Search Results (266)

Objective: This article evaluates the reconstructive potential and functional outcomes, as well as the risks and potential perioperative complications of using free flaps in patients with advanced-stage malignant laryngeal neoplasms who require salvage surgery and reconstruction. Additionally, it assesses the effectiveness of various flap harvesting and in-setting techniques, including the performance of microvascular anastomoses. Materials and Methods: This retrospective study included 13 male patients (age range 47–76 years) diagnosed with laryngeal neoplasms, who were referred to the Department of Otolaryngology at the University of Verona between 2017 and 2022. All patients underwent salvage total laryngectomy followed by concurrent reconstructive surgery utilizing microvascular flaps. Recovery of function (phonation) and incidence of complications were evaluated in a follow-up of at least three years. Results: Only one patient experienced necrotic failure of the microvascular free flap, probably due to post-op complications. The patient required revision on the 10th day after surgery and was reconstructed using a pedicled pectoralis major muscle flap. Two patients developed a pharyngocutaneous fistula. Other three patients had pharyngoesophageal stenosis, two experienced recurrence, and one patient passed away due to septic shock. All patients achieved satisfactory functional outcomes regarding vocalization, while complete oral intake was restored in eight patients. Conclusions: Considering the limited sample size, the findings suggest that microvascular flaps represent a feasible option for reconstructing advanced laryngeal tumors, though complication rate may still be considerable. Tailoring reconstructive approaches to individual patients may enhance surgical outcomes. Full article

Background and Objectives: This study aimed to evaluate the treatment outcomes of adults with pulmonary drug-susceptible tuberculosis (DS-TB) in Lithuania over 22 years, and to examine associations between treatment outcomes, various risk factors, and temporal trends. Materials and Methods: A retrospective cohort analysis was conducted using data from the National Tuberculosis Information System from 2000 to 2021. A total of 18,697 adult patients with DS-TB were included. Patients were grouped into three time periods: Period I (2000–2007), Period II (2008–2015), and Period III (2016–2021). Treatment outcomes were categorized as successful (treatment completed with recovery) or unsuccessful (patients who encountered treatment failure, died during treatment, or converted to drug-resistant tuberculosis). Associations with individual risk factors, including smoking, alcohol use, comorbidities, and sociodemographic variables, were analyzed. Results: Treatment success rates improved steadily across the study periods: 82.3% in Period I, 84.4% in Period II, and 87.6% in Period III. Mortality rates declined over time but remained substantial: 17.1%, 15.2%, and 12.0% in Periods I, II, and III, respectively. Non-lethal treatment failures decreased slightly (0.6%, 0.4%, and 0.4%). Multivariate analysis identified significant associations between treatment failure and multiple risk factors, including low BMI, male gender, unemployment, homelessness, smoking, alcohol and substance use, and comorbid conditions such as cancer, cardiovascular disease, chronic lung disease, diabetes mellitus, HIV, and renal failure. Conclusions: Treatment outcomes for DS-TB in Lithuania have improved over the past two decades; however, certain modifiable risk factors—such as low BMI, homelessness, substance use, and comorbidities—remain strongly linked to treatment failure. To further improve outcomes, targeted interventions such as nutritional support, housing programs, and integrated addiction services should be prioritized for high-risk groups within national TB control efforts. Full article

Treatment for acute liver failure (ALF) is constrained by shortages of liver transplant donors and immune rejection. Porcine bone marrow mesenchymal stem cells (pBMSCs) demonstrate clinical potential in xenotransplantation due to their abundant availability, low immunogenicity, and strong proliferative activity. This study is the first to investigate the reparative effects and mechanisms of pBMSCs derived from Luopan Mountain pigs in a D-galactosamine (D-GalN)-induced ALF rat model. The results demonstrated that tail-vein transplantation of pBMSCs significantly improved survival rates in ALF rats; reduced serum ALT, AST, and TBIL levels; enhanced hepatic glycogen metabolism; and mitigated histopathological liver damage. Additionally, pBMSC transplantation upregulated serum HGF, IGF-1, and VEGF levels while inhibiting hepatocyte apoptosis. Mechanistic studies indicate that pBMSCs promote liver function recovery and regeneration by activating the PI3K/Akt/mTOR signaling pathway and suppressing its key negative regulator, PTEN, by regulating the expression of key genes involved in inflammation, fibrosis, proliferation, and apoptosis. This study provides crucial experimental evidence for the use of pBMSCs in treating acute liver failure (ALF) and lays the groundwork for its clinical translation in the field of xenotransplantation. Full article

Power outages in non-faulted zones caused by system failures significantly reduce the reliability of distribution networks. To address this issue, this paper proposes a fault self-healing technique based on the integration of soft open points (SOPs) and network reconfiguration. A mathematical model for power restoration is developed. The model incorporates SOP operational constraints and the stochastic output of photovoltaic (PV) distributed generation. And this formulation enables the determination of the optimal network reconfiguration strategy and enhances the restoration capability. The study first analyzes the operational principles of SOPs and formulates corresponding constraints based on their voltage support and power flow regulation capabilities. The stochastic nature of PV power output is then modeled and integrated into the restoration model to enhance its practical applicability. This restoration model is further reformulated as a second-order cone programming (SOCP) problem to enable efficient computation of the optimal network configuration. The proposed method is simulated and validated in MATLAB R2019a. Results demonstrate that combining the SOP with the reconfiguration strategy achieves a 100% load restoration rate. This represents a significant improvement compared to traditional network reconfiguration methods. Furthermore, the second-order cone programming (SOCP) transformation ensures computational efficiency. The proposed approach effectively enhances both the fault recovery capability and operational reliability of distribution networks with high penetration of renewable energy. Full article

Purpose: While peak oxygen uptake ($\stackrel{.}{\mathrm{V}}$O_2peak) is the gold standard method for assessing exercise tolerance, there is a tendency for underestimation. Several other cardiopulmonary exercise testing (CPET) variables may provide additive prognostic value beyond $\stackrel{.}{\mathrm{V}}$O_2peak alone. The aim of this study was to examine if alternative CPET indices of exercise tolerance are (a) impaired in people with T2D and (b) independently associated with measures of cardiovascular structure and function measured via echocardiography and cardiac MRI. Methods: Participants with type 2 diabetes (T2D) and healthy controls underwent cardiac magnetic resonance imaging, transthoracic echocardiography, and a CPET. Multiple linear regression was used to determine the relationship between indices of exercise tolerance and markers of cardiovascular structure and function. Results: A total of 84 people with T2D and 36 healthy volunteers were included in the analysis. All CPET outcomes were worse in those with T2D vs. the controls. Three CPET outcomes were associated with markers of cardiovascular structure and function: $\stackrel{.}{\mathrm{V}}$O₂ recovery with mean aortic distensibility (β = 0.218, p = 0.049); heart rate recovery with early filling velocity on transmitral Doppler/early relaxation velocity (β = −0.270, p = 0.024), left ventricular mass/volume ratio (β = −0.248, p = 0.030) and mean aortic distensibility (β = 0.222, p = 0.029); and $\stackrel{.}{\mathrm{V}}$O₂ at the ventilatory threshold with myocardial perfusion reserve (β = 0.273, p = 0.018). Perspective: These lesser-used CPET indices could be used to identify which people with T2D are at elevated risk of progression to symptomatic heart failure. However, larger longitudinal studies are required to confirm these findings and their potential clinical application. Full article

Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications—shock, renal failure, and respiratory insufficiency—arise from an overwhelming systemic inflammatory response driven by markedly elevated pro-inflammatory cytokines. Massive release of IL-2, IL-6, and TNF-α underlies the systemic inflammatory response syndrome (SIRS). Continuous veno-venous hemofiltration (CVVH) with the oXiris filter, adsorbing endotoxins and cytokines, has been used in sepsis and applied early in SAP to reduce cytokine load and organ injury. Aims: To evaluate the efficacy and safety of early CVVH with the oXiris filter in modulating the systemic inflammatory response by removing toxic cytokines from the bloodstream in patients with SAP complicated by organ dysfunction and refractory sepsis. Methods: This single-centre, retrospective, observational study was conducted at a tertiary university hospital between 2000 and 2022. Forty-eight consecutive patients with SAP at onset, defined according to the 2012 Atlanta Classification, with an APACHE II score ≥ 19 and persistent organ dysfunction (>48 h), were included. All patients were unresponsive to initial intensive care within the first 24 h and underwent urgent laparotomy with extensive peritoneal lavage, pancreatic necrosectomy, and placement of multiple abdominal drains, followed by transfer to the intensive care unit. CVVH (Prismax system) with the oXiris filter was initiated within 12 h post-surgery. IL-6 and TNF-α were selected as inflammatory markers and measured in both serum and ultrafiltrate at baseline (0 h) and at 24, 48, 72, and 96 h. These measurements were correlated with clinical parameters and prognostic scores (APACHE II, SOFA). Results: Treatment was well tolerated in all patients. The 28-day survival rate was 97.9%. There was a significant time-dependent decrease in IL-6 (p = 0.019) and TNF-α (p = 0.008) concentrations in the ultrafiltrate, consistent with high early adsorption followed by a reduced cytokine burden, whereas serum levels showed a non-significant downward trend (IL-6 p = 0.08; TNF-α p = 0.310). The APACHE II score decreased from 23 postoperatively to 8 by the second week (−65.2%; p = 0.013), with a statistically significant correlation between cytokine reduction and clinical improvement. Adverse events were rare and manageable. Conclusions: Early CVVH with the oXiris filter in SAP, complicated by MODS and refractory sepsis, proved safe, well-tolerated, and potentially effective in reducing cytokine burden and improving prognostic indices. These findings support the hypothesis of a relevant immunomodulatory effect, warranting prospective controlled trials to confirm its true impact on survival and organ recovery. Full article

End-stage kidney disease is preferably treated by kidney transplantation. The function of the allograft often determines kidney-controlled processes and requires long-term monitoring. Kidneys are organs with a very high metabolic rate, and, thus, a metabolomics approach is suitable to observe systemic metabolic changes that are related to graft adaptation. To understand these ongoing changes in post-transplant pediatric patients, we applied a targeted liquid chromatography/tandem mass spectrometry-based metabolomics approach. Time-dependent changes of 140 metabolites in plasma samples prospectively collected from 23 pediatric kidney graft recipients receiving tacrolimus-based immunosuppression were monitored over the first 4 years after transplantation and compared to levels prior to transplantation. Furthermore, by comparing the pre-transplant metabolite levels to those measured in healthy children, we were able to obtain insights into the pathways associated with kidney failure. Arginine biosynthesis, alanine, aspartate, glutamine, and glutamate metabolism, taurine and tryptophan metabolism were the most affected pathways that separate the pediatric patients with and without kidney failure. Accumulation of uremic toxins such as various tryptophan/kynurenine and tryptophan/indole metabolism pathway intermediates, and betaine and methionine cycle metabolites was evident in patients with restricted kidney function. Furthermore, reduced nicotinamide production, insufficient hydroxylation of phenylalanine to tyrosine, lowered cysteine, arginine, glutamine, taurine, and overall amino acid utilization, as well as diminished levels of protective antioxidants such as glutathione and vitamins B6 and C, were all the result of progressive kidney failure leading to transplantation. Importantly, following kidney transplantation and recovery of kidney function, the levels of most of the previously described metabolites normalized toward the levels observed in healthy participants. The here identified metabolic patterns could be used as markers to monitor the progression of pediatric chronic kidney disease patients towards kidney failure, and assuming their direct association with kidney function, they could serve as markers of successful graft adaptation. Full article

As is typical of deep rock engineering, fault-controlled hydrothermal systems (FHS) have emerged as a highly promising solution for geothermal energy exploitation. The stability and thermal recovery performance of such systems are critical to their long-term efficiency and viability. In this study, we establish a coupled Thermo-Hydro-Mechanical (THM) model to investigate the mechanical response and thermal output of an FHS. The stability of the system is evaluated based on the evolution of the failure zone within the fault. Key findings include the following: (1) The pore pressure distribution between injection and production wells leads to an elliptical failure pattern in the fault, caused by the constraint exerted by the negative pore pressure zone around the production well on the positive pressure zone around the injection well along the well connectivity direction; (2) Reducing the injection flow rate by 50% can result in a 76% decrease in the thermal recovery efficiency. Meanwhile, reducing the number of reinjection sub-wells from seven to three can lead to a 95% reduction in the failure volume; and (3) Larger fault thickness diminishes both failure volume and thermal performance; specifically, increasing the fault thickness from 5 m to 30 m can result in an 89% reduction in the failure volume. The fault damage zone volume exhibits a sharp decrease as permeability rises from 2 × 10⁻¹² m² to 8 × 10⁻¹² m². This study provides scientific insights and practical guidelines for the design and stability assessment of FHS-based geothermal systems. Full article

Background: Autonomic dysfunction is commonly encountered after acute ischemic stroke (AIS) and may influence both functional recovery and survival. Heart rate variability (HRV) provides a non-invasive measure of autonomic balance, but its temporal evolution and prognostic significance in AIS remain insufficiently evaluated. Methods: In this prospective observational study, 148 AIS patients (mean age of 65.93 ± 9.19 years) underwent HRV assessment at baseline, one month, and three months follow-up, between January 2022 and October 2024. Time and frequency domain parameters, including Standard Deviation of NN intervals (SDNN), Low-Frequency (LF) power, High-Frequency (HF) power, and LF/HF ratio, were analyzed. Functional outcome was assessed using the modified Rankin Scale (mRS), with a good outcome defined as mRS ≤ 2. Multivariable logistic regression identified independent predictors of poor outcome (mRS > 2) at each time point. Mortality was recorded at one and three months, and potential predictors were evaluated. Results: Over three months, SDNN increased by 34.84% (p < 0.001), HF power rose by 22.26% (p < 0.001), LF power decreased by 21.61% (p < 0.001), and LF/HF ratio declined by 35.41% (p < 0.001), indicating a shift toward parasympathetic predominance. Higher SDNN correlated strongly with better functional status and was an important predictor of favorable outcome at all time points (p < 0.001). Higher LF/HF ratio predicted poor outcome at baseline (p < 0.01) and three months (p < 0.001). At three months, mortality reached 12.2%, with significant predictors including coronary artery disease (CAD), heart failure (HF), chronic kidney disease (CKD), and altered HRV parameters. Conclusions: Post-stroke recovery is characterized by the progressive restoration of autonomic balance, with higher SDNN and lower LF/HF associated with improved functional recovery and survival. HRV analysis offers valuable prognostic insight and may aid in risk stratification after AIS. Full article

Enhancing the failure tolerance ability of networks is crucial, as node or link failures are common occurrences on-site. The current fault tolerance schemes are divided into reactive and proactive schemes. The reactive scheme requires detection and repair after the failure occurs, which may lead to long-term network interruptions. The proactive scheme can reduce recovery time through preset backup paths, but requires additional resources. Aiming at the problems of long recovery time or high overhead of the current failure tolerance schemes, the Polymorphic Network adopts field-definable network baseline technology, which can support diversified addressing and routing capabilities, making it possible to implement a more complex and efficient failure tolerance scheme. Inspired by this, we propose an efficient Multi-topology Failure Tolerance mechanism in Polymorphic Network (MFT-PN). The MFT-PN embeds a failure recovery function into the packet processing logic by leveraging the full programmable characteristics of the network element, improving failure recovery efficiency. The backup path information is pushed into the header of the failed packet to reduce the flow table storage overhead. Meanwhile, MFT-PN introduces the concept of multi-topology routing by constructing multiple logical topologies, with each topology adopting different failure recovery strategies. Then, we design a multi-topology loop-free link backup algorithm to calculate the backup path for each topology, providing extensive coverage for different failure scenarios. Experimental results show that compared with the existing strategies, MFT-PN can reduce resource overhead by over 72% and the packet loss rate by over 59%, as well as effectively cope with multiple failure scenarios. Full article

Autonomous underwater vehicles (AUVs) play a crucial role in marine environments, such as in inspecting marine structures and monitoring the condition of subsea pipelines. After completing their mission, AUVs dock with recovery systems at designated locations. However, underwater docking carries a significant risk of failure due to unpredictable maritime conditions. Considering the limitations in communication during the mission, docking failure can lead to the loss of collected data and failure of the entire AUV mission. In this study, a hypothetical AUV docking scenario was defined based on expert knowledge and without actual operational data. A Markov chain-based probabilistic model was employed to quantitatively assess the risk of the system during the mission. Environmental factors were excluded from the evaluation, and the simulation results were classified into five categories: success, timeout, internal component failure, exceeding a predefined sequence repetition limit, and spending the electrical energy under the battery SOC threshold. By analyzing the failure points of each category, strategies to improve the scenario success rate were discussed. This study quantitatively identified the interactions between constraints and risk factors that should be considered when establishing AUV docking plans through a virtual scenario-based failure analysis, thereby providing an evaluation framework that can be utilized in actual design. Full article

Background: Right atrial thrombus (RAT), though rare, carries a high risk of pulmonary or systemic embolism and a 25–44% mortality rate. In LVAD candidates, coexisting RAT significantly complicates perioperative management due to their critical condition and high risk of decompensation during surgery. Percutaneous thrombectomy offers a less invasive, lower-risk alternative to open surgery, enabling faster recovery. Case Presentation: We present a case of a 76-year-old male with ischemic cardiomyopathy and heart failure secondary to Adriamycin chemotherapy with an ejection fraction (EF) of 26%, diabetes mellitus, and stage 3 chronic kidney disease, scheduled for left ventricular assist device (LVAD) implantation. Preoperative echocardiography revealed a large, multilobulated, mobile thrombus in the right atrium. Given the high surgical risk and thrombus mobility, percutaneous thrombectomy using the AngioVac system (Angiodynamics, Latham, NY, USA) was performed. The thrombus was successfully removed, and the patient was discharged on apixaban for long-term anticoagulation. Advanced medical therapy and transplant/durable LVAD evaluation were delayed by 35 days to allow for the stabilization of any postoperative effects. Conclusions: This case underscores the efficacy of percutaneous thrombectomy as a bridge to LVAD in high-risk patients, reducing thromboembolic complications and supporting safe LVAD implantation. Full article

Background/Objectives: Fulminant myocarditis (FM) is an uncommon but potentially reversible form of myocardial inflammation that can rapidly progress to cardiogenic shock (CS). In patients who are refractory to conventional treatment, venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an effective life support strategy. However, the factors that determine functional recovery remain uncertain. The primary objective of this study was to characterize patients who recover ventricular function. Secondary objectives included analyzing VA-ECMO-related complications and overall patient survival. Methods: This was a retrospective, single-center, observational study including all consecutive patients diagnosed with FM between 2008 and 2025 who were supported with VA-ECMO (n = 22). Clinical, biochemical, echocardiographic, and imaging variables were collected. Patients were classified based on their outcomes as either recovery or death/transplantation. Differential factors potentially affecting myocardial recovery, survival, and complications were analyzed. Results: The mean age was 49.7 ± 11 years, with 36% being male. Severe cardiogenic shock was the most common initial presentation (86%), and the average time from symptom onset to hospital admission was 5.7 days. Regarding mechanical support, the non-recovery group required longer ECMO support (328 ± 225 h vs. 188 ± 103 h; p = 0.03). The presence of fibrosis on cardiac magnetic resonance imaging (MRI) was associated with a lower probability of recovery (100% vs. 44.4%; p = 0.03). Renal failure and vascular complications were more frequent in the non-recovery group, with a significantly higher rate of surgical reintervention (50% vs. 10%; p = 0.04). Echocardiography performed before discharge (recovery group) vs. before death/transplant (non-recovery group) showed significant differences in left ventricular ejection fraction (51.1% vs. 29.5%; p = 0.04), along with better levels of creatinine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), leukocytes, and C-reactive protein (CRP) in the recovery group. In-hospital survival for the entire cohort was 63.6%, significantly higher in the recovery group (100% vs. 33.3%; p < 0.01). One-year survival was 59%, which was also greater among those who recovered (90% vs. 33.3%; p = 0.02). Conclusions: FM is associated with an acceptable in-hospital survival rate. The presence of myocardial fibrosis on MRI and longer ECMO support duration were observed to be associated with a lower likelihood of cardiac recovery. Patients who recovered showed better ventricular function at discharge, as well as reduced systemic inflammation and renal dysfunction. These findings highlight the importance of early identification of predictors of myocardial recovery to optimize management and therapeutic decision making in this high-risk population. Full article

Heart failure (HF) remains a global health challenge with high rates of hospitalization and mortality, particularly among the elderly. Many episodes of worsening HF occur before symptoms arise, underscoring the need for sensitive monitoring tools. Respiratory Stability Time (RST) is a novel index that quantifies the duration of stable respiration during sleep, reflecting pulmonary congestion and circulatory status. RST can be measured continuously and non-invasively using a contactless under-mattress sensor. Observational cohort studies show that low RST predicts poor prognosis, while its improvement parallels recovery from decompensation. Importantly, recent prospective multicenter observations involving 100 patients demonstrated that sustained RST decline often precedes HF readmission, probably enabling early intervention. A multicenter trial (ITMETHOD-HF III), involving 80 patients, is currently testing whether RST-guided therapy can reduce HF readmissions. RST might substantially enhance current HF management by enabling us to provide proactive therapeutic intervention, though further validation is warranted. Full article

The aim of this study was to describe changes in estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF) and clinical outcomes in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). A total of 321 patients (67 [58–74] years old, 19.3% females) were included; 134 (41.7%) had AF. AF patients were less frequently prescribed angiotensin receptor–neprilysin inhibitor (ARNi), with no differences concerning sodium–glucose transport protein 2 inhibitors (SGLT2is) and had lower median baseline eGFR values. At 6- and 12-month follow-ups, renal function declined similarly in both groups, with no difference in the proportion of patients experiencing an eGFR decrease of ≥30% from baseline. Regarding cardiac remodeling, patients without AF showed a higher proportion of individuals with an LVEF improvement of ≥10% from baseline, however with no differences between groups in LVEF final recovery. During a median follow-up of 582 (339–1481) days, AF patients showed a higher risk of composite outcome (aHR, 95% CI: 2.12, 1.16–3.86) and of hospitalization for heart failure (hHF) (2.80, 1.44–5.46), without differences in all-cause death. Delta eGFR changes with at least a 30% decline in eGFR were associated with a higher risk of the primary endpoint. Despite lower baseline renal function, AF patients exhibited similar LVEF improvement and renal decline, which emphasizes the importance of guideline-directed medical therapy. AF was associated with a higher risk of adverse events, primarily driven by hHF. Full article