Search Results (126,658)

Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93–1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46–2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42–3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70–1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85–1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59–1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes. Full article

Developing far-offshore wind power integrated with hydrogen production represents a critical pathway for China’s energy decarbonization. However, the investment prospects of off-grid offshore wind-to-hydrogen projects remain highly uncertain due to volatile technology costs and hydrogen prices, complicating the evaluation of project value and optimal timing. To address the oversimplified treatment of electrolyzer operation and the limited consideration of alkaline electrolyzers in the existing studies, this paper proposes an integrated assessment framework that combines time-series operational simulation with real options analysis. A detailed dynamic model of an alkaline (ALK)–proton exchange membrane (PEM) hybrid configuration is developed to simulate the coordinated hydrogen production under fluctuating wind power. Technical learning effects and stochastic hydrogen price processes are incorporated, and the least-squares Monte Carlo method is applied to determine the optimal investment strategies. A case study of a planned far-offshore wind farm in Guangdong indicates that, compared with a standalone PEM configuration, the hybrid configuration reduces the levelized hydrogen cost by about 15%, increases the investment value by up to 17 times under slow technological progress, and brings forward the optimal investment year by five years, from 2039 to 2034. Sensitivity analysis shows that expected hydrogen prices and discount rates dominate the investment outcomes. Full article

Hyaluronic acid (HA)–based nanocapsules containing plant-derived bioactives are promising formulations for dermatological applications. In this study, nanocapsules containing extracts of Arnica montana, Calendula officinalis and Aesculus hippocastanum were synthesized and their structural and functional properties were characterized. Scanning electron microscopy confirmed the formation of spherical nanostructures with uniform morphology, while rheological analyses demonstrated stable viscoelastic behavior suitable for topical application. Their antimicrobial potential was assessed on microorganisms isolated from multiple regions of healthy human skin and opportunistic pathogens. A diverse panel of approx. 100 bacterial and fungal isolates was identified using MALDI-TOF MS. The antimicrobial activity of formulations was compared with commonly used disinfectants: H₂O₂, octenidine, isopropanol and topical ophthalmic antiseptic. Arnica-based formulations showed the strongest inhibitory effect against both Gram-positive and Gram-negative bacteria, whereas chestnut extract demonstrated selective activity against Candida spp. Calendula-based formulations exhibited limited antimicrobial activity. These findings demonstrate that plant-extract-loaded HA nanocapsules exhibit selective antimicrobial properties dependent on extract type and microbial group, supporting their potential as multifunctional components of future dermatological formulations. Full article

Rapid urbanization has intensified the mismatch between urban green space (UGS) and urban spatial vitality (USV), hindering sustainable development. To address this, we developed the Urban Green Space Vitality Adaptation Model (UGSVAM) and analyzed 64 subdistricts in central Nanjing. Specifically, this study asks: Does the mismatch exist? What are its spatiotemporal patterns? What factors drive it? Methodologically, we use the Gini coefficient and Lorenz curve to assess overall UGS-USV adaptation, then construct the Urban Green Space Vitality Density (UGVD) indicator to quantify the match level, classifying units as overloaded, underloaded, or balanced. OLS and GWR reveal global and local influencing mechanisms, while quadrant analysis supports differentiated planning. Results show: (1) UGS-USV adaptation in Nanjing is weak, with Gini coefficients of 0.466 (weekday) and 0.456 (weekend). UGVD exhibits a spatial pattern of a primary overload core in the central city, a secondary core in the southwest, and peripheral decline, with the southeast underloaded. Overloaded units also show notable temporal variation. (2) Globally POI density and intersection density promote UGVD, while excessive transport facilities, air pollution, and high temperatures inhibit it—ecological factors have stronger weekend effects. (3) Locally, the northeast is more sensitive to POI density, the southwest to transport and heat, and the Jiangbei New Area could enhance green space carrying capacity through transport optimization and spatial integration. The UGSVAM integrates spatial diagnosis, mechanism analysis, and planning response, offering a transferable framework for refining green space governance in high-density cities. Full article

Blind image quality assessment (BIQA) without reference images remains significantly challenging due to the fact that perceptual quality is largely determined by subtle, spatially localized distortions. However, existing Contrastive Language–Image Pre-training (CLIP)-based methods exhibit limited sensitivity to fine-grained degradations such as local blur, noise, compression artifacts, and exposure inconsistencies, since they are optimized for global semantic alignment. To overcome these limitations, we propose a fine-grained vision–language framework that enhances distortion-aware representation by considering both fine-grained visual and detailed textual domains. Specially, our method employs a fine-grained CLIP architecture in conjunction with explicit textual descriptions to enable the effective identification of subtle regional degradations. Furthermore, a parameter-efficient prompt-tuning strategy is utilized to facilitate the learning of task-adaptive prompt representations tailored to image quality assessment (IQA). Extensive experiments on three widely used in-the-wild IQA benchmarks show that the proposed method achieves strong consistency with human subjective judgments: our training-free FGCLIP-IQA reaches a maximum SROCC of 0.732 on KonIQ-10k, outperforming the vanilla CLIP-IQA baseline, while the prompt-tuned FGCLIP-IQA+ further achieves a maximum SROCC of 0.909 on KonIQ-10k with only a small number of learnable parameters and exhibits robust cross-dataset generalization capabilities. These results demonstrate that the fine-grained vision–language alignment shows great potential for future development, and provides an efficient and accurate solution for the BIQA task. Full article

The main distinction between open and laparoscopic ovariectomy (OVE) is pneumoperitoneum (PNP) and anesthesia management. The objective of this study was to evaluate the effect of laparoscopic and open OVE on plasma cortisol, oxidative stress (OS), and cardiorespiratory parameters in dogs under the same anesthesia protocol. Twenty healthy female dogs were assigned to laparotomy OVE (LPTOVE, n = 10) and laparoscopic OVE (LAPOVE, n = 10) groups. OS was assessed using the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Blood samples were collected prior to sedation (T0); prior to surgical incision (T1); prior to surgical closure in the LPTOVE group; and prior to the deflation of CO₂ in the LAPOVE group (T2), 2 h after the surgery (T3). The monitored cardiorespiratory parameters were heart rate, respiratory rate, and end-tidal CO₂ (EtCO₂). Cortisol levels at T3 were markedly elevated in the LPTOVE group compared to the LAPOVE group. No substantial changes in TOS, TAS, or OSI between groups were detected. In the LAPOVE group, TOS diminished at T2, but TAS declined and OSI escalated at T3. EtCO₂ levels were elevated in the LAPOVE group at the end of the procedure. These findings support laparoscopic OVE as a less traumatic alternative to open surgery, with careful management of PNP and anesthesia recommended to minimize postoperative stress. Full article

Wearable device-based Human Activity Recognition (HAR) is widely used in health management, rehabilitation, and personal safety. While contemporary HAR research effectively classifies a wide range of discrete activities, there remains a significant gap in organizing these heterogeneous motions into a structured intensity framework suitable for continuous risk assessment. Furthermore, many high-performing models rely on computationally intensive architectures that hinder real-time deployment on resource-constrained wearables. We propose an on-device method for estimating five-level activity intensity in real time using only accelerometer signals from a commercial smartwatch. To bridge the gap between simple identification and intensity modeling, 13 dynamic and emergency-like wrist motions were integrated with 11 daily activities from the PAMAP2 dataset, yielding 21 activities mapped onto an ordinal five-level intensity scale. A finetuned Multi-Layer Perceptron (MLP) classifier trained on this integrated dataset achieved 0.939 accuracy and a quadratic weighted kappa (QWK) of 0.971. The model was deployed on a Galaxy Watch 7, achieving $<1$ ms inference latency and a size $<0.1$ MB, confirming real-time feasibility. This approach demonstrates that organizing diverse activities into a lightweight, intensity-aware framework provides a robust foundation for safety-aware monitoring systems under real-world, on-device constraints. Full article

Hurricanes create compound hazards such as storm surge, flooding, and wind-driven debris that can degrade roadway capacity, fragment network connectivity, and hinder evacuation and shelter operations. From a sustainability perspective, improving evacuation planning is essential for reducing disaster-related losses, protecting vulnerable populations, and strengthening the resilience of coastal communities facing intensifying climate-driven hazards. This paper develops a micro-scale, agent-based evacuation modeling framework to assess evacuation performance under baseline and compound-hazard conditions, with emphasis on municipal decision support. The framework is demonstrated for Westbrook, Connecticut, at the census block-group scale in AnyLogic by integrating household locations, vehicle availability, road-network connectivity, and shelter capacities from publicly available datasets. Evacuation propensity and destination choice are parameterized using survey data, enabling empirically grounded decisions for in-town versus out-of-town evacuation among household-vehicle agents. Compound disruptions are represented through flood-related road closures derived from SLOSH storm-surge outputs and stochastic wind-related disruptions that dynamically constrain accessibility during the simulation. Scenarios are evaluated for Saffir–Simpson Category 1–2 and Category 3–4 hurricanes under baseline and compound conditions. Model outputs quantify normalized evacuation time, congestion and critical intersections, shelter demand and unmet capacity, evacuation failure, and spatial heterogeneity across block groups. Results indicate that compound flooding substantially increases evacuation times and failure rates, with the largest performance degradation concentrated in higher-vulnerability areas. Optimization experiments further compare the effectiveness of behavioral shifts, shelter-capacity expansion, and earlier departure timing in reducing delays and unmet shelter demand. Overall, the proposed framework provides transparent, reproducible, and scalable analytics that town engineers and emergency planners can use to evaluate evacuation readiness under compound hurricane impacts. Full article

The FOCUS mission is an integrative project developed at the Universidad Nacional de San Martín (UNSAM), Argentina, featuring a constellation of small satellites equipped with X-band Synthetic Aperture Radar (SAR) sensors. Designed with autonomous orbit control, the mission enables Interferometric SAR (InSAR) applications for critical infrastructure monitoring, providing scalable and cost-effective global observation capabilities. This paper presents the modeling, design, and numerical evaluation of the Attitude and Orbit Determination and Control System (AODCS) for the FOCUS mission. The analysis incorporates realistic constraints, including actuator saturation, sensor noise, underactuation effects, and hardware limitations—specifically regarding magnetorquer magnetic moments, reaction wheel capacities, and propulsion unit impulse bounds. Utilizing the NASA 42 attitude and orbit simulator, numerical simulations were conducted to assess stability, pointing accuracy, and agile maneuver tracking through specialized guidance laws. The results confirm that the proposed AODCS architecture achieves stable, responsive performance and supports continuous orbit maintenance, ensuring adequate target acquisition per orbit. Additionally, the selection of star trackers allows achieving a secondary objective through the detection of Resident Space Objects. Full article

Despite recent biotechnological advancements in the brewing industry, the effective valorization of spent grains from craft beer production remains challenging due to the nutritional variability of cereal-based raw materials. This study analyzes the proteins, free amino acids, fatty acids, and mineral composition of spent grains obtained from two beer types brewed with different proportions of maize grits and malted wheat, in order to assess the influence of adjunct composition. Protein content ranged between 25.81% and 28.43%, with higher values observed in the wheat-based spent grain. Total free amino acids were also higher in the wheat-based sample (190.03 mg/100 g) compared to the maize-based variant (178.66 mg/100 g). Both samples showed a similar fatty acid profile dominated by linoleic acid (51.39–51.58%), while phosphorus was the predominant mineral (up to 2700.03 mg/kg). These results suggest that adjunct type influences the nutritional characteristics of spent grains and provide a basis for their differentiated valorization in sustainable agri-food systems. Full article

Glucocorticoids (GCs) are widely used for their potent anti-inflammatory and immunosuppressive effects, but their use is strongly associated with negative impacts on bone health. Rapid bone loss and an increased risk of fragility fractures are characteristics of glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis. While oral GCs are a well-known cause of GIOP, growing evidence suggests that non-oral routes of administration may also negatively affect the skeleton. This review summarizes current knowledge on the pathophysiology of GIOP, highlighting the complex relationship between direct and indirect mechanisms. It examines the effects of various routes of GC administration—oral, intravenous, inhaled, topical, and epidural—on bone mineral density, microarchitecture, and fracture. While parenteral GCs may have fewer systemic effects than oral therapy, long-term exposure or high cumulative doses may still cause clinically significant skeletal deterioration. This review also discusses current methods for assessing, preventing, and treating the fracture risk associated with GIOP. These strategies include lifestyle modifications, calcium and vitamin D supplements, and medications such as denosumab, bisphosphonates, and anabolic agents. Reducing the incidence of glucocorticoid-associated fractures and improving prevention and treatment requires an understanding of how GCs impact bone. Full article

Background/Objectives: Advanced childhood cerebral X-linked adrenoleukodystrophy (cALD) is traditionally regarded as an irreversible terminal phase of neurodegeneration driven by inflammatory demyelination and axonal loss. Experimental evidence indicates that endogenous bioelectrical fields regulate central nervous system organisation, raising the possibility that functional network collapse in cALD may be biologically modifiable, even in the presence of persistent structural damage. This study examined whether longitudinal modulation of endogenous bioelectrical network organisation is associated with sustained clinical and neurophysiological stabilisation in advanced cALD. Methods: We performed a longitudinal observational analysis of two paediatric patients with advanced childhood cerebral X-linked adrenoleukodystrophy undergoing repeated neuroregenerative treatment cycles. Standardised scalp electroencephalography was recorded during spontaneous wakefulness and repeated over months under comparable vigilance conditions. Multimodal analysis included conventional EEG, quantitative EEG, independent component analysis, and standardised low-resolution electromagnetic tomography (sLORETA). Clinical function was assessed using validated measures of consciousness, swallowing, and voluntary motor behaviour. Results: Across patients, longitudinal recordings demonstrated sustained stabilisation of consciousness, swallowing, and voluntary motor function, accompanied by reproducible reorganisation of pathological brain rhythms. Delta and theta oscillations showed a consistent topographical redistribution from limbic–frontoinsular networks towards sensorimotor and parietal integrative cortices. These changes were observed across modalities and timepoints and are unlikely to reflect spontaneous fluctuation, delayed effects of haematopoietic stem cell transplantation, or state-dependent EEG variation. Conclusions: Advanced childhood cerebral X-linked adrenoleukodystrophy is associated with disorganisation of endogenous bioelectrical network activity. In this longitudinal analysis, large-scale network reorganisation was temporally associated with sustained clinical stabilisation, supporting a view of late-stage cALD as a dynamic disorder of network-level vulnerability, rather than a fixed terminal state. Full article

Background/Objectives: The flavonoid quercetin (Q) has recently been suggested as a natural anti-aging and senolytic agent. However, its low stability and poor oral bioavailability may limit its efficacy. To address this, we investigated whether a lecithin-based formulation of Q, Quercefit™ (QF), enhances stress resistance and delays aging in vivo. Methods: The nematode Caenorhabditis elegans was used as an animal model to evaluate the effects of QF under physiological and stress conditions. Unformulated Q was administered as a control. Worm survival, healthspan, resistance to thermal and oxidative stress, and expression of stress- and longevity-related genes were assessed. All the experiments were conducted at least in triplicate, each including a minimum of 15 worms. The data were analyzed using Student’s t-test, one-way or two-way ANOVA, and Bonferroni’s post hoc test. Results: One hundred micromolar Q administered in QF was more effective than equimolar unformulated Q in increasing the worms’ ability to resist acute thermal stress at 35 °C (tested on 75 worms/group) and oxidative stress caused by 0.5 mM hydrogen peroxide (tested on 75 worms/group). In this last case, the protective effect of QF was similar to that of N-acetylcysteine and ascorbic acid. Under experimental conditions mimicking the long-term consequences of thermal stress, QF, like Q, increased the worms’ lifespan and healthspan by approximately 50%, counteracting the age-related decline associated with stress (120 worms/group). These benefits are supported by QF’s capacity to act as a reactive oxygen species scavenger; suppress heat-shock element gene transcription activated by thermal stress, such as hsp-16.2 and hsp-70, and stimulate the sod-3 and gst-4 genes that are involved in antioxidant and detoxification responses. Conclusions: These findings suggest that Q, when administered in the QF formulation, can act at the transcriptional level to protect against aging induced by stressful conditions. Full article

Background: Informal sewing workers are widely exposed to ergonomic and workload-related risks but remain largely excluded from formal occupational health protection, particularly in low- and middle-income countries. This study evaluated integrated physical and mental workload risks associated with WMSDs among informal sewing workers to develop contextually feasible preventive guidelines based on the Hierarchy of Ergonomic Control. Methods: A mixed-methods study was conducted among 150 informal sewing workers in Ubon Ratchathani Province, Thailand. Quantitative data were collected using a structured questionnaire, the Rapid Upper Limb Assessment (RULA), the Nordic Musculoskeletal Questionnaire (NMQ), and the NASA Task Load Index (NASA-TLX). Associations between sociodemographic characteristics, ergonomic risks, and WMSDs were analyzed using chi-square tests and correlation analysis. Qualitative data were obtained through a focus group discussion with key stakeholders to develop ergonomic control strategies guided by the HEC framework. Results: The majority of participants were female and middle-aged, with widespread exposure to high-risk ergonomic conditions, including prolonged sitting, repetitive tasks, and awkward postures. A high prevalence of WMSDs was observed, particularly in the neck, shoulders, and back. Younger workers and those with lower educational attainment experienced significantly higher ergonomic risk exposure and WMSD prevalence. NASA-TLX results indicated that physical demand and performance pressure were the main contributors to overall workload. Application of the HEC framework showed that elimination and substitution controls were the most effective strategies for reducing ergonomic risks, followed by engineering controls, while administrative measures and personal protective equipment were less effective. Conclusions: Informal sewing workers face substantial ergonomic and mental workload risks that contribute to a high burden of WMSDs. Prioritizing higher-order ergonomic controls, integrating workload management, and implementing community-based ergonomic interventions are essential to improving occupational health and reducing inequities among informal workers. Full article