Search Results (4,694)

Background and Objectives: Rapid recovery and patient comfort are key goals in ambulatory surgery. Although sevoflurane anesthesia is widely used, target-controlled infusion (TCI) with propofol and remifentanil has gained attention for its potential benefits. However, comparative data regarding recovery profiles and respiratory safety remain limited. Materials and Methods: In this prospective randomized controlled trial, 51 ASA I–II patients undergoing outpatient gynecologic surgery were assigned to either a TCI group (n = 25) or an inhalation mask (IM) group using sevoflurane and nitrous oxide (n = 26). Primary outcomes included time to postanesthesia care unit (PACU) discharge readiness and patient and surgeon satisfaction. Secondary outcomes included eye-opening time, anesthesia duration, PACU stay, and respiratory adverse events. Results: Time to Aldrete score ≥9 did not differ significantly between groups (p = 0.697). The IM group demonstrated faster eye opening (p = 0.002), while patient satisfaction was higher in the TCI group (p < 0.001). Surgeon satisfaction favored the IM group (p = 0.035). Respiratory depression occurred more frequently in the TCI group (28.0% vs. 0%, p = 0.012). Conclusions: Sevoflurane anesthesia allowed faster emergence, whereas TCI provided greater patient satisfaction but increased respiratory risk. Both techniques are feasible for ambulatory gynecologic surgery when appropriately selected. Trial registration: This study was retrospectively registered at the Clinical Research Information Service (CRIS), Republic of Korea (KCT0011352). Full article

Lightweight concrete incorporating expanded polystyrene (EPS) remains an active area of research due to its potential to produce more sustainable resource-efficient construction materials. However, identifying the optimal mix design for EPS-infused concrete typically requires extensive experimental trials, resulting in significant time, cost, and material consumption. To address this challenge, this study proposes an artificial neural network (ANN) predictive model with 5-fold cross-validation to estimate compressive strength performance and to develop mix design recommendations based on actual and predicted results. A total of 55 experimental samples were prepared and grouped into 11 batches, with the EPS volume replacement levels ranging from 0% to 50% at 5% increments. Model performance was evaluated using mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE), coefficient of determination (R²), and scatter index (SI), with graphical representations like predicted vs. actual plots, response plots, and residual plots, and the results were benchmarked against a multiple linear regression (MLR) model. Among the tested configurations, the 4-5-1 ANN model demonstrated the highest predictive accuracy. Furthermore, a Shapley (SHAP) analysis was conducted to interpret the model behavior and determine the relative importance of the input variables. The findings reveal that EPS content had the greatest influence on compressive strength prediction, followed by slump value, then gravel content, and finally concrete density. Full article

PDMS SlipChips are vital for precision medicine, but their performance often degrades when solutions leak or air pockets become trapped between layers. These failures stem from the inherent stickiness of PDMS and uneven surface contact, as the sliding nature of the device prevents permanent sealing. This work addresses these technical hurdles by integrating magnetic clamping with oil-infused lubrication and refined microwell geometries. A 3D-printed magnetic fixture maintains steady contact pressure during operation, while custom-made microstages provide the precise control needed to align microwells across the x–y plane. By allowing the porous PDMS to absorb silicone oil, we created a stable lubricating interface that prevents leakage and reduces friction without sacrificing mobility. We found that a microwell-to-channel width ratio of five substantially suppresses bubble formation compared with narrower designs. These enhancements ensure the generation of consistent, discrete concentration gradients and establish a reliable platform for high-throughput assays using minute sample volumes. Full article

Background/Objectives: After several decades of using titrated paclitaxel infusions, our institution adopted non-titrated infusions in April 2023 to streamline infusion workflows. We aimed to evaluate whether this alteration in infusion was associated with a higher incidence of HSRs. Methods: This was a retrospective cohort study of patients receiving paclitaxel with titration versus non-titration from April 2022 through November 2023. Patients diagnosed with gynecologic cancers who presented for their first or second paclitaxel lifetime infusions were included. Results: A total of 150 patients were included in this study, each with one or two infusions, for a total of 282 infusion visits. There were 176 infusions performed with titrated paclitaxel (62.4%), and 106 infusions performed with non-titrated paclitaxel dose (37.6%). HSRs occurred in 20.8% of the non-titrated paclitaxel infusions and in 11.9% of titrated paclitaxel infusions (RR 1.73 (95% CI 1.006–3.006), p = 0.047). Additionally, when stratifying by first- or second-visit infusions, the HSR rate increased significantly for non-titrated infusions to 22.4% during the second visit, while there was a decrease to 8.4% for titrated infusions (RR 2.66 (95% CI 1.105–6.413), p = 0.029). Non-titrated infusion reactions were associated with higher grades of reaction. Conclusions: HSRs occurred more frequently with non-titrated infusions, particularly during the second administration, suggesting that eliminating titration may increase hypersensitivity risk. These findings support a prospective evaluation of titration rates to further refine paclitaxel administration. Full article

Background: Maintaining therapeutic meropenem plasma concentrations requires prolonged infusion, but stability concerns exist between preparation and administration. This study compared the stability and operability of ready-to-use powder–liquid double-chamber bag (DCB) infusions versus traditional powder-for-injection (PFI) meropenem under clinical conditions. Methods: Infusions at clinically relevant concentrations were stored at 2–8 °C, 25 ± 5 °C, and 40 ± 2 °C for 12 h. Stability assessments included appearance, pH, osmolality, insoluble particle count, meropenem content (HPLC), and impurity A level. Results: DCBs demonstrated superior content uniformity, significantly fewer insoluble particles (p < 0.05), and greater operational simplicity compared to PFI. Refrigeration maintained meropenem content > 95% and effectively suppressed impurity formation for up to 12 h. However, at both room temperature and elevated temperature, impurity A exceeded pharmacopoeial limits within 2 h, particularly at higher concentrations. An innovative bedside solvent volume adjustment method enabled DCBs to deliver high-concentration infusions, facilitating individualized critical care dosing. Conclusions: Compared with traditional powder injection formulations, the Meropenem powder–liquid dual-chamber bag offers more convenient operation under routine preparation conditions and poses a lower risk of contamination during the preparation process. Its stability is more sensitive to storage temperature, requiring strict adherence to refrigeration conditions. When stored under standardized conditions, the dual-chamber bag can better ensure drug efficacy stability and medication safety, making it particularly suitable for clinical emergency use and standardized workflow management. Full article

The purpose of this work is to investigate the binding state of inorganic elements to flavonoid components in aqueous extract of Silybum marianum (SM) seeds, as well as the antioxidant activity of the extract. This study employed reversed-phase high-performance liquid chromatography (RP-HPLC) to separate silymarin flavonoids in boiling water decoction of SM seeds, and collected the post-column effluent in the segments according to the retention time of seven main silymarin flavonoid components. Inductively coupled plasma mass spectrometry (ICP-MS) was subsequently utilized to quantify nine inorganic elements (As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Zn) in the collected HPLC fractions of the decoction. Meanwhile, electron paramagnetic resonance spectroscopy (EPR) was employed to assess the free radical scavenging activity of aqueous extract of SM seeds, using the signal intensity changes of 2,2-diphenyl-1-picrylhydrazyl (DPPH) and DMPO-OH• adducts as quantitative metrics. The results showed that essential trace elements (Cu, Fe, Mn, Zn) mainly existed as inorganic ions or strong polar forms in the tea-like infusion, with weak binding to flavonoid compounds. On the other hand, the aqueous extract exhibited significant •OH scavenging capacity, with a scavenging rate of 95% against •OH generated by continuous 5 min ultraviolet irradiation of H₂O₂ aqueous solution. This study provides experimental evidence for the development of SM as a food–medicine dual-purpose resource, proposing that consumption of SM seed tea represents a facile and effective approach to supplement trace elements and intake silymarin for enhancing endogenous antioxidant defense. Full article

Background: Staphylococcal bloodstream infections (BSIs) and infective endocarditis (IE) are associated with high morbidity and mortality. Among the different antimicrobial combination strategies proposed to enhance antibacterial activity, the association of daptomycin and ceftobiprole may be valuable. The aim of this study was to assess the PK/PD target attainment, safety, and clinical outcomes of such combination therapy for BSI and IE treatment. Methods: This retrospective monocentric study included adult patients with targeted treatment of staphylococcal BSI or IE with daptomycin plus continuous infusion (CI) ceftobiprole. Therapeutic drug monitoring (TDM) was performed for both agents, including Bayesian estimation of daptomycin 24 h area under the concentration–time curve (AUC_24h). PK/PD targets were defined as daptomycin AUC_24h/MIC ≥ 666 and ≥1081, and ceftobiprole steady-state concentration/MIC ≥ 4. Dose adjustments, safety, microbiological response, and clinical outcomes were assessed. Results: Twenty-three patients (11 BSI and 12 IE) were included. Methicillin-resistant Staphylococci were identified in 91.3% of cases. At first TDM assessment, daptomycin PK/PD targets were achieved in all patients, while ceftobiprole targets were achieved in 91.6% of BSI cases and in all IE cases. PK-/PD-guided dose de-escalation was frequently feasible. Clinical cure was observed in 77.8% of evaluable patients with BSI and in 91.7% with IE. Creatine phosphokinase elevations occurred in two patients, while hyper-eosinophilia was observed in 69.6% and was manageable with monitoring. Conclusions: Targeted therapy with daptomycin plus CI ceftobiprole achieved high PK/PD target attainment and favorable clinical outcomes in staphylococcal BSI and IE. TDM and model-informed precision dosing may enable dose optimization and may improve the balance between efficacy and safety. Multicenter studies are warranted. Full article

Ice accretion on aircraft, wind-turbine blades, power networks, civil infrastructure, and exposed sensors poses severe safety risks and economic costs. Passive icephobic surfaces mitigate icing by delaying heterogeneous nucleation, altering droplet impact/solidification and wetting transitions, and/or weakening the ice–substrate bond so that accreted ice sheds under modest aerodynamic, gravitational, or vibrational loads. This review synthesizes recent progress using a unified mechanism framework linking (i) nucleation and early freezing, (ii) droplet dynamics during impact or condensation/frosting, and (iii) ice accretion and removal governed by interfacial fracture. Smooth low-surface-energy coatings, textured (superhydrophobic) surfaces, slippery liquid-infused porous surfaces (SLIPS), and low-interfacial-toughness strategies are critically compared in terms of achievable performance ranges, failure modes, durability limits, fabrication scalability, and test-method dependence. Ice-adhesion measurement approaches (push-off, pull-off/tensile, centrifugal) are assessed and a minimum reporting checklist is provided to improve comparability. Case studies across aviation, wind energy, power infrastructure, sensors, and emerging civil-engineering coatings highlight that durability and scale-dependent failure modes remain the dominant barriers to durable, energy-free icing mitigation. The review concludes with priorities for eco-friendly chemistries, self-healing or renewable layers, standardized testing/reporting, and data-driven (machine learning-assisted) optimization to accelerate translation into durable passive ice-mitigation technologies. Full article

Although previous studies have examined factors influencing organizational appeal, how AI-adoption signals influence prospective applicants remains unclear. Building on signaling theory, this study explores whether, when, and how organizations’ AI-adoption signals enhance their attractiveness to potential applicants. Two experiments were conducted to test the hypothesized model. Study 1 (N = 145) employed a scenario-based design to compare organizational attractiveness between AI-adoption signal and no-signal conditions, confirming that AI-adoption signals are significantly positively associated with organizational attractiveness. Study 2 (N = 240) recruited active job seekers and validated a moderated mediation model: perceived innovation ability mediates the positive association between AI-adoption signals and organizational attractiveness, especially among job seekers with high AI self-efficacy. By conceptualizing AI adoption as an organizational signal, this research extends signaling theory to the context of technology-infused recruitment and offers practical insights for designing more effective recruitment strategies in the digital era. Full article

Delamination in laminated composites originates from premature matrix cracking within the interlaminar region, ultimately leading to ply separation under indirect loading. Among the techniques proposed to mitigate this failure mode, through-thickness stitching has emerged as a localized reinforcement strategy capable of enhancing interlaminar performance without modifying the in-plane laminate architecture. However, previous studies report that stitching can either improve or degrade the mechanical properties of the composite, with stitch density identified as a critical variable. This work aims to keep the tensile strength of a stitched composite at levels comparable to its unstitched counterpart. The reinforcement was applied using an eight-strand polyethylene thread (0.28 mm in diameter) embedded in a low-viscosity epoxy infusion system (MAX 1618 A/B) combined with a 90° biaxial fiberglass woven fabric. The tensile behavior of laminates was examined for three longitudinal stitching configurations consisting of 2, 3, and 5 continuous stitch lines. Results show that increasing stitch count produces a progressive reduction in tensile strength, attributed to stress concentration around stitch sites and microstructural effects such as resin-rich zones and fiber waviness. Full article

A 2-year-old female Labrador Retriever, with a body condition score of 6/9, underwent ovariohysterectomy 24 h prior at another center and was urgently referred for a possible exploratory laparotomy. The dog presented with lethargy, abdominal pain, and a haematoma with active bleeding in the surgical wound, indicating a possible haemoabdomen. An abdominal-Focused Assessment with Sonography for Trauma (A-FAST) revealed fluid in all four quadrants (abdominal fluid score-AFS 4/4) without abdominal distension, corresponding to an effusion with a packed cell volume of 15% and 4 g/dL of protein. Haematological analysis showed a slight decrease in haematocrit (HCT) and red blood cells, with neutrophilia, while the rest of the blood tests were within normal limits. Physical examination parameters were mostly normal, except for cardiac auscultation where tachycardia, irregular rhythm, and pulse deficit were noted, with normal blood pressure. The electrocardiogram (ECG) indicated both monomorphic and polymorphic ventricular tachycardia with isolated episodes of sinus tachycardia. Treatment included the administration of metamizole, methadone, and maintenance fluid therapy, along with compressive abdominal bandaging. Lidocaine and continuous infusion of fentanyl therapy were initiated. The dog’s HCT, platelets, temperature, and blood pressure remained in the normal range. During the first 8 h, both the ECG and A-FAST showed no relevant changes. From the 9th hour onward, there was a predominance of sinus rhythm, the free fluid decreased to AFS 1/4, allowing for the gradual suspension of lidocaine. Tests for Leishmania, Ehrlichia, Anaplasma, Babesia, and Dirofilaria were negative. The evolution remained favorable, and the dog was discharged after 72 h, showing a good outcome in the cardiology follow-up 5 days later. Full article

Background: Intraoperative high-volume diuresis is a common but under-recognized phenomenon during off-pump coronary artery bypass grafting (OPCABG). Its clinical correlates and implications for perioperative management remain incompletely characterized. Methods: This single-center retrospective cohort study included 1274 adults undergoing elective OPCABG between January and August 2025. High-volume diuresis was defined as urine output ≥ 5 mL·kg⁻¹·h⁻¹. Multivariable logistic regression was used to identify factors independently associated with intraoperative high-volume diuresis. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: High-volume diuresis occurred in 39.6% of patients. Older age, hypertension and greater intraoperative fluid infusion were independently associated with high-volume diuresis, whereas preoperative diuretic and greater cumulative exposure to systolic blood pressure < 100 mmHg were inversely associated with diuresis. The multivariable model demonstrated acceptable discrimination (AUC = 0.756). Postoperative outcomes, including acute kidney injury, duration of mechanical ventilation, intensive care unit stay, and hospital length of stay, did not differ between groups. Conclusions: Intraoperative high-volume diuresis during OPCABG reflects complex physiological and hemodynamic responses and can be anticipated based on preoperative and intraoperative factors. These findings support a more individualized interpretation of urine output and perioperative management strategies in OPCABG. Full article

Background/Objectives: Eliglustat is an oral therapy for Gaucher disease type 1 (GD1) that may reduce infusion-related logistical burden, particularly in resource-constrained settings. Post-approval evidence from routine clinical practice in China remains limited. This study evaluated its real-world effectiveness and safety in Chinese adults with GD1. Methods: This retrospective, multicenter study included adults with GD1 receiving eliglustat monotherapy for ≥6 months. Outcomes included plasma glucosylsphingosine (lyso-Gb1), hemoglobin (HGB), platelet count (PLT), liver and spleen volumes, and adverse events (AEs). Depending on distribution, paired changes were analyzed using paired t tests or Wilcoxon signed-rank tests. p < 0.05 was considered statistically significant. Results: Nineteen patients were included in the effectiveness analysis, with a median follow-up of 7 months (range, 6–9). Lyso-Gb1 decreased from 468 to 210 ng/mL (p < 0.0001). HGB increased from 123 to 131 g/L (p = 0.147); among six patients with baseline anemia, 83.3% improved and 33.3% normalized. PLT increased from 109 to 132 × 10⁹/L (p = 0.019); among 12 patients with baseline thrombocytopenia, 58.3% improved. Liver volume decreased from 1808 to 1747 mL (p = 0.016) (1.22 to 1.01 multiples of normal; p < 0.001). Spleen volume decreased from 473 to 452 mL (p = 0.016) (4.69 to 5.17 multiples of normal; p = 0.015). Lyso-Gb1 reduction was greater in patients without prior enzyme replacement therapy (ERT) exposure than in those with prior ERT exposure (−55.1% vs. −43.1%; p = 0.049). In the safety analysis group (n = 90), suspected drug-related AEs occurred in 27.8% of patients, mainly gastrointestinal or skin-related, and were limited to grade I/II. No serious AE or treatment discontinuation occurred. Conclusions: In routine clinical practice in China, eliglustat was associated with rapid substantial reductions in plasma lyso-Gb1, early improvements in hematologic and visceral parameters, and favorable short-term tolerability in adults with GD1. Full article

Background: Transarterial chemoembolization (TACE) is an established image-guided, minimally invasive therapy for unresectable hepatocellular carcinoma (HCC). However, post-embolization hypoxia often triggers compensatory angiogenesis and an immunosuppressive microenvironment, limiting long-term efficacy. We hypothesized that the immediate image-guided hepatic arterial infusion (HAI) of a PD-1 inhibitor following TACE could synergistically enhance local tumor control. Methods: In this retrospective, propensity-score-matched study, 226 patients with unresectable HCC (January 2021–June 2024) were analyzed. After 1:1 matching, 84 pairs were included: Study Group (TACE + HAI-nivolumab) and Control Group (TACE alone). Nivolumab (3 mg/kg) was infused via the hepatic artery under fluoroscopic guidance immediately after embolization. Primary endpoints were overall survival (OS) and progression-free survival (PFS); secondary endpoints included objective response rate (ORR) by mRECIST and changes in serum angiogenesis/immune biomarkers. Results: The Study Group demonstrated significantly longer median OS (16.2 vs. 12.8 months; HR 0.62, 95% CI: 0.44–0.88, p = 0.007) and median PFS (9.8 vs. 6.5 months; p < 0.001). ORR was higher with combination therapy (58.3% vs. 36.9%, p = 0.006). Mechanistically, HAI-nivolumab suppressed the post-TACE surge in VEGF and Ang-2 (p < 0.001) and increased the peripheral CD4+/CD8+ T-cell ratio. Grade 3/4 adverse events were comparable between groups (14.3% vs. 10.7%, p = 0.485). Conclusions: The image-guided combination of TACE with immediate HAI of nivolumab is associated with improved survival and tumor response in unresectable HCC. This strategy may counteract the adverse post-embolization microenvironment by simultaneously inhibiting angiogenesis and reactivating local immunity, representing an advanced image-guided combination therapy with strong translational relevance. Full article

The α-glucosidase inhibitory activity of Keemun black tea arises from complex interactions among its major polyphenols, which cannot be reliably predicted from the activities of isolated compounds. In this study, eight dominant polyphenols were investigated using a quantitative reconstruction–omission framework designed to reflect typical household tea brewing. The fully reconstructed system recovered approximately 72% of the inhibitory activity of the diluted native infusion, supporting the functional representativeness of the selected compounds. Systematic omission experiments revealed that antagonistic interactions, particularly among theaflavins, dominated the net inhibitory outcome, with removal of the most potent inhibitor, theaflavin-3,3′-digallate (TFDG), paradoxically increasing overall activity. Pairwise Combination Index analysis further demonstrated concentration-dependent biphasic interactions, exemplified by the epigallocatechin-3-gallate (EGCG)–TFDG pair, while molecular docking suggested overlapping binding sites as a potential structural basis for competitive inhibition. Collectively, this work provides a system-level dissection of α-glucosidase inhibition in black tea. Although the reconstructed system does not fully capture all contributions, the proposed framework offers a generalizable strategy for investigating interaction-driven bioactivity in complex dietary matrices and for further mechanistic studies. Full article