protection costs, spacing effects, and completion capital. Produced-water reuse and lifecycle emission benchmarking represent practical tools for reducing the environmental footprint of child-well development programs while simultaneously lowering freshwater demand and disposal volumes. These economic and environmental dimensions are inseparable from the technical optimization of stimulation intensity and are addressed explicitly in this review. This review concludes that child-well stimulation intensity should be optimized within a pad-scale framework that integrates depletion state, spacing, landing-zone selection, parent-well management, and long-term value rather than being uniformly maximized. Full article

Objective: To evaluate the feasibility of sentinel lymph node (SLN) identification in distal esophageal and esophagogastric junction (EGJ) adenocarcinoma and determine whether the SLN concept applies to this disease. Methods: Patients undergoing esophagectomy for clinical stage I-IVA esophageal and EGJ adenocarcinoma underwent SLN mapping by near-infrared detection of indocyanine green (ICG) injected via endoscopy before esophagectomy. Lymphatic drainage patterns were recorded, and the first identified nodes (SLNs) were harvested. Standard esophagectomy and lymphadenectomy were performed. SLN status was compared with overall nodal status. Results: Of 90 included patients, 77 received ICG; SLN mapping was successful in 64 (83%). Ten patients had two SLN stations identified; the remainder had one. The most common SLN location was along the left gastric artery (36/74 [48%]), followed by the paracardial (17/74 [23%]) and periesophageal (15/74 [20%]) stations. Seven patients had SLNs positive for metastasis (in one, the SLN was the only positive node; in the rest, metastatic nodes were identified in the same or other stations). Of the 57 patients with negative SLNs, 11 (19%) had ≥1 positive node in the same or different nodal station. The false-negative rate was 61.1%. Conclusions: SLN mapping with ICG is feasible in patients with distal esophageal and EGJ adenocarcinoma, with a high rate of successful node identification. Occult nodal metastasis in patients with negative SLNs limits the reliability of SLN assessment as a determinant for selective lymphadenectomy. Full article

At the same structural position within the northern part of Block K, the coalbed methane (CBM) wells in the 3^# and 15^# coal seams exhibit marked productivity disparities. This study integrates a correlation analysis of engineering parameters with dynamic diagnosis of production indicator curves to examine two dimensions: static engineering compatibility and dynamic seepage interference. The results show that the degree of matching between engineering parameters and geological conditions is a key factor controlling the productivity variation. The 3^# coal seam has favorable engineering performance, and boosting fracturing scale and drainage rate both help promote gas output. Compared with the 3^# coal seam, the 15^# coal seam has a notable deficiency in engineering compatibility: its effective horizontal section length and coal encounter rate decrease by 8.4% and 5%, respectively, while sidetracking frequency increases approximately fivefold; moreover, enlarging fracturing scale does not bring better gas results. Production indicator curves were established based on the relationship between cumulative water production per unit effective horizontal length and production pressure difference and were classified into upward-convex and downward-concave types. The resulting chart for exogenous water interference enables quantitative characterization of key metrics, including theoretical ultimate gas production, interference level, and gas production efficiency. The theoretical ultimate gas production of the 3^# coal seam reaches 69.454 m³/(d·m), over ten times that of the 15^# coal seam, but the critical interference threshold of the 3^# seam is lower than that of the 15^# seam. Most 3^# wells are stably located in the non-interference zone, indicating high production capacity and strong sensitivity to exogenous water interference. For the 15^# seam, the production indicator curves of most wells deviate toward the interference zone at an early production stage, reflecting strong exogenous water leakage recharge. Therefore, for this block, CBM development must shift from the traditional approach of blindly enlarging stimulation scale to geological compatibility and recognition of exogenous water interference. Full article

Flooding during the rice (Oryza sativa L.) jointing stage threatens yield stability in regions with concentrated rainfall and limited drainage. However, the extent to which the water regime before flooding modifies rice growth and yield formation remains poorly understood. A pot experiment was conducted over two years to compare controlled irrigation (CI) with conventional flooding irrigation (CF) across three flooding depths and two durations imposed at the jointing stage. Flooding increased tiller number, plant height, and total leaf area, but reduced net photosynthetic rate and grain yield. Yield loss increased with flooding depth and duration. Under corresponding flooding treatments, CI moderated vegetative expansion and maintained a higher net photosynthetic rate, greater root dry matter, and a higher root-to-shoot ratio than CF. Relative to the corresponding non-flooded controls, yield loss ranged from 4.11% to 39.33% under CI and from 5.63% to 52.50% under CF. The lower yield loss under CI was associated with greater effective panicle number, higher seed setting rate, and better maintenance of photosynthetic activity and root biomass. These findings indicate that the water regime before flooding can influence biomass allocation and yield formation during the jointing stage flooding. Controlled irrigation combined with timely drainage may help reduce yield risk in rice systems exposed to temporary flooding. Full article