Search Results (24,499)

Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney–pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams. Full article

Background: Pulmonary involvement is the most common prognosis-related organ involvement in idiopathic inflammatory myopathy (IIM). Owing to the large number of antibodies, the evidence for lung involvement and rare antibodies is limited. In everyday clinical practice, the interpretation of positive myositis antibodies represents a challenge. Methods: This study is a retrospective monocentric analysis. The data collection regarding positive myositis antibodies and possible pulmonary involvement was carried out from July 2019 to May 2022. Data analysis revealed positive results for one of the following antibodies: EJ, PL7, OJ, PL12, Mi-2α, TIF1γ, MDA5, SAE, NXP2, SRP, Ku, PM-Scl100 and PM-Scl75. In our analysis, patients with IIM, patients with inflammatory rheumatic disease other than IIM and patients without inflammatory rheumatic disease are described. The results of high-resolution computed tomography (HRCT), pulmonary function tests, echocardiographic examinations and their associated clinical findings are examined. Results: In the entire cohort, 209 patients with positive myositis antibodies were detected. In total, 22 (10.5%) patients had interstitial lung disease (ILD) patterns on HRCT. In the subgroup of patients with IIM, a significantly higher proportion of patients with lung involvement (n = 13, 35.1%) was found than in the group with other inflammatory rheumatic diseases (IRDs) (n = 6, 6.7%) or in the group without IRDs (n = 3, 3.7%). When the antibody groups were considered, the PL12-positive patients had the largest proportion of ILD (42%), followed by the MDA5-positive patients (40%). Conclusions: In patients with IIM, myositis antibodies are highly relevant for assessing the risk of lung involvement. In groups with other IRD or without IRD, antibody detection does not represent this high relevance for lung involvement. A differentiated assessment of the various MSAs or MAAs detected, as well as clinical parameters, allows for further important risk assessment for prognosis-relevant lung involvement. Full article

Analyzing the two-phase flow behavior in bearing lubrication is crucial for understanding friction and wear mechanisms, optimizing lubrication design, and improving bearing operational efficiency and reliability. However, the complexity of oil–air two-phase flow in high-speed bearings poses significant research challenges. Currently, there is a lack of comparative studies employing different simulation strategies to address this issue, leaving a gap in evidence-based guidance for selecting appropriate simulation approaches in practical applications. This study begins with a comparative analysis between experimental and simulation results to validate the reliability of the adopted simulation approach. Subsequently, a comparative evaluation of different simulation methods is conducted to provide a scientific basis for relevant decision-making. Evaluated from three dimensions—adaptability to rotational speed conditions, research focuses (oil distribution and power loss), and computational economy—the findings reveal that FVM excels at medium-to-high speeds, accurately predicting continuous oil film distribution and power loss, while MPS, leveraging its meshless Lagrangian characteristics, demonstrates superior capability in describing physical phenomena under extreme conditions, albeit with higher computational costs. Economically, FVM, supported by mature software ecosystems and parallel computing optimization, is more suitable for industrial design applications, whereas MPS, being more reliant on high-performance hardware, is better suited for academic research and customized scenarios. The study further proposes that future research could adopt an FVM-MPS coupled approach to balance efficiency and precision, offering a new paradigm for multi-scale lubrication analysis in bearings. Full article

Karst groundwater systems are critical to water supply and ecological sustainability in northern China, yet their heterogeneity poses challenges for flow characterization. The Yuquan Mountain (YM) Spring, historically a major karst spring in western Beijing, has experienced persistent drying, raising concerns about its recharge and flow mechanisms. This study integrates published isotope data, spatial distributions of Na⁺ and Cl⁻ as hydrochemical tracers, groundwater age estimates, and geophysical survey results to assess the recharge sources and flow pathways within the YM Spring catchment area. The analysis identifies two major recharge zones: the Tanzhesi area, primarily recharged by direct infiltration of precipitation through exposed carbonate rocks, and the Junzhuang area, which receives mixed recharge from rainfall and Yongding River seepage. Three potential flow pathways are proposed, including shallow flow along faults and strata, and a deeper, speculative route through the Jiulongshan-Xiangyu syncline. The synthesis of multiple lines of evidence leads to a refined conceptual model that illustrates how geological structures govern recharge, flow, and discharge processes in this karst system. These findings not only enhance the understanding of subsurface hydrodynamics in complex geological settings but also provide a scientific basis for future spring restoration planning and groundwater management strategies in the regions. Full article

Background and Objectives: There is a global rise of public interest in integrative medicine. The principles of integrative medicine combining conventional medicine with evidence-based complementary therapies have been implemented in many medical areas, including plastic surgery, to improve patient’s outcome. The aim of the present study was to systematically analyze the application and use of additional non-pharmacological interventions (NPIs) of patients of a German department of plastic surgery. Materials and Methods: The present real-world data study utilized data from the Network Oncology registry between 2016 and 2021. Patients included in this study were at the age of 18 or above, stayed at the department of plastic surgery and received at least one plastic surgical procedure. Adjusted multivariable logistic regression analyses were performed to detect associations between the acceptance of NPIs and predicting factors such as age, gender, year of admission, or length of hospital stay. Results: In total, 265 patients were enrolled in the study between January 2016 and December 2021 with a median age of 65 years (IQR: 52–80) and a male/female ratio of 0.77. Most of the patients received reconstructive surgery (90.19%), followed by hand surgery (5.68%) and aesthetic surgery (2.64%). In total, 42.5% of the enrolled patients accepted and applied NPIs. Physiotherapy, rhythmical embrocations, and compresses were the most often administered NPIs. Conclusions: This exploratory analysis provides a descriptive overview of the application and acceptance of NPIs in plastic surgery patients within a German integrative care setting. While NPIs appear to be well accepted by a subset of patients, further prospective studies are needed to evaluate their impact on clinical outcomes such as postoperative recovery, pain management, patient-reported quality of life, and overall satisfaction with care. Full article

The removal of high-concentration m-cresol from industrial wastewater remains a significant challenge due to its toxicity and persistence. In this study, a commercially available functionalized resin with a high BET surface area (1439 m² g⁻¹) and hierarchical pore structure was employed for the adsorption of pure m-cresol at an initial concentration of 20 g L⁻¹, representative of coal-based industrial effluents. Comprehensive characterization confirmed the presence of oxygen-rich functional groups, amorphous polymeric structure, and uniform surface morphology conducive to adsorption. Batch experiments were conducted to evaluate the effects of resin dosage, contact time, temperature, and equilibrium concentration. Under optimized conditions (0.15 g resin, 60 °C), a maximum adsorption capacity of 556.3 mg g⁻¹ and removal efficiency of 71% were achieved. Kinetic analysis revealed that the pseudo-second-order model best described the adsorption process (R² > 0.99). Isotherm data fit the Langmuir model most closely (R² = 0.9953), yielding a monolayer capacity of 833.3 mg g⁻¹. Thermodynamic analysis showed that adsorption was spontaneous (ΔG° < 0), endothermic (ΔH° = 7.553 kJ mol⁻¹), and accompanied by increased entropy (ΔS° = 29.90 J mol⁻¹ K⁻¹). The good agreement with the PSO model is indicative of chemisorption, as supported by other lines of evidence, including thermodynamic parameters (e.g., positive ΔH° and ΔS°), surface functional group characteristics, and molecular interactions. The adsorption mechanism was elucidated through comprehensive modeling of adsorption kinetics, isotherms, and thermodynamics, combined with detailed physicochemical characterization of the resin prior to adsorption, reinforcing the mechanistic understanding of m-cresol–resin interactions. Full article

This case report presents a multidisciplinary forensic investigation into a cold case involving a missing person in Italy, likely linked to a homicide that occurred in 2008. The investigation applied a standardized protocol integrating satellite imagery analysis, site reconnaissance, vegetation clearance, ground-penetrating radar (GPR), and cadaver dog (K9) deployment. A dedicated decision tree guided each phase, allowing for efficient allocation of resources and minimizing investigative delays. Although no human remains were recovered, the case demonstrates the practical utility and operational robustness of a structured, evidence-based model that supports decision-making even in the absence of positive findings. The approach highlights the relevance of “negative” results, which, when derived through scientifically validated procedures, offer substantial value by excluding burial scenarios with a high degree of reliability. This case is particularly significant in the Italian forensic context, where the adoption of standardized search protocols remains limited, especially in complex outdoor environments. The integration of geophysical, remote sensing, and canine methodologies—rooted in forensic geoarchaeology—provides a replicable framework that enhances both investigative effectiveness and the evidentiary admissibility of findings in court. The protocol illustrated in this study supports the consistent evaluation of large and morphologically complex areas, reduces the risk of interpretive error, and reinforces the transparency and scientific rigor expected in judicial settings. As such, it offers a model for improving forensic search strategies in both national and international contexts, particularly in long-standing or high-profile missing persons cases. Full article

Background: The typification of the name Aegilops tauschii Coss. (Poaceae: Triticeae) is revisited. Several authors cited a gathering from Iberia as the locality and Buxbaum as the collector of as the type, but no actual specimens from this collection have been located, nor is there evidence that such a gathering existed. In 1994, van Slageren designated as lectotype an illustration from Buxbaum’s Plantarum minus cognitarum centuria I (1728), which, although original material, is not the only element cited in the protologue. The protologue mentions several gatherings, some of which are represented by identifiable herbarium specimens qualifying as syntypes. Methods: This work is based on the analysis of the protologue of Aegilops tauschii and the study of specimens conserved in several herbaria. According to the International Code of Nomenclature for algae, fungi, and plants (ICN, Shenzhen Code 2018), an illustration does not hold the same nomenclatural weight as preserved specimens cited in the protologue. Therefore, van Slageren’s lectotypification does not comply with Art. 9.12 of the ICN and must be superseded. Results: The original material includes multiple elements, and a new lectotype is designated from a specimen at PRC from Azerbaijan. Full article

The demand for high-performance computing (HPC) continues to grow, driven by its critical role in advancing innovations in the rapidly evolving field of artificial intelligence. HPC has now entered the era of exascale supercomputers, introducing significant challenges related to sustainability. Balancing HPC performance with environmental sustainability presents a complex, multi-objective optimization problem. To the best of the author’s knowledge, no recent comprehensive investigation has explored the interplay between supercomputer performance and sustainability over a five-year period. This paper addresses this gap by examining the balance between these two aspects over a five-year period. This study collects and analyzes multi-year data on supercomputer performance and energy efficiency. The findings indicate that supercomputers pursuing higher performance often face challenges in maintaining top sustainability, while those focusing on sustainability tend to face challenges in achieving top performance. The analysis reveals that both the performance and power consumption of supercomputers have been rapidly increasing over the last five years. The findings also reveal that the performance of the most computationally powerful supercomputers is directly proportional to power consumption. The energy efficiency gains achieved by some top-performing supercomputers become challenging to maintain in the pursuit of higher performance. The findings of this study highlight the ongoing race toward zettascale supercomputers. This study can provide policymakers, researchers, and technologists with foundational evidence for rethinking supercomputing in the era of artificial intelligence. Full article

Achieving the construction sector’s dual carbon objectives necessitates scaling green energy adoption in new residential buildings. The current literature critically overlooks four unresolved problems: oversimplified penalty mechanisms, ignoring escalating regulatory costs; static subsidies misaligned with market maturity evolution; systematic exclusion of innovation feedback from energy suppliers; and underexplored behavioral evolution of building owners. This study establishes a government–suppliers–owners evolutionary game framework with dynamically calibrated policies, simulated using MATLAB multi-scenario analysis. Novel findings demonstrate: (1) A dual-threshold penalty effect where excessive fines diminish policy returns due to regulatory costs, requiring dynamic calibration distinct from fixed-penalty approaches; (2) Market-maturity-phased subsidies increasing owner adoption probability by 30% through staged progression; (3) Energy suppliers’ cost-reducing innovations as pivotal feedback drivers resolving coordination failures, overlooked in prior tripartite models; (4) Owners’ adoption motivation shifts from short-term economic incentives to environmentally driven decisions under policy guidance. The framework resolves these gaps through integrated dynamic mechanisms, providing policymakers with evidence-based regulatory thresholds, energy suppliers with cost-reduction targets, and academia with replicable modeling tools. Full article

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study—47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00–1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57–22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83–10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63–36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00–1.04) and peak lactate (HR 1.16, 95% C.I. 1.11–1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights. Full article

Thailand’s southern border provinces need youth-focused multicultural leadership programs integrating local religious–cultural elements, community involvement, and long-term evaluation to enhance social cohesion and sustainable development. This study aimed to develop and evaluate a program to foster multicultural leadership among youth in Thailand’s three southern border provinces. The research was conducted in two phases. The first phase involved synthesizing key multicultural leadership characteristics, designing a structured program and assessing its relevance and coherence through expert evaluation. The second phase focused on empirical validation by implementing the program with 22 selected youth participants, employing repeated-measures analysis of variance to assess its effectiveness. Additionally, experts evaluated the program’s validity, appropriateness, cost-effectiveness, utility, and feasibility. The resulting program, “EARCA”, comprises five core components: Experiential Exposure, Active Exploration & Engagement, Reflective Thinking & Analysis, Concept Integration & Synthesis, and Application & Extension. Expert assessments confirmed its appropriateness at the highest level, with a consistency index ranging from 0.8 to 1.0. Statistical analyses demonstrated significant improvements in all dimensions of multicultural leadership among participants. Furthermore, the program was rated highly accurate, appropriate, cost-effective, practical, and feasible for real-world implementation. These findings offer valuable insights for policymakers and practitioners seeking to enhance multicultural leadership development through structured, evidence-based interventions. Full article

Promoting sustainable development requires a clear understanding of how short-term fluctuations in anthropogenic emissions affect urban environmental quality. This is especially relevant for cities experiencing rapid industrial changes or emergency policy interventions. Among key environmental concerns, variations in ambient pollutants like ozone (O₃) are closely tied to both public health and long-term sustainability goals. However, traditional chemical transport models often face challenges in accurately estimating emission changes and providing timely assessments. In contrast, statistical approaches such as the difference-in-differences (DID) model utilize observational data to improve evaluation accuracy and efficiency. This study leverages the synthetic difference-in-differences (SDID) approach, which integrates the strengths of both DID and the synthetic control method (SCM), to provide a more reliable and accurate analysis of the impacts of interventions on city-level air quality. Using Shanghai’s 2022 lockdown as a case study, we compare the deweathered ozone (O₃) concentration in Shanghai to a counterfactual constructed from a weighted average of cities in the Yangtze River Delta (YRD) that did not undergo lockdown. The quasi-natural experiment reveals an average increase of 4.4 μg/m³ (95% CI: 0.24–8.56) in Shanghai’s maximum daily 8 h O₃ concentration attributable to the lockdown. The SDID method reduces reliance on the parallel trends assumption and improves the estimate stability through unit- and time-specific weights. Multiple robustness checks confirm the reliability of these findings, underscoring the efficacy of the SDID approach in quantitatively evaluating the causal impact of emission perturbations on air quality. This study provides credible causal evidence of the environmental impact of short-term policy interventions, highlighting the utility of SDID in informing adaptive air quality management. The findings support the development of timely, evidence-based strategies for sustainable urban governance and environmental policy design. Full article

The swift advancements in autonomous vehicle systems have facilitated their implementation across various industries, including agriculture. However, studies primarily focus on passenger vehicles, with fewer examining autonomous trucks. Therefore, this study reviews autonomous truck systems implementation in North Dakota’s agricultural industry to develop comprehensive technology readiness frameworks and strategic deployment approaches. The review integrates systematic literature review and event history analysis of 52 studies, categorized using Social–Ecological–Technological Systems framework across six dimensions: technological, economic, social change, legal, environmental, and implementation challenges. The Technology Readiness Level (TRL) analysis reveals 39.5% of technologies achieving commercial readiness (TRL 8–9), including GPS/RTK positioning and V2V communication demonstrated through Minn-Dak Farmers Cooperative deployments, while gaps exist in TRL 4–6 technologies, particularly cold-weather operations. Nonetheless, challenges remain, including legislative fragmentation, inadequate rural infrastructure, and barriers to public acceptance. The study provides evidence-based recommendations that support a strategic three-phase deployment approach for the adoption of autonomous trucks in agriculture. Full article

Background/Objetives: Antimicrobial Resistance (AMR) is a multifaceted issue that the World Health Organization (WHO) identifies as one of the primary threats to global health for humans, animals, and the environment. In Colombia, AMR has been extensively studied at the hospital level; however, there are limited environmental studies, particularly concerning leachates from landfills. The objective of this study was to identify and determine the genetic relationships, as well as the sensitivity profiles to antibiotics and heavy metals, of ten Pseudomonas mendocina isolates from a leachate pond. Methods: Identification was conducted using MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight), while genotyping was performed via rep-PCR. Antibiotic susceptibility to β-lactams, aminoglycosides, and quinolones was assessed using the Kirby-Bauer method. Additionally, sensitivity profile to heavy metals was evaluated using the broth microdilution technique. Results: Rep-PCR analysis indicated that 60% (n = 6/10) of the isolates exhibited a clonal relationship. Sensitivity testing revealed that 30% (n = 3/10) of the isolates displayed reduced sensitivity to aminoglycosides and β-lactams. Finally, the broth microdilution showed that 90% (n = 9/10) of the isolates were tolerant to copper sulfate. Conclusions: These results provide evidence that landfill leachates may serve as a potential reservoir for bacteria harboring antimicrobial resistance determinants. Full article