Search Results (274)

In remote alpaca breeding regions, access to advanced sperm analysis laboratories is limited. This study validates a practical cytometric method for evaluating sperm viability and acrosomal integrity in epididymal alpaca sperm using early fluorochrome staining, formaldehyde fixation, and intermediate storage. Thirty-two testes were transported at 5 °C, and spermatozoa were collected from the cauda epididymis. After morphometric screening, 26 samples were included. Aliquots were stained with Zombie Green (viability) and FITC–PSA (acrosomal integrity), at time zero. Each aliquot was divided for cytometric analysis at T0 (immediately), T24 (24 h after formaldehyde fixation) and T1w (1 week post-fixation). Fixed samples showed higher viability and acrosomal integrity values (T24: 70.75%, 97.24%; T1w: 71.80%, 97.21%) than T0 (67.63%, 95.89%). This may reflect fluorescence alterations associated with fixation. Strong correlations and Bland–Altman analysis confirmed consistency across time points. This method enables accurate sperm quality evaluation up to one week after collection, offering a useful tool for reproductive monitoring in field conditions without immediate analysis. Further research on ejaculated semen and field protocols is recommended. Full article

Background/Objective: In-hospital cardiac arrest has high incidence and poor survival rates, posing a significant healthcare challenge. It is important to intervene in the hours before the cardiac arrest to prevent poor outcomes. The modified early warning score (MEWS) is a validated tool for identifying a deteriorating patient. It is an aggregate of vital signs and level of consciousness. We retrospectively evaluated MEWS for trends that might predict patient outcomes. Methods: We performed a single-center, one-year, retrospective study. A comprehensive review was conducted for patients aged 18 years and above who experienced a cardiac arrest. Cases that occurred within an intensive care unit, emergency department, during a procedure, or outside the hospital were excluded. A total of 87 cases met our predefined inclusion criteria. We collected data at 12 h, 6 h and 1 h time periods prior to the cardiac arrest. A trend analysis using a linear model with analysis of variance with Bonferroni correction was performed. Results: Out of 87 patients included in the study, 59 (67.8%) had an immediate return of spontaneous circulation (ROSC). Among those who achieved ROSC, 41 (69.5%) died during the admission. Only 20.7% of the patients that sustained a cardiac arrest survived to discharge. A significant increase in the average MEWS was noted from the 12 h period (MEWS = 3.95 ± 2.4) to the 1 h period (MEWS = 5.98 ± 3.5) (p ≤ 0.001) and the 6 h period (4.65 ± 2.6) to the 1 h period (5.98 ± 3.5) (p = 0.023) prior to cardiac arrest. Conclusions: An increase in the MEWS may be a valuable tool in identifying at-risk patients and provides an opportunity to intervene at least 6 h before a cardiac arrest event. Further research is needed to validate the results of our study. Full article

Background/Objectives: Heart transplantation (HTx) is a lifesaving procedure for end-stage heart failure patients; however, postoperative infections remain a major challenge due to immunosuppressive therapy and surgical complications. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have limitations in distinguishing infections from systemic inflammatory response syndrome (SIRS). Emerging markers such as Presepsin and interleukin-6 (IL-6) may improve diagnostic accuracy. This study aimed to evaluate the kinetics and reliability of these four inflammatory biomarkers in heart transplant recipients in the immediate postoperative period. Methods: This retrospective observational study included 126 patients who underwent HTx at Policlinic of Bari between January 2022 and November 2024. Patients were categorized into infected (n = 26) and non-infected (n = 100) groups based on clinical and microbiological criteria. Biomarkers (CRP, PCT, Presepsin, and IL-6) were measured preoperatively and on postoperative days (PODs) 1, 2, 3, 4, 5, and 10. Statistical analyses included the Mann–Whitney U test and logistic regression to identify the independent predictors of infection. Results: CRP and PCT levels differed significantly between the groups only on day 10, limiting their use as early infection markers. In contrast, Presepsin levels were significantly elevated in infected patients from day 1 (p < 0.001), whereas IL-6 levels showed significant differences from day 3 onward. Presepsin showed the strongest association with infection in the early postoperative phase. Conclusions: Presepsin and IL-6 outperformed CRP and PCT in detecting early postoperative infections in heart transplant recipients. Their early elevation supports their use as reliable markers for guiding timely clinical intervention and improving patient outcomes. Further research is needed to validate these findings in larger cohorts and with different immunosuppressive regimens. Full article

Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset. Full article

Background: The Da Silva Cone procedure for Ebstein anomaly has dramatically improved tricuspid valve competence and clinical outcomes. However, preoperative left ventricular (LV) dysfunction and immediate postoperative right ventricular (RV) systolic dysfunction are frequently observed. While excellent valve outcomes are well established, recovery of biventricular function following the Cone remains less defined. This study aimed to evaluate longitudinal changes in RV and LV function postoperatively and over a minimum of six months post-Cone operation. Methods: A single center retrospective review of 134 patients who underwent Cone repair for Ebstein’s anomaly from 2016 to 2024 was performed. Echocardiograms were analyzed at three time points: preoperative (Time 1), hospital discharge (Time 2), and ≥6 months postoperative (Time 3). RV parameters included fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid S′. LV parameters included left ventricular ejection fraction (LVEF), end-diastolic volume indexed to body surface area (LVEDVi), left ventricular stroke volume (LVSVi), and mitral E/E′. Subgroup analyses examined outcomes by prior Glenn, Starnes procedure, and degree of RV dilation. Paired two sample t-tests were used to compare serial measures. Results: Median age at surgery was 7.8 years (IQR: 2.3–17.7). All patients had discharge echocardiograms; 70 had follow-up studies at ≥6 months. RV function declined postoperatively with reductions in FAC (35% to 21%), TAPSE (2.0 to 0.8 cm), and S′ (13 to 5 cm/s), all p < 0.001. By Time 3, these measures improved (FAC to 29%, TAPSE to 1.3 cm, S′ to 7 cm/s) but did not fully return to baseline. LVEDVi and LVSVi increased significantly by Time 3 (LVEDVi: 47 to 54 mL/m²; LVSVi: 30 to 34 mL/m²; p < 0.001), while LVEF remained unchanged. Patients with prior Glenn or Starnes had greater Time 1 LV volumes and lower RV function, but by Time 3, most differences resolved. Moderate–severe preoperative RV dilation was associated with worse RV function at Time 2 and normalized by Time 3. Conclusions: The Da Silva Cone procedure leads to early postoperative RV dysfunction with partial recovery over the mid-term follow-up. Concurrently, LV filling and stroke volume improve, reflecting favorable interventricular interaction. These findings support echocardiographic surveillance to guide functional recovery post-Cone and inform patient counseling. Full article

Background/Objectives: Partial maxillectomy frequently results in severe impairments of oral functions, such as difficulties in chewing, speech, swallowing, and facial appearance. Immediate prosthetic rehabilitation is challenging because soft tissue healing is typically required before impression taking. This study aimed to (1) develop a comprehensive digital workflow for fabricating immediate obturator prostheses using preoperative data and (2) assess their early clinical effectiveness in restoring oral functions after surgery. Methods: In this prospective clinical study, 20 patients undergoing partial maxillectomy from January 2023 to January 2025 were enrolled. A digital workflow combining cone-beam computed tomography (CBCT), intraoral scanning, CAD/CAM design, and 3D metal printing was implemented. Obturator prostheses were digitally designed preoperatively and inserted immediately post-resection. Functional outcomes were postoperatively evaluated after one month using the Obturator Functioning Scale (OFS), which measures functional, speech, esthetic, and psychosocial aspects. Results: The digitally fabricated immediate obturator prostheses were successfully placed intraoperatively in all patients. Most participants reported mild to moderate difficulties, with speech-related issues being the most common, while esthetic concerns were minimal. Masticatory function was satisfactorily restored in 75% of cases, and 60% of patients experienced minimal fluid leakage during swallowing. No significant differences were found between genders. Patients with larger defects tended to report greater functional challenges. Conclusions: The digitally planned immediate obturator prosthesis provides a practical and effective solution for early rehabilitation following partial maxillectomy. This digital workflow reduces patient discomfort, restores key oral functions, and facilitates psychosocial recovery. Full article

Grounded in the theory of metacognitive prediction error minimization, this study is the first to propose and empirically validate the mechanism of implicit metacognitive predictive processing by which bodily interaction influences the Aha! experience. Three experimental groups were designed to manipulate the level of temporal synchrony in bodily interaction: Immediate Mirror Group, Delayed Mirror Group, and No-Interaction Control Group. A three-stage experimental paradigm—Prediction, Execution, and Feedback—was constructed to decompose the traditional holistic insight task into three sequential components: solution time prediction (prediction phase), riddle solving (execution phase), and self-evaluation of Aha! experience (feedback phase). Behavioral results indicated that bodily interaction significantly influenced the intensity of the Aha! experience, likely mediated by metacognitive predictive processing. Significant or marginally significant differences emerged across key measures among the three groups. Furthermore, fNIRS results revealed that low-frequency amplitude during the “solution time prediction” task was associated with the Somato-Cognitive Action Network (SCAN), suggesting its involvement in the early predictive stage. Functional connectivity analysis also identified Channel 16 within the reward network as potentially critical to the Aha! experience, warranting further investigation. Additionally, the high similarity in functional connectivity patterns between the Mirror Game and the three insight tasks implies that shared neural mechanisms of metacognitive predictive processing are engaged during both bodily interaction and insight. Brain network analyses further indicated that the Reward Network (RN), Dorsal Attention Network (DAN), and Ventral Attention Network (VAN) are key neural substrates supporting this mechanism, while the SCAN network was not consistently involved during the insight formation stage. In sum, this study makes three key contributions: (1) it proposes a novel theoretical mechanism—implicit metacognitive predictive processing; (2) it establishes a quantifiable, three-stage paradigm for insight research; and (3) it outlines a dynamic neural pathway from bodily interaction to insight experience. Most importantly, the findings offer an integrative model that bridges embodied cognition, enactive cognition, and metacognitive predictive processing, providing a unified account of the Aha! experience. Full article

Type 1 diabetes is classified into three clinical subtypes: fulminant type 1 diabetes, acute-onset type 1 diabetes, and slowly progressive type 1 diabetes, also known as latent autoimmune diabetes in adults. Among these, the fulminant and slowly progressive forms may develop in association with pregnancy and are herein collectively referred to as “pregnancy-associated type 1 diabetes”. Fulminant type 1 diabetes can manifest suddenly during pregnancy, often accompanied by ketoacidosis, posing a significant risk to both the mother and the fetus. Early diagnosis and treatment are, therefore, critical. In pregnant women with no prior history of diabetes who present with marked hyperglycemia (≥288 mg/dL) but relatively low HbA1c levels (<8.7%), fulminant type 1 diabetes should be suspected, and insulin therapy should be initiated immediately. Conversely, women diagnosed with gestational diabetes who test positive for anti-islet autoantibodies are at high risk of developing slowly progressive type 1 diabetes postpartum. For these patients, regular monitoring of blood glucose levels, HbA1c, and endogenous insulin secretion is essential for early detection and management. Full article

Background: Febrile neutropenia is a critical complication in patients with hematological malignancies; immediate initiation of empirical treatment with a broad-spectrum agent is the standard of care. In this study, we aimed to evaluate the cost-effectiveness of long- and short-term antibiotic treatments. Methods: We conducted a retrospective cohort study. We collected data on admissions between 1 January 2018 and 31 December 2022. Adult patients treated with meropenem were included and treatment duration was categorized. Short-term treatment (STT) was defined as a period of 7 days or less, and long-term treatment (LTT) was defined as longer than 7 days. To comparatively estimate costs in both groups, it was hypothesized where STT patients were assumed to receive LTT. Three scenarios were modeled to calculate potential cost reductions. Results: In total, 151 high-risk patients were eligible, with 93 and 58 in the STT and LTT groups, respectively. Both groups exhibited similar clinical characteristics and statistically no significant differences in outcomes. The average costs for the STT and LTT groups were statistically significantly different at USD 9294.01 and USD 13,515.27, respectively. From the regression analysis, cost reductions per patient of USD 164, 527, and 690 were estimated for the three intervention scenarios. Conclusions: Notably, even though the clinical outcomes of STT were not statistically different from those of LTT, the cost of the STT group were statistically significantly lower than that of the LTT group. The early discontinuation of empirical meropenem treatment may offer financial advantages to healthcare systems. Full article

Older adults make up about 12% of the public sector, primary care, and hospital use and represent a large proportion of the users of healthcare services. Older people are also more vulnerable to serious injury from unexpected falls due to tripping, slipping, or illness. This underscores the immediate necessity of stable and cost-effective e-health technologies in maintaining independent living. Artificial intelligence (AI) and machine learning (ML) offer promising solutions for early fall prediction and continuous health monitoring. This paper introduces a novel cooperative AI model that forecasts the risk of future falls in the elderly based on behavioral and health abnormalities. Two AI models’ predictions are combined to produce accurate predictions: The ${AI}_1$ model is based on vital signs using Fuzzy Logic, and the ${AI}_2$ model is based on Activities of Daily Living (ADLs) using a Deep Belief Network (DBN). A meta-model then combines the outputs to generate a total fall risk prediction. The results show 85.71% sensitivity, 100% specificity, and 90.00% prediction accuracy when compared to the Morse Falls Scale (MFS). This emphasizes how deep learning-based cooperative systems can improve well-being for older adults living alone, facilitate more precise fall risk assessment, and improve preventive care. Full article

The scaling up of carbon capture, utilization, and storage (CCUS) deployment is constrained by multiple factors, including technological immaturity, high capital expenditures, and extended investment return periods. The existing research on CCUS investment decisions predominantly centers on coal-fired power plants, with the utilization pathways placing a primary emphasis on storage or enhanced oil recovery (EOR). There is limited research available regarding the chemical utilization of carbon dioxide (CO₂). This study develops an options-based analytical model, employing geometric Brownian motion to characterize carbon and oil price uncertainties while incorporating the learning curve effect in carbon capture infrastructure costs. Additionally, revenues from chemical utilization and EOR are integrated into the return model. A case study is conducted on a process producing 100,000 tons of methanol annually via CO₂ hydrogenation. Based on numerical simulations, we determine the optimal investment conditions for the “CO₂-to-methanol + EOR” collaborative scheme. Parameter sensitivity analyses further evaluate how key variables—carbon pricing, oil market dynamics, targeted subsidies, and the cost of renewable electricity—influence investment timing and feasibility. The results reveal that the following: (1) Carbon pricing plays a pivotal role in influencing investment decisions related to CCUS. A stable and sufficiently high carbon price improves the economic feasibility of CCUS projects. When the initial carbon price reaches 125 CNY/t or higher, refining–chemical integrated plants are incentivized to make immediate investments. (2) Increases in oil prices also encourage CCUS investment decisions by refining–chemical integrated plants, but the effect is weaker than that of carbon prices. The model reveals that when oil prices exceed USD 134 per barrel, the investment trigger is activated, leading to earlier project implementation. (3) EOR subsidy and the initial equipment investment subsidy can promote investment and bring forward the expected exercise time of the option. Immediate investment conditions will be triggered when EOR subsidy reaches CNY 75 per barrel or more, or the subsidy coefficient reaches 0.2 or higher. (4) The levelized cost of electricity (LCOE) from photovoltaic sources is identified as a key determinant of hydrogen production economics. A sustained decline in LCOE—from CNY 0.30/kWh to 0.22/kWh, and further to 0.12/kWh or below—significantly advances the optimal investment window. When LCOE reaches CNY 0.12/kWh, the project achieves economic viability, enabling investment potentially as early as 2025. This study provides guidance and reference cases for CCUS investment decisions integrating EOR and chemical utilization in China’s refining–chemical integrated plants. Full article

Background/Objectives: A preventative vaccine against human cytomegalovirus (HCMV) infection and disease remains an unmet medical need. Several attenuated virus and antigen-based HCMV vaccine candidates have been proposed; however, development challenges have limited their progression through the clinical pipeline. Method: A high-throughput and robust relative potency assay, Imaging of Relative Viral Expression (IRVE), was developed and applied to measure the infection of a live-attenuated HCMV vaccine candidate in ARPE-19 epithelial cells. The IRVE assay measures HCMV infection by immunostaining Immediate Early 1 (IE1) protein and enumeration of IE1-positive, infected cells against total cells. Increased throughput was accomplished using 384-well plate automation on a custom-designed integrated robotic system. Results: The IRVE assay effectively measures relative potency changes in an HCMV vaccine candidate under different upstream processes, downstream processes, and formulation conditions. Key assay parameters including microplate format, cell density, serum concentration, infection time and influence of cell age were evaluated and optimized. The IRVE assay was correlated to historical, lower throughput HCMV potency assays, including plaque and Infectivity of Early Gene Expression (IEE), validating its application as a potency screening tool. Conclusions: The IRVE assay has been successfully implemented to support HCMV vaccine development over several years of clinical development. Full article

Background: Inflammation plays an important role in the initiation of atrial fibrillation (AF) and the development of fibrosis following pulmonary vein isolation (PVI). We aimed to investigate whether early post-PVI levels of C-reactive protein (CRP), white blood cells, tumour necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-ß1) are associated with long-term arrhythmia recurrence. Methods: This prospective observational study included 48 patients with paroxysmal AF undergoing PVI. Peripheral venous blood samples were collected on the day of hospitalisation (T0), immediately after the procedure (T1) and after 24 h (T2), seven days (T3) and one month (T4) following the procedure. Blood samples were obtained from the coronary sinus (CS) before and after PVI. CRP levels, leukocyte (LKc) and neutrophile (Neu) counts were determined. TGF-β1 and TNF-α were analysed using the enzyme-linked immunosorbent assay (ELISA). After discharge, follow-up visits were scheduled at seven days and one-, three-, six-, nine- and twelve-months post-ablation, with 24 h Holter monitoring at each visit. Results: Patients were allocated into a recurrent and a non-recurrent group. Baseline characteristics did not differ between the groups, except for the duration of AF, which was found to be a significant arrhythmia recurrence predictor. Patients in the non-recurrent group had statistically significantly higher LKc at all time points, and Neu at T2 and T3. CRP and TGF-β1 concentrations were significantly higher in the non-recurrent group, while TNF-α concentration was significantly higher in the recurrent group at the T2 time point. Significantly higher concentrations of CS TNF-α at T1 and TGF-β1 at T0 and T1 were documented in the non-recurrent group. Conclusions: The study shows that an enhanced inflammatory response early after PVI, characterised by increased CRP, WBC and TGF-β1 levels, may play a protective role against late arrhythmia recurrence. Full article

Background: Prevention of an irreversible sequalae in neurosyphilis patients requires immediate high-dose intravenous benzylpenicillin administered for a prolonged period of time. However, life-threatening neutropenia has been reported as one of the complications following extended usage of benzylpenicillin. Case presentation: We report a 54-year-old male patient with HIV who developed high-dose benzylpenicillin-induced febrile neutropenia during neurosyphilis treatment. The patient developed a fever of up to 39.8 °C, severe leukopenia (<1 × 10⁹/L), and neutropenia (0.2 × 10⁹/L). He also presented with slightly elevated C-reactive protein and procalcitonin levels but had no clear symptoms of other infections. The diagnosis was confirmed by excluding other possible causes of neutropenia: flu, measles, sepsis, and HIV-related neutropenia. Third-generation antipseudomonal cephalosporin in combination with vancomycin and granulocyte colony-stimulating factor were administered, and the patient saw a rapid improvement in clinical symptoms and laboratory findings. Conclusions: High-dose benzylpenicillin-induced neutropenia should be considered a complication after prolonged periods of neurosyphilis treatment with high-dose benzylpenicillin when there is no evidence of other potential causes of neutropenia. Early diagnosis and proper treatment are critical in order to prevent this dangerous condition from deteriorating further. Full article

Objectives: This study evaluated the effectiveness of three-dimensional (3D) navigated transsacral screw fixation in patients with sacral insufficiency fractures (SIF) who experienced inadequate mobilization after conservative management. Methods: We conducted a retrospective analysis of 53 patients (mean [±standard deviation] age 78.7 [±10.8] years; range 43.7–92.4; 81.1% female) with sacral insufficiency fractures confirmed by computed tomography or magnetic resonance imaging. Documented osteoporosis was present in 28 (52.8%) of these patients. All had failed conservative management due to persistent sacral pain or inability to mobilize. Therefore, they underwent 3D-navigated transsacral screw fixation. We collected data on demographics, fracture classification (FFP system), pain levels (Visual Analog Scale [VAS]), opioid consumption, time to mobilization, and length of hospital stay. Clinical outcomes were recorded at discharge, 1 month, and 3 months post-op; telephone interviews were conducted between 1 January and 28 February 2024 to assess longer-term pain relief and functional status. Results: Using the fragility fractures of the pelvis (FFP) classification, 60.8% of patients had FFP IIa fractures, 11.8% had FFP IIc, and 21.6% had FFP IVb. Two transsacral screws were placed in 34.0% of cases and three in 38.0%. We observed significant postoperative pain reduction—median (interquartile range [IQR]) VAS-at-rest decreased from 5 (4) preoperatively to 2 (2) at discharge and 0 (1) at 3 months (p < 0.001)—along with reduced opioid use (from 92.5% of patients on the immediate postoperative day to 45.0% at 3 months, p = 0.003). Early mobilization was achieved in 96.2% of patients. The mean hospital stay was 11.7 ± 5.1 days (95% confidence interval [CI]: 10.3–13.2; range 3–25 days), with the few outlier cases (>21 days) attributable to medical complications or delayed rehabilitation placement. The overall complication rate was low (7.5%, predominantly minor wound issues), and the 3-month reoperation rate was 7.7%. Conclusions: The 3D-navigated transsacral screw fixation is a minimally invasive and effective approach for managing sacral insufficiency fractures. It provides substantial pain relief, enables early mobilization, and demonstrates a low complication rate at 3 months. This technique shows promise in improving short-term outcomes for patients who do not respond to conservative care, regardless of osteoporosis status, although further research is needed to evaluate long-term fracture healing and functional recovery. Full article