Search Results (61,823)

Background/Objectives: Managing postoperative drainage and reducing the length of hospital stays continue to represent significant challenges in thoracic surgery. While systemic antifibrinolytics are effective, concerns persist regarding neurotoxicity and thromboembolic risks. In this study, we evaluated the efficacy and safety of a unique, high-volume topical tranexamic acid (t-TXA) lavage protocol designed to optimize pleuroparenchymal contact and stabilize local hyperfibrinolysis. Methods: A retrospective comparative study was conducted involving 52 patients undergoing major lung resection, divided into a t-TXA group (n = 26) and a control group (n = 26). The t-TXA group received an intrathoracic lavage consisting of 5 g of tranexamic acid (TXA) diluted in 500 mL of saline, while the control group received 500 mL of saline alone. The primary outcomes included postoperative day (POD) 1 drainage volumes and length of stay (LOS). The secondary outcomes were focused on hematological parameters and safety profiles, including a structured one-year follow-up for all patients. Due to the study’s exploratory nature, primary outcomes were assessed using 95% confidence intervals for hypothesis generation rather than a priori sample size calculations. Results: No significant differences were observed between groups regarding sex, surgical approach, or resection type. The t-TXA group demonstrated a significantly shorter LOS (4.20 ± 1.23 days) compared to the control group (5.88 ± 2.23 days; p = 0.001). While POD 1 drainage was numerically lower in the t-TXA group (189.23 ± 235.06 mL) versus the control (284.23 ± 169.40 mL), this difference did not reach statistical significance (p = 0.101). However, exploratory correlation analysis revealed a moderate negative association between t-TXA application and POD 1 drainage (r = −0.412; p = 0.002). Postoperative platelet counts were significantly lower in the t-TXA group (p = 0.009). No thromboembolic events, late complications, or deaths occurred in either group during the one-year follow-up period. Conclusions: High-volume t-TXA lavage is a promising adjuvant associated with significantly shorter hospital stays and a trend toward reduced postoperative drainage. While our 12-month follow-up confirmed a favorable safety profile with no adverse events, these findings should be interpreted as preliminary and hypothesis-generating. The retrospective nature of this study precludes definitive recommendations, underscoring the need for well-powered prospective randomized trials to establish the long-term safety and clinical utility of t-TXA in thoracic surgery. Full article

Emery–Dreifuss muscular dystrophy (EDMD) is a rare inherited neuromuscular disorder within the spectrum of nuclear envelope diseases, classically characterized by early musculo-tendinous contractures, slowly progressive myopathy, and cardiac involvement dominated by conduction disease and arrhythmias, with variable evolution toward cardiomyopathy and heart failure. This narrative review provides a comprehensive and clinically actionable synthesis of cardiovascular manifestations across EDMD genotypes and phenotypes, outlining pragmatic diagnostic and therapeutic pathways for real-world care. A targeted literature search was performed in PubMed, Embase, and Web of Science, focusing on studies addressing cardiovascular involvement in EDMD. Relevant original studies, case series, registries, guideline documents, and high-quality reviews were selected and synthesized narratively, with particular emphasis on diagnostic strategies, risk stratification, and management approaches. Cardiac involvement in EDMD encompasses a broad and heterogeneous spectrum, including atrial disease and conduction disturbances, ventricular arrhythmias, dilated cardiomyopathy, thromboembolic complications, and sudden cardiac death. Phenotypic expression varies according to the underlying genetic substrate, with distinct atrial- and ventricular-dominant trajectories. Early recognition and structured cardiovascular surveillance are essential to guide timely intervention, including anticoagulation, device therapy, and heart failure management. Despite growing awareness, significant gaps remain in risk prediction and standardized management strategies. EDMD represents a paradigmatic model of cardiomyopathy characterized by prominent electrical instability and systemic involvement. A structured, genotype- and phenotype-informed approach centered on early surveillance, proactive arrhythmia and thromboembolic risk management and timely device therapy may improve clinical decision-making in real-world settings. Future perspectives include the integration of precision medicine and the development of gene- and pathway-targeted therapies, with the potential to shift from symptomatic management toward disease-modifying strategies. Full article

Vietnam’s exports expanded dramatically from $14.5 billion in 2000 to $405 billion in 2024, elevating the country to the world’s 22nd largest exporter despite persistent global shocks. This paper introduces the application of the Causal Machine Learning Approach to Resilience Estimation (CLARE) to industry-level trade analysis, utilizing a comprehensive panel of 97 HS2 sectors from 2000 to 2024 (2425 observations) drawn from UN COMTRADE and WITS databases. We implement Double Machine Learning to estimate causal effects of the Global Financial Crisis (2008–2009) and COVID-19 pandemic (2020–2021) on export growth. Results reveal stark industry disparities: electrical machinery (HS85) exhibits exceptional resilience, fueled by 72% high-technology content and low product concentration, while knitted apparel (HS61) proves highly vulnerable. Fixed effect regressions substantiate core hypotheses: a 10-percentage-point increase in high-tech share elevates the resilience index by 0.031 points (approximately 4.1% relative to the sample mean); a one-standard-deviation reduction in product HHI (0.14 units) yields a 0.026-point gain (3.6% relative); and each additional FTA contributes 0.047 points (approximately 6.2% relative), with all estimates significant at conventional levels. Robustness encompassing alternative learners, detrended outcomes, and synthetic controls upholds findings. Policy recommendations center on accelerating high-tech global value chain integration—targeting semiconductors and electric vehicles—while optimizing CPTPP and EVFTA utilization (currently 35%) and mitigating US–China market concentration (45% of exports). These insights chart pathways for Vietnam’s Vision 2045 high-income ambition amid intensifying geopolitical and climate risks, providing a replicable framework for other export-reliant emerging economies. Full article

Background: Early risk assessment in acute pulmonary embolism (PE) remains challenging, particularly in normotensive patients. Lactate may offer incremental prognostic value beyond conventional tools. We investigated the association between arterial lactate and in-hospital mortality in acute PE. Methods: In this retrospective single-center study, 327 adult patients diagnosed with acute PE by computed tomography pulmonary angiography who underwent arterial blood gas analysis within the first six hours of emergency department presentation were included. Patients were categorized according to the occurrence of in-hospital mortality, including 103 (31.5%) non-survivors and 224 (68.5%) survivors, and their demographic, clinical, laboratory, and echocardiographic characteristics were compared accordingly. Results: Arterial lactate levels were significantly higher in non-survivors than survivors [4.1 vs. 1.9 mmol/L; p < 0.001], with a stepwise increase in mortality across lactate categories (<2, 2–4, >4 mmol/L; p < 0.001). In normotensive patients (n = 211), lactate ≥2 mmol/L was associated with higher mortality compared with <2 mmol/L (35.7% vs. 8.7%; OR 5.8, 95% CI 2.7–12.5; p < 0.001). In multivariable logistic regression analysis performed in normotensive patients, arterial lactate level, PESI score, and the presence of cerebrovascular disease were identified as independent predictors of in-hospital mortality, whereas troponin did not retain independent significance. In normotensive patients, lactate showed better discriminative ability than troponin I (AUC 0.718 vs. 0.553). Conclusions: Arterial lactate levels are independently associated with in-hospital mortality in acute PE. Elevated lactate may help identify high-risk patients even in the absence of hypotension and may provide incremental prognostic value beyond existing risk stratification tools. These findings suggest the use of arterial lactate in early risk assessment. Full article

Introduction: Distress during pediatric magnetic resonance imaging (MRI) neuroimaging can compromise scan quality and negatively impact children’s experiences. This review aimed to systematically synthesize biomarkers and psychological factors associated with distress in children, adolescents, and young adults undergoing neuroimaging. Methods: This systematic review was conducted according to PRISMA and AMSTAR-2 guidelines and preregistered in OSF. A systematic search was performed in six electronic databases, including observational articles published between 2000 and 2025 that assessed distress during MRI and functional MRI (fMRI). Data extraction and risk of bias assessment (QUIPS tool) were performed independently by two reviewers. Results: Ten studies (n = 558) examining distress during neuroimaging were included in this review. Distress was assessed through subjective self- and parent-reports, objective physiological measures, and qualitative interviews. Overall, distress levels were low to moderate; most participants tolerated scans well, though younger age, male sex, parental anxiety, procedure length, and chronic illness were associated with greater discomfort. Noise, immobility, and boredom emerged as the most frequent triggers, while strategies such as distraction, age-appropriate information, and reducing waiting times were perceived as helpful. Among participants with cancer, scan-related anxiety was closely linked to fear of recurrence and perceived stress. Risk of bias across studies was moderate to high, particularly in domains of attrition and statistical reporting. Conclusions: Distress during scanning is driven by anticipatory and parental anxiety, procedure length, and chronic illness. Biomarkers (e.g., cortisol, blood pressure) showed inconsistent links with subjective distress, highlighting the need for integrated measures. Full article

The increasing prevalence of cancer in Thailand over the past decade has resulted in a substantial rise in the use of anticancer drugs, which are eventually discharged into municipal wastewater through hospital and domestic effluents. The inability of conventional wastewater treatment systems to completely remove these pharmaceuticals has been widely reported. The continuous release of these emerging anticancer agents into aquatic environments reduces water quality and threatens biodiversity. Even at trace levels, these compounds may act as persistent pollutants capable of impairing ecosystem. This study investigated the occurrence and concentration levels of three widely used chemotherapeutic agents including cyclophosphamide (COP), doxorubicin (DOX), and vincristine (VIN) in Bangkok’s municipal wastewater to evaluate their potential environmental risks. Thirty-two influent and effluent wastewater samples were collected from eight large-scale wastewater treatment plants (WWTPs) from October 2024 to January 2025. Samples were processed using solid-phase extraction (SPE) and analyzed by liquid chromatography–triple quadrupole mass spectrometry (LC–MS/MS). The analytical method demonstrated high precision and reproducibility, with relative standard deviations (%RSD) below the 20% acceptance limit for all compounds. Method accuracy ranged from 81.84% to 107.21%. Results showed the presence of only COP in almost influent and effluent at levels ranging from 0.26 to 2.06 µg/L. In contrast, DOX and VIN levels remained consistently below the limits of quantitation (LOQ) in all WWTP samples. This study establishes the first baseline for COP, DOX, and VIN contamination in Bangkok’s municipal wastewater. Notably, the residue of COP in wastewater suggests that current wastewater treatment facilities in Thailand are insufficient for its removal, posing a potential long-term risk to local aquatic ecosystems. Full article

Earthquake-induced landslide reactivation poses a sustained hazard for years following major seismic events, yet operational prediction remains constrained by heterogeneous multi-modal data, sparse supervision, and the absence of uncertainty-aware frameworks. This paper presents PIMSEL, a physically guided multi-modal semi-supervised framework for post-seismic landslide reactivation risk assessment. PIMSEL integrates satellite-derived morphological features, precipitation time series, and seismic hazard attributes through four components: entropy-regularized optimal transport for cross-modal semantic alignment without paired supervision; causally constrained hierarchical fusion enforcing domain-consistent modal weighting; scenario-based prototype mutation for semi-supervised learning from sparse expert annotations; and prototype-anchored variational graph clustering that simultaneously stratifies landslides into HIGH, MEDIUM, and LOW risk tiers and produces decomposed aleatoric and epistemic uncertainty estimates for operational triage. The HIGH risk tier operationally corresponds to predicted reactivation, validated against 598 documented reactivation events across 7482 co-seismic landslides from three Sichuan Province earthquake sequences: the 2013 Lushan (Mw 7.0), 2017 Jiuzhaigou (Mw 7.0), and 2022 Luding (Mw 6.8) events. PIMSEL achieves 82.5% reactivation recall and 66.4% precision, outperforming twelve baselines across clustering quality, classification, and uncertainty calibration metrics. Ablation studies confirm that optimal transport alignment contributes the largest individual performance gain. Current limitations include quarterly assessment frequency and dependence on optical imagery under cloud cover, which future integration of real-time meteorological triggers and SAR data should address. Full article

Background/Objectives: Previous cross-sectional studies investigated the associations of low handgrip strength (HS), a primary indicator of probable sarcopenia (PS), with biomarkers related to anemia. However, existing evidence is inconsistent, and data establishing causality remain limited. The present prospective study aimed to evaluate whether serum vitamin B12, folate, homocysteine (Hcy), and ferritin levels are associated with PS risk. Methods: This study analyzed data from 1930 adults aged 45–76 years who had normal muscle quantity at baseline. Serum biomarkers were assessed at baseline and PS defined by low HS was determined at 6-year follow-up. The modified Poisson regression method was employed to calculate multivariable risk ratios (RRs) and 95% confidence intervals (CIs). Results: Among all participants, PS risk was inversely related to serum vitamin B12 levels (p = 0.06), while it was lowest in the high-normal ranges of serum Hcy (12.1–15 μmol/L) and ferritin (101–200 ng/mL) levels. The RRs (95% CIs) for PS risk were 0.73 (0.60, 0.89) and 0.75 (0.64, 0.87) for high-normal Hcy and ferritin categories, respectively, compared with the lowest category. On examining the associations of elevated Hcy and ferritin levels with PS risk, age was identified as a significant modifier for elevated Hcy levels (>15 μmol/L) (p for interaction < 0.05); a reduced risk was observed in younger participants, whereas an increased risk was noted in older participants. Conclusions: These findings suggest that high-normal ferritin levels may be optimal for alleviating PS risk, irrespective of age, and that elevated Hcy levels could be detrimental for older adults in preventing PS risk. Full article

Background/Objectives: Clear cell renal cell carcinoma (ccRCC) involves complex interactions between immune evasion and metabolic reprogramming. This study aimed to characterize ccRCC through integrated immunometabolic profiling, develop a prognostic signature, and investigate the functional role of the key driver gene UCN using in vitro and in vivo approaches. Methods: Integrated immunometabolic profiling was performed to identify molecular subtypes and establish a prognostic gene signature. Two distinct molecular subtypes were identified, and a 9-gene Immune Metabolic Index (IMI) was constructed. The functional role of the key driver gene UCN was investigated through in vitro functional assays and in vivo xenograft models in BALB/c mice, including combination with PD-1 blockade. Results: Two molecular subtypes with significant survival differences (p < 0.001) were identified. The established IMI demonstrated high prognostic accuracy, with Area Under the Curve (AUC) values of 0.813, 0.751, and 0.779 at 1-, 3-, and 5-year intervals, respectively. UCN was identified as the highest-risk gene in the signature. Functional assays showed that UCN silencing significantly inhibited cell proliferation and migration (p < 0.05). In BALB/c mouse xenograft models, UCN silencing remodeled the tumor microenvironment by increasing CD8+ T cell infiltration and reducing regulatory T cells (p < 0.01). Furthermore, UCN knockdown significantly suppressed tumor growth and synergized with PD-1 blockade to enhance antitumor efficacy (p < 0.001). Conclusions: The IMI is a robust tool for risk stratification in ccRCC. Targeting the UCN-driven immunometabolic axis represents a promising therapeutic strategy to overcome immune resistance in ccRCC. Full article

The rapid translocation of pesticide and metal residues in the environment and their entry into the food chain pose a significant risk to human health. Given the high global consumption of honey, quality control emphasizes the need for continuous monitoring and risk assessment. To evaluate contamination levels in honey from northern Croatia, a region with intensive agricultural land use, 38 comb honey and 22 extracted honey samples were collected by purposive one-time sampling in June 2023. These samples were analyzed for 190 pesticides using liquid chromatography–tandem mass spectrometry (LC-MS/MS) and gas chromatography–tandem mass spectrometry (GC-MS/MS), and for 17 trace metal(loid)s using inductively coupled plasma mass spectrometry (ICP-MS). The highest detection frequencies were observed for fipronil-sulfone, trifloxystrobin, and coumaphos in comb honey, and for N-(2,4-dimethylphenyl)-formamide (DMF) and N-(2,4-dimethylphenyl)-N′-methylformamidine (DPMF) in extracted honey. Glyphosate was the only pesticide to exceed the European Union (EU) maximum residue level (MRL) of 0.05 mg/kg in three honey samples. Elemental analysis quantified most target metals, with aluminum (Al), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni) and zinc (Zn) being the most abundant, while silver (Ag), arsenic (As), and selenium (Se) were not detected in this study. None of the samples contained lead (Pb) above the regulatory limit for honey established in the EU (0.1 mg/kg). To ensure food safety, further efforts are required to assess the health risks associated with exposure to these contaminants through consumption of the evaluated food. Full article

Introduction: This systematic review examines the association between ultraprocessed food (UPF) intake and cognitive and executive function in adults. Given the global rise in overweight and obesity and the increasing consumption of UPFs, understanding their potential impact on brain health is of growing importance. Method: A comprehensive literature search was conducted in PubMed, EBSCO, and Scopus databases following PRISMA guidelines. Fourteen studies met inclusion criteria, encompassing cross-sectional, longitudinal, and experimental designs. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool. Results: The majority of studies (78.5%) reported a significant association between higher UPF consumption and poorer cognitive outcomes, including deficits in memory, executive function, and global cognition. Longitudinal studies consistently demonstrated that increased UPF intake is linked to accelerated cognitive decline and a higher risk of mild cognitive impairment and dementia, particularly in middle-aged and older adults. In contrast, cross-sectional findings were more heterogeneous, and evidence in younger populations remains limited and inconclusive. Conclusions: Overall, the findings suggest that high UPF consumption may be a modifiable risk factor for cognitive decline. However, methodological variability and the predominance of observational studies highlight the need for further longitudinal and experimental research to clarify causal mechanisms. Full article

The widespread residual ciprofloxacin (CIP) poses severe environmental and health risks, demanding efficient detection methods. Herein, a Zr–Tb bimetallic MOF (ZTM) was green-synthesized via a room-temperature aqueous route with disodium terephthalate as ligand, and developed as a ratiometric fluorescent probe for CIP detection. Structural characterization confirmed Tb³⁺ was successfully incorporated into the Zr-MOF framework, endowing ZTM with high stability and excellent luminescence. The absorption edge of ZTM (320–330 nm) overlapped with CIP’s 330 nm absorption peak, so 327 nm was selected as the excitation wavelength. Under this excitation, ZTM showed a strong Tb³⁺ emission at 657 nm; upon CIP addition, the 657 nm peak was quenched, while the 491 nm emission was enhanced, realizing a distinct ratiometric response. The ratio I₄₉₁/I₆₅₇ was linear with CIP concentration (0.5–25 μM, R² = 0.992), with a limit of detection far below the statutory 30 μM limit (0.16 μM). ZTM also exhibited excellent selectivity, good pH tolerance (5.0–8.0) and rapid response (1 min). Mechanism analysis revealed that the response was mainly due to the inner filter effect (IFE) between ZTM and CIP. This work provides a green-synthesized MOF probe for sensitive and selective CIP detection in environmental samples. Full article

Malaria is one of the major global public health issues. An estimated 282 million malaria cases occurred worldwide in 2024, and the overall prevention and control progress has stagnated or even reversed in some regions. Mass drug administration (MDA), as a potential strategy to accelerate malaria elimination, has regained attention. This paper reviews the evidence base, controversial focuses, and application strategies of MDA in malaria prevention and control. It aims to promote its scientific application in the elimination phase. MDA plays an important role in malaria prevention and control. However, this strategy is accompanied by core limitations such as long-term drug resistance risks, insufficient implementation sustainability, and a high failure rate of regional adaptation. It also faces challenges from multiple common malaria species, as well as the newly discovered Plasmodium knowlesi. We therefore propose an “MDA+” collaborative strategy integrating vaccines, digital monitoring, and cross-border cooperation, so as to optimize resource allocation, achieve full coverage control over various malaria parasites, and advance the global malaria elimination process. Full article

Wind turbine (WT) drivetrains are exposed to high dynamic loads, especially caused by grid and converter faults. Those loads increase the frictional energy in the contact zone of the gearbox bearings and gear wheels and, thus, theoretically, the probability of failure of the gearbox before the WTs reach their service lifetime. To increase the robustness against grid and converter faults, gearboxes can be designed to include these as special load cases. The critical parts of gearboxes regarding the influence of grid and converter faults are the components of the fast-rotating gearbox side. This paper introduces an optimization procedure for the high-speed shaft (HSS) components of a WT gearbox, considering several electrical faults as special load cases. The basis for data collection in this work is a validated multi-body simulation (MBS) model of a WT drivetrain. Initially, a test plan is formulated using Latin hypercube sampling (LHS). Based on the simulation results generated with the detailed MBS model according to the defined test plan, computationally efficient surrogate models are derived that link the design parameters with the objectives of the optimization. The surrogate models are employed to optimize the microgeometry of the gearbox. The process is done for several electrical faults. With the optimization, the risk of damage to the gear wheels can be reduced by 28% with a reduced or equal risk of damage to the HSS bearing, depending on the load case. It is also shown via comparison that the optimal design for one critical fault simultaneously leads to a sufficient improvement for other electrical faults (max. 4% reduction in improvement of objectives). Thus, it is sufficient to do the optimization regarding electrical faults only for one critical fault, reducing the necessary computational effort significantly. Full article

Acute coronary syndromes (ACS) remain time-critical clinical emergencies in which early diagnosis and accurate risk stratification determine management and outcomes. Although symptoms, electrocardiography, and high-sensitivity cardiac troponin (hs-cTn) provide a reliable framework for detecting myocardial injury, they offer limited insight into plaque instability, thromboinflammatory activity, vascular repair, and post-infarction remodeling. In this narrative review, we examine the biological rationale and current clinical evidence supporting brain-derived neurotrophic factor (BDNF) as a candidate biomarker in ACS, with particular attention to pre-analytical, analytical, and phenotypic sources of heterogeneity. Available studies show that circulating BDNF concentrations vary substantially according to biological matrix, timing of sampling, ACS subtype, and assay methodology, which likely contributes to inconsistent findings across cohorts. Overall, current evidence does not support BDNF as a diagnostic alternative to hs-cTn in rule-in or rule-out pathways. However, BDNF may have value in biological phenotyping and risk stratification by reflecting platelet activation, endothelial dysfunction, inflammatory signaling, and remodeling processes after ACS. Further progress will require standardized pre-analytical procedures, separate assessment of mature BDNF and proBDNF, serial sampling, and validation in large multicenter studies. Full article