Search Results (6,395)

Background: Uncontrolled donation after circulatory death (uDCD) remains underutilized globally, despite critical organ shortages. We report outcomes from Israel’s uDCD kidney transplant program compared with the matched donation after brain death (DBD) recipients. Methods: This retrospective cohort study analyzed all uDCD kidney transplants performed at the Rabin Medical Center between January 2018 and December 2024, compared with DBD transplants during the same period. Propensity score matching (1:3 ratio) was performed using recipient demographics, comorbidities, and donor characteristics. Primary outcomes included delayed graft function (DGF), graft failure, and patient survival. Results: Among 92 kidney transplants, 21 (22.8%) were from uDCD donors. After propensity-matching (21 uDCD, 63 DBD), significant baseline differences persisted: uDCD recipients were younger (47.2 ± 11.8 vs. 57.5 ± 10.9 years, p < 0.001) despite a similar dialysis vintage (7.2 ± 3.2 vs. 7.7 ± 3.7 years, p = 0.569). Warm ischemia time was 58.5 ± 12.3 vs. 3.0 ± 0.0 min (p < 0.001), and cold ischemia time was longer in uDCD (13.7 ± 5.9 vs. 8.4 ± 2.5 h, p < 0.001). DGF occurred in 90.5% of uDCD versus 54.1% of DBD recipients (p = 0.006). Graft failure was markedly higher in uDCD (28.6% vs. 1.6%, p = 0.001), yet mortality was lower (14.3% vs. 27.9%, p = 0.339). After a median follow-up of 60 months (IQR 48–72) for both groups, the death-censored 5 year graft survival rate was 71.4% for uDCD versus 98.4% for DBD (p < 0.001). Conclusions: Despite higher rates of DGF and graft failure, uDCD kidney transplantation demonstrated an acceptable 5 year patient survival rate in carefully selected younger recipients. These findings support cautious expansion of uDCD programs with rigorous recipient selection criteria and realistic outcome expectations. Full article

In situ physical coal fracturing is one of the key technologies for deep coal resource extraction, among which the liquid nitrogen cyclic freeze–thaw (LNCFT) technique demonstrates remarkable fracturing effects and promising application potential in physical coal breaking. To determine economically viable mining and coalbed methane (CBM) extraction cycles, this study builds on previous research and conducts a series of experiments to investigate the effects of different cold condition temperatures and freeze–thaw cycles on the mesoscopic surface structure and macroscopic mechanical properties of deep, water-rich coal-rock samples. A statistical damage constitutive model for saturated coal-rock under coupled freeze–thaw and loading, incorporating a damage threshold, was established to more accurately describe the damage patterns and mechanisms. The results indicate that lower cold condition temperatures lead to greater mesoscopic crack propagation, lower uniaxial compressive strength, and significantly reduced freeze–thaw failure cycles. Under −45 °C, saturated coal-rock samples experienced macroscopic failure after only 23 freeze–thaw cycles, which is 9 and 15 cycles fewer than those under −30 °C and −15 °C, respectively. Furthermore, measurements of wave velocities in three directions before and after testing revealed that freeze–thaw cycles caused particularly pronounced damage in the direction perpendicular to the bedding planes. Additionally, the established coupled statistical damage constitutive model provides a more accurate and intuitive analysis of the entire process from damage to failure under different cold conditions, showing that as the temperature decreases and freeze–thaw cycles increase, the coal-rock’s brittleness diminishes while plastic deformation and ductile failure characteristics are enhanced. In summary, for coal and CBM extraction using the LNCFT technique, it is recommended to extract gas once after approximately 35 cycles of liquid nitrogen injection. This study provides a theoretical basis for the application of liquid nitrogen cyclic freeze–thaw technology in deep coal fracturing. Full article

Polyvinyl chloride (PVC), owing to its excellent electrical properties and low cost, is widely applied in the inner insulation and outer sheath of cables. To achieve early fault warning based on characteristic gases, this study integrates experimental testing with molecular simulations to systematically reveal the decomposition and gas generation characteristics of different PVC layers under electrical and thermal stresses. The results indicate that inner-layer PVC under electrical stress predominantly generates small-molecule olefins and halogenated hydrocarbons, while outer-layer PVC during thermal decomposition mainly produces hydrogen chloride, alkanes, and fragments of plasticizers. The surrounding atmosphere significantly regulates the gas generation pathways: air promotes the formation of CO₂ and H₂O, whereas electrical discharges accelerate the release of unsaturated hydrocarbons such as acetylene. By employing TG-FTIR, ReaxFF molecular dynamics, and DFT spectral calculations, a normalized infrared spectral library covering typical products was established and combined with the non-negative least squares method to realize quantitative deconvolution of mixed gases. Ultimately, a diagnostic system was constructed based on the concentration ratios of characteristic gases, which can effectively distinguish the failure modes of inner and outer PVC layers as well as different stress types. This provides a feasible approach for early detection of cable faults and supports intelligent maintenance strategies. Full article

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder with unclear pathogenic mechanisms. Dysregulated zinc metabolism contributes to AD pathology. This study aimed to identify zinc metabolism-related hub genes to provide potential biomarkers and therapeutic targets for AD. Methods: We performed an integrative analysis of multiple transcriptomic datasets from AD patients and normal controls. Differentially expressed genes and weighted gene co-expression network analysis (WGCNA) were combined to identify hub genes. We then conducted Gene Set Enrichment Analysis (GSEA), immune cell infiltration analysis (CIBERSORT), and receiver operating characteristic (ROC) curve analysis to assess the hub gene’s biological function, immune context, and diagnostic performance. Drug-gene interactions were predicted using the DrugBank database. Results: We identified a single key zinc transporter–related hub gene, SLC30A3, which was significantly downregulated in AD and demonstrated potential diagnostic value (AUC 0.70–0.80). Lower SLC30A3 expression was strongly associated with impaired synaptic plasticity (long-term potentiation, long-term depression, calcium signaling pathway, and axon guidance), mitochondrial dysfunction (the citrate cycle and oxidative phosphorylation), and pathways common to major neurodegenerative diseases (Parkinson’s disease, AD, Huntington’s disease, and amyotrophic lateral sclerosis). Furthermore, SLC30A3 expression correlated with specific immune infiltrates, particularly the microglia-related chemokine CX3CL1. Zinc chloride and zinc sulfate were identified as potential pharmacological modulators. Conclusions: Our study systematically identifies SLC30A3 as a novel biomarker in AD, linking zinc dyshomeostasis to synaptic failure, metabolic impairment, and neuroimmune dysregulation. These findings offer a new basis for developing targeted diagnostic and therapeutic strategies for AD. Full article

Implant-associated infections remain a major clinical challenge, often leading to implant failure, revision surgery, and increased healthcare burden. Systemic antibiotic administration is limited by poor local bioavailability and systemic side effects, highlighting the need for localized drug-delivery systems that can simultaneously support tissue integration and prevent bacterial colonization. This study aimed to develop and characterize a novel generation of chitosan membranes loaded with hydroxyapatite–clindamycin phosphate (CS/HA-CLY) for localized infection prevention at implantation sites. The composite membranes’ physicochemical characteristics were analyzed using ATR FT-IR, XPS, SEM, XRD, and contact angle measurements. Furthermore, the in vitro biomineralization potential was assessed employing the Taguchi method, while the in vitro release of clindamycin phosphate was examined through UV-Vis spectrophotometry. The CS/HA-CLY membranes exhibited improved wettability, drug release behavior, and biomineralization ability compared to neat CS. These results suggest that the developed composite membranes could successfully combine antibacterial efficacy and biocompatibility, supporting their potential as multifunctional biomaterials for preventing implant-related infections while promoting tissue integration. These findings provide a promising basis for further biological assays and in vitro evaluation. Full article

Objectives: To compare the clinical characteristics and surgical outcomes of initial and subsequent eyes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD). Design: Single-center observational retrospective cohort study. Methods: Sixty-eight patients who underwent surgery for sequential, bilateral RRD between January 2016 and December 2023 were included. Baseline characteristics, surgical procedures and postoperative outcomes were collected for both eyes. The primary outcome measure was the single-surgery anatomic success (SSAS), and the secondary outcome was final best-corrected visual acuity (BCVA). Results: Of the sixty-eight patients, 57 (83.8%) were male with a median age of 60.8 [55.1;69.0] years at first presentation. The median interval between RRD in the two eyes was 17.1 [11.5;33.5] months. Subsequent eyes presented with shorter symptom duration (p < 0.001), better baseline BCVA (p = 0.001), fewer quadrants involved (p < 0.001) and less frequent macular detachment (p = 0.004) compared with initial eyes. Preoperative grade B or C proliferative vitreoretinopathy (PVR) was observed in 33.8% of initial and 25.0% of subsequent eyes (p = 0.286). SSAS was achieved in 66.2% of initial and 73.5% of subsequent eyes (p = 0.458), with PVR as the main cause of failure (65.2% versus 61.1%, p = 1). The final median BCVA was similar in both eyes (0.1 [0.0;0.4] logMAR, p = 0.901). Conclusions: Although subsequent eyes were diagnosed earlier and presented with less advanced RRD, these advantages did not result in superior anatomical or functional outcomes. The high prevalence of PVR in both eyes likely accounts for these findings, supporting the hypothesis of a shared biological predisposition. Full article

Background: Escherichia coli (E. coli) bacteremia is a significant cause of mortality, particularly in older adults. Limited data exists on clinical outcomes in octogenarians. This study aims to evaluate the clinical outcomes of E. coli bacteremia in octogenarians and determine whether appropriate empirical therapy leads to improved outcomes in this specific population. Methods: We conducted a retrospective cohort study of hospitalized patients with E. coli bacteremia at Beilinson Hospital from January 2012 to December 2022. Clinical characteristics, bacteremia sources, antibiotic resistance patterns, and patient outcomes were analyzed. The primary outcome was 30-day mortality. Multivariate regression was used to assess the impact of empirical antibiotic appropriateness on mortality. Results: The study included 2717 patients, of which 1042 (38%) were 80 years or older. Older patients had more comorbidities with increased rates of ischemic heart disease (20% vs. 14%, p < 0.01) and congestive heart failure (19% vs. 9%, p < 0.01). Patients with 3rd generation cephalosporin resistant strains were more likely to receive inappropriate empiric antibiotic therapy (54% vs. 23%, p < 0.01). Although appropriate empirical therapy was associated with improved survival in univariate analysis (19% vs. 28%, p < 0.01), it was not an independent predictor of 30-day mortality in multivariate analysis [adjusted OR = 1.10, 95% CI (0.64–1.81), p = 0.7]. A lower SOFA score [adjusted OR = 0.17, CI95% (0.01–0.31), p < 0.01] was associated with decreased 30-day mortality. Hypoalbuminemia was significantly associated with increased 30-day mortality [adjusted OR = 2.49, CI95% (0.1.56–3.97), p < 0.01]. Conclusions: E. coli bacteremia in octogenarians is associated with significant mortality. While timely appropriate antibiotic therapy is crucial, mortality appears to be more influenced by overall health status, comorbidities, and infection severity. Future research should focus on addressing these factors and developing personalized care strategies to improve survival in this high-risk group. Full article

Ultra-high-performance concrete (UHPC) has been widely utilised in strengthening and rehabilitating conventional normal concrete (NC) structures due to its exceptional mechanical properties and durability. However, in cold climates, the interfacial bond between UHPC and NC is susceptible to degradation under freeze–thaw cycles, potentially compromising the composite action and long-term performance of strengthened structures. This study systematically investigated the shear behaviour of a UHPC-NC interface with planted reinforcement subjected to various freeze–thaw conditions. The experiments were conducted considering different numbers of freeze–thaw cycles (0, 20, 40, 60, 80, and 100) and salt solution concentrations (0%, 3.5%, and 5%). Direct shear tests were performed to evaluate interfacial failure modes, mass loss, and shear strength degradation. Results identified three characteristic failure modes: adhesive debonding at the interface, mixed failure involving both the interface and the NC substrate, and crushing failure within the NC substrate. Specimens exposed to 3.5% salt solution experienced the most significant deterioration, exhibiting a 35% reduction in shear strength after 100 freeze–thaw cycles. Normally, lower salt concentrations were found to induce greater interfacial damage compared to higher concentrations. The study underscores the importance of increasing the embedment depth of the planted reinforcement to alleviate stress concentration and enhance interfacial durability in freeze–thaw environments. Full article

Mechanical damage to apples that occurs without visible skin rupture represents a significant issue during handling and harvesting. The aim of this study was to evaluate the potential for detecting initial internal tissue failure using parameters derived from the deformation curve obtained during a quasi-static penetration test. Particular attention was given to the parameter Pa, defined as the pressure at the yield point, which indicates the onset of structural failure in the tissue. The occurrence of Pa was monitored across five apple genotypes, and the results demonstrated the parameter’s sensitivity to latent internal damage. The parameter Pc, characterising resistance in the later phase of penetration, also showed a strong correlation with fruit bulk density. Significant differences in all mechanical characteristics were observed between the genotypes. The results highlight the potential of these parameters for assessing varietal suitability for mechanised harvesting and sorting. The proposed methodology is readily applicable in the selection of new genotypes within breeding programmes as well as in post-harvest situations. Full article

Hydropower is the primary source of electricity in several countries in Latin America. Hydropower provides approximately 80% of Ecuador’s electricity; however, it remains highly vulnerable to climate change, resulting in uncertainties in power generation due to altered precipitation patterns, runoff, and systematic failures. Consequently, Ecuadorians are becoming increasingly reliant on diesel generators during crises, resulting in public health, safety, and economic impacts, as well as social and political disruptions. This study evaluated noise pollution in the central urban area of the city of Loja for the first time during the 2024–2025 electricity crisis in Ecuador. A Type 1 integrating sound-level meter was used to monitor noise pollution (LAeq, 10min) at 20 locations during periods of generator operation and non-operation. At each location, the number of generators, the density of commercial activities along the streets, as well as traffic and other urban characteristics, were recorded. Results revealed that the presence of generators, street width, and the number of generators significantly increased the LAeq, 10min, often exceeding the limits set by the World Health Organization and Ecuador’s environmental regulations. Frequency spectrum analysis revealed that medium frequencies increased with A-weighting, while low frequencies rose with C-weighting, suggesting potential health risks to the local population. The thematic noise map during generator inactivity showed lower noise levels, averaging around 71.5 dBA. Conversely, when the generators were operational, noise levels exceeded 79.6 dBA, indicating a significant increase in environmental noise exposure associated with their use. This highlights an urgent need to implement and expand renewable energy sources, as existing options like wind power, photovoltaic energy, and biomass are insufficient to meet community demands. Full article

Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, and intraoperative evaluation is subjective. This study aimed to establish objective assessment methods by analyzing the correlations between a novel visual grading system, CT Hounsfield units (HU), and actual bone strength. Materials and Methods: This prospective study included 131 patients undergoing posterior-stabilized TKA. We developed a novel visual grading system (Excellent, Good, Fair, Poor) based on femoral cutting surface characteristics. CT HUs were measured preoperatively by an assisting surgeon in the box bone area. Femoral box specimens underwent indentation testing to determine their actual bone strength. Minimum Required Strength (MRS) was defined at 2.5-fold the patient’s body weight, and Estimated Withstanding Strength (EWS) was determined by scaling first failure load using area ratios. Patients were classified as “cementless suitable” (EWS > MRS) or “cemented mandatory” (EWS < MRS). Correlations were assessed using Spearman’s rank correlation for visual grade and Pearson correlation for Hounsfield units. ROC curve analysis determined diagnostic accuracy. Results: Visual grade exhibited an exceptionally robust relationship to bone strength (Spearman ρ = 0.903, p < 0.01), whereas HU showed substantial correlation (Pearson r = 0.660, p < 0.01, R² = 0.435). Visual grading achieved excellent diagnostic accuracy (AUC = 0.974, sensitivity 95.1%, specificity 95.9%) using “Good” grade as cutoff. HU demonstrated AUC of 0.938 with 92.7% sensitivity and 81.6% specificity at a cutoff value of 65.2. Conclusions: Our novel visual grading system and CT HU demonstrated excellent correlations with actual distal femoral bone strength and outstanding diagnostic performance for identifying cementless TKA candidates. Unlike traditional subjective intraoperative assessments such as the “thumb test”, this system provides objective visual criteria directly correlated with actual bone strength. Preoperative HU screening with intraoperative visual grading can help prevent early failure. Full article

Slate typically contains significant bedding structures and often displays varying mechanical properties under different inclination conditions, with numerous adverse impacts on construction projects. In light of its anisotropic characteristics, a slate foundation pit in Changsha is considered in this study, and uniaxial and triaxial compression tests are initially conducted on slate under various bedding inclination angles. Through these tests, the mechanical parameters of the slate are obtained, and the laws governing the variation in the stress–strain curves and failure modes are analyzed. The results show that the peak strength and elastic modulus present an obvious “U-shaped” variation with the bedding dip angle, reaching the minimum values in the range of 45–60°, and the corresponding failure mode is mainly sliding failure along the bedding plane. The mechanical parameters obtained for slate are input into FLAC3D 6.0 software to simulate a triaxial compressive test of slate, and the calculation results are used to verify the accuracy of the parameters obtained from the tests. Based on these parameters, the foundation pit engineering in the background is simulated in order to analyze the deformation characteristics of the pit under different inclination angles. The simulation results indicate that the foundation pit deformation has significant asymmetry, with larger settlement on the dip side and greater horizontal displacement of the piles. The research findings of this paper can provide a reference for the design and construction of similar slate foundation pit projects. Full article

The accurate real-time delineation of overburden failure zones, specifically the caved and water-conducted fracture zones, remains a significant challenge in longwall mining, as conventional monitoring methods often lack the spatial continuity and resolution for precise, full-profile strain measurement. Based on the hydrogeological data of the E9103 working face in Hengjin Coal Mine, a numerical calculation model for the overburden strata of the E9103 working face was established to simulate and analyze the stress distribution, failure characteristics, and development height of the water-conducting fracture zones in the overburden strata of the working face. To address this problem, this study presents the application of a distributed optical fiber sensing (DOFS) system, centering on an innovative fiber installation technology. The methodology involves embedding the sensing fiber into boreholes within the overlying strata and employing grouting to achieve effective coupling with the rock mass, a critical step that restores the in situ geological environment and ensures measurement reliability. Field validation at the E9103 longwall face successfully captured the dynamic evolution of the strain field during mining. The results quantitatively identified the caved zone at a height of 13.1–16.33 m and the water-conducted fracture zone at 58–60.6 m. By detecting abrupt strain changes, the system enables the back-analysis of fracture propagation paths and the identification of potential seepage channels. This work demonstrates that the proposed DOFS-based monitoring system, with its precise spatial resolution and real-time capability, provides a robust scientific basis for the early warning of roof hazards, such as water inrushes, thereby contributing to the advancement of intelligent and safe mining practices. Full article

This study assesses the flexural performance of concrete beams repaired with externally bonded carbon-fiber-reinforced polymer (CFRP) patches under controlled damage conditions. Prismatic beams (7 × 7 × 28 cm) underwent three-point bending tests in four configurations: uncracked, uncracked-reinforced, cracked-unrepaired, and cracked-repaired. Pre-existing damage was caused by mid-span notches at a = 7, 21, and 35 mm. CFRP patches were placed on the tension face, and the ultimate load and failure mode were recorded. Repairing CFRP beams increased maximum load by up to 240% compared to unrepaired counterparts, and the failure characteristic changed from brittle shear to ductile flexural. Strengthening uncracked beams also yielded significant benefits. These findings show that patch-type CFRP reinforcement effectively recovers and enhances flexural performance across a wide range of crack severity, and they provide quantitative guidelines for determining repair levels depending on original crack depth. Full article

Ensuring the safe operation of large hydro-generators is essential for energy supply and economic development. Stator-winding single-phase grounding faults are among the most common failures in such generators. Conventional protection methods—such as fundamental voltage protection, third-harmonic voltage saturation, and low-frequency injection—lack fault location capability and cannot assess the fault severity. This paper proposes a stepwise variable-frequency pulse injection method for fault diagnosis and location in large hydro-generator stator windings. A finite element model of a salient-pole hydro-generator is established to analyze magnetic flux density and electromotive force distributions under normal and fault conditions, from which fault characteristics are derived. Equivalent circuit models suitable for low- and high-frequency pulse injection are developed. A bidirectional pulse injection circuit and algorithm are designed to identify the fault phase via terminal current vector characteristics, diagnose the faulty branch based on leakage loop equivalent inductance, and locate the fault point using voltage–current signal slopes. Simulation results validate the effectiveness of the proposed diagnostic approach. Full article