Search Results (1,238)

In complex energy storage operating scenarios, batteries seldom undergo complete charge–discharge cycles required for periodic capacity calibration. Methods based on accelerated aging experiments can indicate possible aging paths; however, due to uncertainties like changing operating conditions, environmental variations, and manufacturing inconsistencies, the degradation information obtained from such experiments may not be applicable to the entire lifecycle. To address this, we developed a stage-wise state-of-health (SOH) prediction approach that combined offline training with online updating. During the offline training phase, multiple single-cell experiments were conducted under various combinations of depth of discharge (DOD) and C-rate. Multi-dimensional health features (HFs) were extracted, and an accelerated aging probability $p_{AA}$ was defined. Based on the correlation statistics between HFs, $k_{HF}$, the SOH, and $p_{AA}$, all cells in the dataset were divided into general early, middle, and late aging stages. For each stage, cells were further classified by their longevity (long, medium, and short), and multiple models were trained offline for each category. The results show that models trained on cells following similar aging paths achieve significantly better performance than a model trained on all data combined. Meanwhile, HF optimization was performed via a three-step process: an initial screening based on expert knowledge, a second screening using Spearman correlation coefficients, and an automatic feature importance ranking using a random forest regression (RFR) model. The proposed method is innovative in the following ways: (1) The stage-wise multi-model strategy significantly improves the SOH prediction accuracy across the entire lifecycle, maintaining the mean absolute percentage error (MAPE) within 1%. (2) The improved model provides uncertainty quantification, issuing a warning signal at least 50 cycles before the onset of accelerated aging. (3) The analysis of feature importance from the model outputs allows the indirect identification of the primary aging mechanisms at different stages. (4) The model is robust against missing or low-quality HFs. If certain features cannot be obtained or are of poor quality, the prediction process does not fail. Full article

Physical activity often remains low after hospitalisation for acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Although post-hospitalisation rehabilitation has shown to support recovery, its impact on daily activity levels in the early post-exacerbation phase is unclear. This study describes the changes in physical activity (PA) and clinical outcomes during an 8-week rehabilitation following hospitalisation for AECOPD. This prospective observational cohort study included patients recently discharged after AECOPD from Aalborg University Hospital, Denmark. Participants received municipality-delivered post-hospitalisation rehabilitation consisting of tailored physiotherapy and occupational therapy of individually determined frequency. PA was assessed using thigh-worn triaxial accelerometers measuring 24 h/day over 8 weeks. Clinical outcomes included lung function (FEV1% predicted), dyspnoea scores, health-related quality of life (EuroQol 5-dimension, 5-level (EQ-5D-5L); EuroQol visual analogue scale (EQ-VAS)), frailty (Clinical Frailty Scale (CFS)), functional status (Short Physical Performance Battery (SPPB)), and symptom burden (COPD Assessment Test (CAT); St. George’s Respiratory Questionnaire (SGRQ)). Changes from baseline to 8 weeks were analysed using linear mixed-effects models and bootstrap resampling. Forty-three participants with a mean age 73.4 years, 67.4% female, and moderate frailty (CFS 5.4 ± 1.3) were included. Physical activity remained largely unchanged. Gait speed and total SPPB declined, whereas self-perceived health improved (EQ-VAS Δ +7.8, p = 0.008). Lung function, dyspnoea, and health related quality of life scores showed no significant change. In this frail, recently admitted COPD population, physical activity did not increase during the rehabilitation period, and some functional parameters declined. The improvement in self-perceived health suggests a divergence between subjective and objective outcomes. These findings highlight the need for long-term, tailored, and flexible approaches to support recovery after AECOPD. Full article

Background: Chagas disease, caused by Trypanosoma cruzi, remains endemic throughout Latin America but is increasingly reported in urban areas due to migration and vector adaptation. The cardiac form is the most severe manifestation, associated with arrhythmia, mural thrombus formation, and a high risk of cardioembolic events. Stroke secondary to Chagas cardiomyopathy is uncommon and poses diagnostic and therapeutic challenges. Case Presentation: A 58-year-old woman with serologic evidence of T. cruzi infection presented with sudden-onset dyspnea, oppressive chest pain, and left-sided weakness. Neurological examination revealed left brachiocrural hemiparesis and mild dysarthria (NIHSS = 9). Non-contrast cranial CT showed an acute infarct in the right middle cerebral artery territory (ASPECTS = 7). Electrocardiography demonstrated typical atrial flutter with variable conduction, and transthoracic echocardiography revealed a markedly dilated left atrium containing a mural thrombus and a left ventricular ejection fraction of 45%. Intravenous thrombolysis with alteplase (0.9 mg/kg) was administered within 4.5 h of symptom onset. Pharmacologic rhythm control was achieved using intravenous and oral amiodarone, followed by oral anticoagulation with warfarin (target INR 2.0–3.0) after excluding hemorrhagic transformation. The patient showed rapid neurological improvement (NIHSS reduction from 9 to 2) and was discharged on day 10 with minimal residual deficit (mRS = 1), sinus rhythm, and stable hemodynamics. Conclusions: This case highlights the rare coexistence of Chagas cardiomyopathy, atrial flutter, and cardioembolic stroke due to left atrial thrombus. Early recognition, adherence to evidence-based guidelines, and multidisciplinary management were key to achieving a favorable outcome. Timely diagnosis and intervention remain crucial to preventing severe complications in patients with Chagas disease. Full article

Background and Clinical Significance: Cutaneous aspergillosis caused by Aspergillus flavus is rare and coinfection with Klebsiella pneumoniae was reported only in pulmonary disease. Case Presentation: We describe a 57-year-old woman with no prior comorbidities who developed septic shock requiring intensive care, broad-spectrum antibiotics, corticosteroids, and renal replacement therapy. Six days after discharge, she was readmitted with fever, leukopenia, thrombocytopenia, cavitary lung lesions, and multiple erythematous nodules on the limbs and mammary regions. Bronchial aspirate cultures detected K. pneumoniae, while progressive cutaneous lesions required surgical debridement. Histopathology revealed angioinvasive septate hyphae, and MALDI-TOF identified A. flavus. The K. pneumoniae strain was extensively drug resistant; A. flavus was susceptible only to azoles. Despite targeted therapy, lesions progressed requiring bilateral mastectomy. Conclusions: This case illustrates a previously unreported scenario in which secondary immunosuppression after severe sepsis led to concurrent cutaneous A. flavus infection and extensively drug-resistant (XDR) K. pneumoniae. Early recognition of mixed fungal–bacterial infections is essential for appropriate management. Full article

Background: Osteoradionecrosis (ORN) of the jaw is a severe, progressive complication of radiation therapy for head and neck malignancies. ORN features radiologically overlaps osteomyelitis and tumor recurrence. This study analyzes jaw ORN imaging characteristics and progression and proposes an ORN CT-based grading system that builds on current ClinRAD grades. Materials and Methods: A retrospective cohort study of 35 patients with biopsy-proven or clinically diagnosed ORN following radiation therapy. Initial and follow-up imaging were assessed to evaluate the radiological evolution of ORN. The imaging findings were statistically analyzed using IBM SPSS v26, and literature comparisons were made. Results: The median onset of ORN post-radiotherapy was 27–28 months (range: 2–119 months). The most common clinical presentations included non-healing ulcers (49%), pain (34%), and discharging sinuses (31%). Mandibular involvement was predominant (51%), with focal bone alterations being more frequent (63%). CT findings at clinical suspicion of ORN included resorption (100%), erosions (100%), sclerosis (86%), and fragmentation (83%). Follow-up imaging showed increased bone erosion (77%), fragmentation (92%), and sclerosis (92%). A CT-based grading system is proposed to classify ORN progression. Conclusions: ORN follows a predictable radiological progression, beginning with trabecular resorption and cortical erosion, leading to fragmentation and sequestrum formation. The proposed grading system provides a structured approach for early diagnosis. The proposed grading system provides a structured approach for diagnosis. Larger studies of imaging analyses are required to validate these findings and refine diagnostic criteria. Full article

Background: Right ventricular (RV) dysfunction is common in advanced lung disease due to chronic pressure overload and altered pulmonary vascular mechanics. Lung transplantation (LTx) reduces RV afterload, and pulmonary rehabilitation (PR) may further enhance functional recovery. However, the combined effects of LTx and structured PR on RV myocardial deformation—particularly using speckle-tracking echocardiography (STE)—remain insufficiently characterized. Methods: This single-arm pre–post study included 20 bilateral lung transplant recipients who completed an 8-week, twice-weekly supervised outpatient PR program. Echocardiographic evaluation—including 2D measurements, M-mode, tissue Doppler imaging (TDI), and STE-derived strain parameters—was performed immediately post-discharge (baseline) and after PR. RV global longitudinal strain (RVGLS) and RV free-wall longitudinal strain (RVFWS) served as primary functional outcomes. Results: Improvements were observed in RV myocardial deformation after PR. RVGLS improved from a median of 15.52% to 16.64% (p = 0.004), and RVFWS increased from 15.82% to 17.10% (p = 0.001). RV mid-cavity diameter decreased significantly (p = 0.042), reflecting favorably altered RV geometry. Conventional parameters—including TAPSE, S′ velocity, RVEDA, and FAC—showed no statistically significant changes. These findings indicate that STE parameters are more sensitive than traditional indices for detecting early RV remodeling in the post-transplant period. Conclusions: Lung transplantation combined with a structured PR program was associated with early improvements in RV deformation indices measurable by STE, even when traditional echocardiographic indices remained within normal limits. STE may therefore serve as a sensitive tool for monitoring subclinical RV recovery after LTx and for assessing the additive benefits of PR. Full article

An integrated early warning system (EWS) for compound coastal and fluvial flooding is developed for Pyrgos, Western Greece, where low-lying geomorphology and past storm events highlight the need for rapid, impact-based forecasting. The methodology couples historical and climate-informed metocean and river discharge datasets within a numerical modeling framework consisting of a mild-slope wave model, the CSHORE coastal profile model, and HEC-RAS 2D inundation simulations. A weighted K-Means clustering approach is used to generate representative extreme scenarios, yielding more than 4000 coupled simulations that train and validate Artificial Neural Networks (ANNs). The optimal feed-forward ANN accurately predicts spatially distributed flood depths across the HEC-RAS grid using only offshore wave characteristics, water level, and river discharge as inputs, reducing computation time from hours to seconds. Blind tests demonstrate close agreement with full numerical simulations, with average differences typically below 5% and minor deviations confined to negligible water depths. These results confirm the ANN’s capability to emulate complex compound flooding dynamics with high computational efficiency. Deployed as a web application (EWS_CoCoFlood), the system provides actionable, near-real-time inundation forecasts to support local civil protection authorities. The framework is modular and scalable, enabling future integration of urban and rainfall-induced flooding processes and coastal morphological change. Full article

Background: Survivors of severe traumatic brain injury (TBI) show highly heterogeneous recovery but early functional trajectories across rehabilitation, and their relationship with 1-year outcomes remain poorly characterized. Methods: We performed a secondary analysis of the Traumatic Brain Injury Model Systems (TBIMS) National Database. Adults with severe TBI (Glasgow Coma Scale ≤ 8, post-traumatic amnesia (PTA) > 7 days, or neurosurgical intervention) who received inpatient rehabilitation with Functional Independence Measure (FIM) admission and discharge totals and 1-year Glasgow Outcome Scale—Extended (GOS-E) were included (n = 9438). K-means clustering on FIM admission, FIM discharge, and 1-year GOS-E identified early functional recovery trajectories. Multinomial logistic regression related trajectory class to age, sex, PTA duration, rehabilitation length of stay (LOS), and total LOS. Logistic regression examined associations between trajectory class and 1-year home residence and rehospitalization, adjusted for age and sex. Results: Three trajectories emerged: low-functioning/limited improvers (28.0%), substantial improvers (33.7%), and high-functioning (38.3%). The low-functioning trajectory showed lower FIM scores at admission and discharge and worse 1-year GOS-E than the other trajectories. In adjusted models, older age, longer PTA, and longer LOS were associated with less favorable trajectories overall, particularly reducing the likelihood of belonging to the high-functioning trajectory. Substantial improvers and high-functioning patients had higher odds of living at home and lower odds of rehospitalization at 1 year than low-functioning patients. Conclusions: Simple routine measures can yield interpretable recovery trajectories after severe TBI that may support prognosis, discharge planning, and follow-up; these trajectories should be interpreted as population-level probabilities rather than deterministic predictions for individual patients. Full article

Tip discharge in oil-immersed transformers poses a significant threat to insulation integrity. Conventional detection methods, such as gas and electrical analysis, are limited by slow response times or susceptibility to interference. Additionally, the lack of systematic comparisons between aged and fresh oil using multi-modal signal correlations hinders the development of accurate diagnostic strategies. To address this, a multi-modal sensing platform employing optical, UHF, and HFCT sensors, complemented by visual observation, was developed to investigate the evolution characteristics and mechanisms of tip discharge and to compare the detection effectiveness of these methods. Experimental results reveal that aged oil undergoes a novel four-stage evolution, where discharge signals first rise to a local peak, then experience suppression, followed by a dramatic surge, and finally decline slightly before breakdown. This process is governed by an “Impurity-Assisted Cumulative Breakdown Mechanism,” driven by impurity bridge growth and space charge effects, with signal transitions from ‘decoupling’ to synchronization. The optical sensor demonstrated superior sensitivity in early discharge stages compared to electrical methods. In contrast, fresh oil exhibited a “High-Field-Driven Stochastic Breakdown Mechanism,” with isolated pulses from micro-bubble discharges maintaining a metastable state until a critical threshold triggers instantaneous failure. This study enhances the understanding of how oil condition alters discharge mechanisms and underscores the value of multi-modal sensing for insulation condition assessment. Full article

The ongoing expansion of industrial operations has resulted in the generation of a large amount of high-salinity wastewater with complex compositions. The direct discharge of this wastewater poses significant threats to ecosystems and leads to the loss of valuable salt resources, for example, triggering freshwater salinization syndrome and mobilizing heavy metals to form toxic “chemical cocktails”, leading to the loss of valuable salt resources. Desalination of high-salinity wastewater primarily involves two key processes: concentration and crystallization, whereby a concentrated brine is first obtained through membrane-based or thermal methods, followed by salt recovery via crystallization. This review begins by employing a bibliometric analysis to map the knowledge structure and trace the evolution of research trends, revealing that “membrane-thermal integration” has become a dominant research hotspot since 2020. It then provides a systematic examination of advanced treatment technologies, chronicling the progression from early biological methods to contemporary membrane-based and thermal desalination approaches. A specific analysis of the influence of salinity on membrane scaling is also included. Consequently, this paper critically assesses the prospects and challenges of several alternative desalination technologies and proposes that integrated processes, combining membrane-based and thermal desalination, represent a highly promising pathway for achieving zero liquid discharge (ZLD). Finally, we suggest that future research should prioritize the development of key functional materials, explore efficient hybrid physiochemical–biochemical processes, and advance emerging technologies, aimed at enhancing treatment efficiency and reducing operational costs. Full article

Background and Objectives: Febrile neutropenia (FN) is a potentially life-threatening complication in children undergoing cancer treatment. Immediate initiation of empirical antibiotic treatment (EAT) has improved the prognosis and outcomes of FN. Although the ideal timing for initiating EAT is clear, the optimal timing for EAT discontinuation remains debatable. Early hospital discharge (EHD) with continuation of oral antibiotics has also been proposed as an alternative strategy. This narrative review aims to present a comprehensive overview of the evidence on early discontinuation of EAT or EHD in children with FN and cancer. Materials and Methods: A comprehensive literature search was performed to identify relevant studies assessing early EAT discontinuation or EHD in children with cancer and FN. Extracted data included the safety outcomes, the benefits for the patients and the cost for healthcare systems. Results: Thirty-one studies were included; twenty-one investigated the early discontinuation of EAT and ten studies evaluated EHD. Most studies reported early discontinuation of EAT or EHD as a safe FN treatment approach with potential benefits for the patients, especially when applied to selected low-risk FN cases. Reported benefits included shorter hospitalization duration and reduced antibiotic use, with additional economic advantages in several studies. Conclusions: Early discontinuation of EAT appears to be a safe and beneficial management approach for children with FN and cancer by reducing the length of hospital stay and the duration of antibiotic use. EHD with oral therapy continuation also appears to be safe but less beneficial than early discontinuation of EAT. High-quality evidence and standardized criteria are needed to support broader implementation of these strategies in routine clinical practice. Full article

Background: Despite clear evidence supporting the benefits of outpatient cardiac rehabilitation for acute coronary syndrome survivors, participation rates remain low. Many patients face person-level and system-level barriers for outpatient rehabilitation, and their motivation often wanes soon after discharge. Cardiopulmonary exercise testing provides individualized physiological information and may act as an external cue that enhances engagement, yet no randomized trial has evaluated whether announcing a scheduled test can influence rehabilitation attendance. Methods: This single-center, parallel-group, single-blind randomized controlled trial investigates whether informing patients during hospitalization that a cardiopulmonary exercise test will be conducted at their first rehabilitation visit increases early outpatient attendance. Patients with acute coronary syndrome are randomized 1:1 to receive either standard discharge education or the same education plus an exercise testing announcement. All other clinical care follows routine practice. The primary endpoint is completion of the first rehabilitation clinic visit within 30 days. Secondary outcomes include attending at least six rehabilitation sessions within 12 weeks, actual exercise testing completion, and any safety events. The analyses will follow the intention-to-treat principle and will use logistic regression and time-to-event models. The planned sample size is 200 participants. Full article

Background: Posteriorly directed aneurysms at the internal carotid–posterior communicating artery (ICA–PCoA) junction concentrate technical risk at the posteromedial neck where the PCoA origin and perforators exist beneath the optic apparatus. Our aim was to describe, in a reproducible fashion, an anatomy-driven sequence in the management of a ruptured ICA–PCoA aneurysm that visualized the posterior wall and a closing line parallel to the PCoA axis and which is placed within contemporary practice. Case Presentation: This is a single case study employing predetermined surgical techniques demonstrating a reproducible method of anatomical microsurgery applied to a posterior projecting ICA-PCoA aneurysm. The authors describe a 62-year-old female who was stabilized by nimodipine and aggressive blood pressure control in the systolic range 140–160 mmHg after an aneurysmal subarachnoid hemorrhage. Diagnostic contrast catheter angiography showed a left ICA-PCoA aneurysm of 13.1 × 10.0 mm at the base with a neck of 4.3 mm projecting posteriorly into the carotid–optic cistern. Complete adherence to a protocol of staged techniques was employed for the operation, as detailed below. Step 1: Early cisternal decompression requiring total and immediate relaxation of the temporal lobe, rapidly opening up the carotid–optic anatomical window. Step 2: Circumferential dissection about the neck of the aneurysm permitting definition of the true posteromedial wall and definition of the perforator territories and anterior choroidal territories. Step 3: Brief but effective ICA proximal quiescence (58 s) permitting clipping under direct vision. Step 4: Staged closure of two clips with the closing line of the clips orientated parallel to the axis of the PCoA with maintenance of the diameter of all parent vessels, the origin of the PCoA and the integrity of the perforators. Urgent postoperative digital subtraction angiography (DSA) study showed complete exclusion of the aneurysm with no alteration in flow characteristics, and 3 months later DSA studies again showed permanent obliteration and patency of those branches. The immediate DSA demonstrated complete exclusion of the aneurysm with patent supraclinoid ICA caliber and PCoA ostium, the anterior choroidal artery was preserved; no angiographic vasospasm was identified. The postoperative course was uncomplicated; there was no hydrocephalus, seizure disorder or delayed ischemia. At discharge and three months postprocedure the patient was neurologically intact (Modified Rankin Scale 0). Non-contrast cranial CT (three months) demonstrated stable clip position and no hemorrhagic or ischemic sequelae. Conclusions: In posteriorly projecting ICA–PCoA aneurysms that are disturbed beneath the optic apparatus, an anatomy-guided strategy—early cisternal decompression, true posteromedial neck exposure, brief purposeful quieting of the proximal ICA and two-clip closure parallel to the PCoA in selected cases—may provide the opportunity for durable occlusion whilst the physiology of branching is preserved. We intend for this transparent description to be adopted, refined or discarded based on local anatomy and practice. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) remains a major global health problem, affecting over 300 million people worldwide. Its high morbidity and mortality rates impose substantial psychosocial and financial burdens on patients and healthcare systems. In the emergency setting, managing acute exacerbations of COPD (AECOPD) poses a major clinical challenge, as these patients often present with multi-organ dysfunction secondary to hypoxia and hypercapnia. Identifying reliable prognostic biomarkers could improve early risk stratification, guide therapeutic decisions, and enhance patient outcomes. Methods: This multicenter, prospective, observational study aims to evaluate the prognostic significance of several novel biomarkers—resistin, club cell secretory protein 16 (CC16), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), S100β protein—alongside conventional markers such as N-terminal-pro–B-type-Natriuretic-Peptide (NT-proBNP), D-dimer, high-sensitivity troponin I (hs-cTnI), C-reactive protein (CRP), and procalcitonin in patients with AECOPD admitted to the Emergency Department (ED). Blood samples will be collected at admission. The novel biomarkers (resistin, CC16, IL-6, TNF-α, S100β) will be measured using standardized ELISA kits, while conventional biomarkers (NT-proBNP, troponin I, CRP, procalcitonin) will be analyzed using routine automated clinical laboratory methods. Correlations between biomarker levels, clinical and imaging data, severity scores (GCS, SOFA, CFS, Ottawa COPD Risk Scale, DECAF, BAP-65), and short-term outcomes (hospital discharge status and 28-day survival) will be assessed. The study has received approval from the Ethics Committee of the “Iuliu-Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, and all participating hospitals. Written informed consent will be obtained from all participants or their legal representatives. Results: This study protocol does not report results, as data collection and analysis are ongoing. Conclusions /Expected Impact: By identifying novel biomarkers with prognostic and pathophysiological relevance, this research aims to inform the development of early risk stratification tools and support future evidence-based approaches to the management of critically ill COPD patients in the ED. Full article

Background/Objectives: Ambulatory status at hospital discharge contributes to subsequent functional recovery in older adults following hip fracture. This study aimed to identify independent predictors of ambulatory status at hospital discharge following surgery for fragility hip fractures in a tertiary care setting in Southern Thailand. Methods: A retrospective study was conducted among patients aged 50 years and older who underwent surgery for low-energy hip fractures between 1 October 2018, and 30 September 2023. Data on preoperative, intraoperative, postoperative, and process of care factors were collected from electronic medical records. Student’s t-tests and chi-square tests compared candidate variables between groups. Univariable and multivariable risk analyses were performed to identify independent predictors of ambulation at discharge. Results: Among 532 patients (72.7% women; mean age 76.8 ± 9.7 years), 314 (59.0%) were ambulatory at hospital discharge. Multivariable analysis demonstrated that achieving rehabilitation at the ambulation training level (mRR = 24.10; 95% CI: 9.14–63.60; p < 0.001) and undergoing hip arthroplasty (mRR = 1.17; 95% CI: 1.07–1.29; p < 0.001) were significant positive predictors of ambulation. Conversely, a history of cerebrovascular disease with hemiplegic sequelae (mRR = 0.70; 95% CI: 0.53–0.91; p < 0.01) and delayed initiation of rehabilitation more than 72 h postoperatively ((mRR = 0.84; 95% CI: 0.73–0.97; p < 0.05) were associated with reduced likelihood of ambulation. Conclusions: Ambulatory status at hospital discharge was strongly associated with early, ambulation-level rehabilitation and hip arthroplasty, whereas history of stroke and delayed rehabilitation reduced mobility. These findings emphasize the importance of timely, targeted rehabilitation to optimize functional recovery after hip fracture surgery. Full article