Search Results (32,524)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Fertility is considered a significant demographic concern, especially in relation to climate change. This study examines how awareness of climate change, measured by five subscales—climate-friendly behavior, knowledge, personal concern, attitude, and multiplicative action—affects fertility intentions, emphasizing the mediating role of threat perception. Data were collected through an online survey administered to a sample of 817 Palestinian citizens aged 18–49 residing in the West Bank. Structural equation modeling (SEM) was utilized for the data analysis. The results revealed that climate change awareness does not directly affect fertility intentions. However, an indirect effect of climate change awareness on fertility intentions was observed, mediated by threat perception as an intervening variable. Individuals exhibiting increased awareness of climate change and perceptions of future risks demonstrated a greater likelihood of reducing their fertility intentions compared to others. Policymakers in the Palestinian territories should prioritize enhancing public awareness regarding climate change and its associated short- and long-term threats. Therefore, incorporating climate education and associated risks into fertility health programs is essential. Full article

Tea polyphenol oxidase (CsPPO) is a crucial enzyme involved in the production of tea and tea products. However, the recombinant expression of CsPPO in microorganisms is often hindered by challenges such as inclusion body formation and extremely low enzyme activity. In this study, the CsPPO gene (1800 bp) from Camellia sinensis cv. Yihongzao was cloned and 14.5% of its codons were optimized for Pichia pastoris expression. Compared to pre-optimization, codon optimization significantly enhanced CsPPO production in P. pastoris KM71, yielding a 42.89-fold increase in enzyme activity (1286.67 U/mL). The optimal temperature and pH for recombinant CsPPO were determined to be 40 °C and 5.5, respectively. This study demonstrates that codon optimization effectively improves the expression of plant-derived enzymes such as CsPPO in eukaryotic expression systems. Future research should explore the long-term stability of recombinant CsPPO and its potential applications in tea fermentation processes and functional food development. Full article

Precipitation changes have significant impacts on biodiversity and ecosystem productivity. However, the effects of precipitation changes on species diversity have been the focus of most previous studies. Little is known about the contributions of different dimensions of biodiversity (species, functional, and phylogenetic diversity) in linking long-term precipitation changes to ecosystem functions. In this study, a randomized design was conducted in the desert steppes of Ningxia, which included three treatments: natural rainfall, precipitation reduced by 50%, and precipitation increased by 50%. After 4 years of treatment, the effects of precipitation changes on aboveground productivity and its underlying mechanisms were explored. The results showed that (1) reduced precipitation significantly decreased phylogenetic diversity and species diversity, but had no significant effect on functional diversity; (2) reduced precipitation significantly decreased aboveground productivity, while increased precipitation significantly enhanced aboveground productivity; and (3) changes in precipitation primarily regulated aboveground productivity by altering soil nitrogen availability and the size of dominant plant species. This study provides important theoretical and practical guidance for the protection and management of desert steppe vegetation under future climate change. Full article

Avocado (Persea americana), originally from Mesoamerica, has emerged as a focus of intense scientific and industrial interest due to its unique combination of nutritional richness, bioactive potential, and technological versatility. Its pulp, widely consumed across the globe, is notably abundant in monounsaturated fatty acids, especially oleic acid, which can comprise over two-thirds of its lipid content. In addition, it provides significant levels of dietary fiber, fat-soluble vitamins such as A, D, E and K, carotenoids, tocopherols, and phytosterols like β-sitosterol. These constituents are consistently associated with antioxidant, anti-inflammatory, glycemic regulatory, and cardioprotective effects, supported by a growing body of experimental and clinical evidence. This review offers a comprehensive and critical synthesis of the chemical composition and functional properties of avocado, with particular emphasis on its lipid profile, phenolic compounds, and phytosterols. It also explores recent advances in environmentally sustainable extraction techniques, including ultrasound-assisted and microwave-assisted processes, as well as the application of natural deep eutectic solvents. These technologies have demonstrated improved efficiency in recovering bioactives while aligning with the principles of green chemistry. The use of avocado-derived ingredients in nanostructured delivery systems and their incorporation into functional foods, cosmetics, and health-promoting formulations is discussed in detail. Additionally, the potential of native cultivars and the application of precision nutrition strategies are identified as promising avenues for future innovation. Taken together, the findings underscore the avocado’s relevance as a high-value matrix for sustainable development. Future research should focus on optimizing extraction protocols, clarifying pharmacokinetic behavior, and ensuring long-term safety in diverse applications. Full article

The accurate and effective prediction of PM2.5 concentrations is crucial for mitigating air pollution, improving environmental quality, and safeguarding public health. To address the challenge of strong temporal correlations in PM2.5 concentration forecasting, this paper proposes a novel hybrid model that integrates the Particle Optimization Algorithm (POA) and Variational Mode Decomposition (VMD) with the Long Short-Term Memory (LSTM) network. First, POA is employed to optimize VMD by adaptively determining the optimal parameter combination [k, α], enabling the decomposition of the original PM2.5 time series into subcomponents while reducing data noise. Subsequently, an LSTM model is constructed to predict each subcomponent individually, and the predictions are aggregated to derive hourly PM2.5 concentration forecasts. Empirical analysis using datasets from Beijing, Tianjin, and Tangshan demonstrates the following key findings: (1) LSTM outperforms traditional machine learning models in time series forecasting. (2) The proposed model exhibits superior effectiveness and robustness, achieving optimal performance metrics (e.g., MAE: 0.7183, RMSE: 0.8807, MAPE: 4.01%, R²: 99.78%) in comparative experiments, as exemplified by the Beijing dataset. (3) The integration of POA with serial decomposition techniques effectively handles highly volatile and nonlinear data. This model provides a novel and reliable tool for PM2.5 concentration prediction, offering significant benefits for governmental decision-making and public awareness. Full article

The cement industry is a significant contributor to global carbon dioxide emissions, primarily due to the energy demands of its production process and its reliance on clinker, a material formed through the high-temperature calcination of limestone. Strategies to reduce emissions include the adoption of low-carbon fuels, the use of carbon capture and storage (CCS) technologies, and the integration of supplementary cementitious materials (SCMs) to reduce the clinker content. The effectiveness of these measures depends on a complex set of interactions involving technological feasibility, market dynamics, and regulatory frameworks. This study presents a system dynamics model designed to assess how various decarbonization approaches influence long-term emission trends within the cement industry. The model accounts for supply chains, production technologies, market adoption rates, and changes in cement production costs. This study then analyzes a number of scenarios where there is large-scale sustained investment in each of three carbon mitigation strategies. The results show that CCS by itself allows the cement industry to achieve carbon neutrality, but the high capital investment results in a large cost increase for cement. A combined approach using alternative fuels and SCMs was found to achieve a large carbon reduction without a sustained increase in cement prices, highlighting the trade-offs between cost, effectiveness, and system-wide interactions. Full article

Understanding how energy use and economic activity shape carbon emissions is pivotal for achieving global climate targets. This study quantifies the dynamic nexus between disaggregated energy consumption, economic growth, and CO₂ emissions in India and China—two economies that together account for more than one-third of global emissions. Using annual data from 1990 to 2021, we implement Long Short-Term Memory (LSTM) neural networks, which outperform traditional linear models in capturing nonlinearities and lagged effects. The dataset is split into training (1990–2013) and testing (2014–2021) intervals to ensure rigorous out-of-sample validation. Results reveal stark national differences. For India, coal, natural gas consumption, and economic growth are the strongest positive drivers of emissions, whereas renewable energy exerts a significant mitigating effect, and nuclear energy is negligible. In China, emissions are dominated by coal and petroleum use and by economic growth, while renewable and nuclear sources show weak, inconsistent impacts. We recommend retrofitting India’s coal- and gas-plants with carbon capture and storage, doubling clean-tech subsidies, and tripling annual solar-plus-storage auctions to displace fossil baseload. For China, priorities include ultra-supercritical upgrades with carbon capture, utilisation, and storage, green-bond-financed solar–wind buildouts, grid-scale storage deployments, and hydrogen-electric freight corridors. These data-driven pathways simultaneously cut flagship emitters, decouple GDP from carbon, provide replicable models for global net-zero research, and advance climate-resilient economic growth worldwide. Full article

This comprehensive review examines the role of septoplasty in the pediatric population, emphasizing its therapeutic significance in relieving nasal obstruction and facilitating normal craniofacial growth. Despite the evident advantages of septoplasty, its application in young patients remains a subject of ongoing debate. This issue is primarily characterized by concerns regarding the still-developing immaturity of nasal cartilage, potential intraoperative and postoperative risks, and the current absence of robust data on long-term outcomes following septoplasty. Common complications such as bleeding, septal perforation, saddle nose deformity, and persistent nasal obstruction are reported in the literature; however, many studies lack long-term follow-up data on the incidence of these adverse events and revision rates, which may be higher compared to adult populations, often leading to the need for secondary surgical interventions. Strict inclusion criteria and comprehensive patient selection are paramount to maximize therapeutic success while minimizing complications. Current evidence suggests that appropriately indicated septoplasty can improve airway patency, support optimal facial development, and reduce the risk of secondary sinonasal pathology. There is a significant necessity for additional prospective, large-scale studies to establish standardized therapeutic guidelines and management strategies for this specific population, thereby ensuring effective and evidence-based pediatric otolaryngologic care. Full article

Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used for managing cuff tear arthropathy, osteoarthritis, complex fractures, and revision procedures. As the demand for surgical precision and reproducibility grows, immersive technologies such as virtual reality (VR), augmented reality (AR), and metaverse-based platforms are being explored for surgical training, intraoperative guidance, and rehabilitation. While early data suggest potential benefits, a focused synthesis specific to RTSA is lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was performed through 30 May 2025. Eligible studies included those evaluating immersive technologies in the context of RTSA for skill acquisition or intraoperative guidance. Only peer-reviewed articles published in English were included. Data were synthesized narratively due to heterogeneity in study design and outcome metrics. Results: Out of 628 records screened, 21 studies met the inclusion criteria. Five studies evaluated immersive VR for surgical training: four randomized controlled trials and one retrospective case series. VR training improved procedural efficiency and showed non-inferiority to cadaveric training. Sixteen studies investigated intraoperative navigation or AR guidance. Clinical and cadaveric studies consistently reported improved accuracy in glenoid baseplate positioning with reduced angular and linear deviations in postoperative controls as compared to preoperative planning. Conclusions: Immersive technologies show promise in enhancing training, intraoperative accuracy, and procedural consistency in RTSA. VR and AR platforms may support standardized surgical education and precision-based practice, but their broad clinical impact remains limited by small sample sizes, heterogeneous methodologies, and limited long-term outcomes. Further multicenter trials with standardized endpoints and cost-effectiveness analyses are warranted. Postoperative rehabilitation using immersive technologies in RTSA remains underexplored and presents an opportunity for future research. Full article

Eutrophication has become the primary water quality issue for most of the freshwater and coastal marine ecosystems in the world. Caused by excessive nitrogen (N) and phosphorus (P) inputs, it has a significant impact on aquatic ecosystems, resulting in algal blooms, oxygen depletion, and biodiversity loss. Zeolites have been identified as effective adsorbents for removal of these pollutants, improving water quality and ecosystem health. Kinetic and isotherm adsorption experiments were conducted to examine the adsorption efficiency of four zeolites of various origins (Greek, Slovakian, Turkish, and Bulgarian) and a specific modification (ZeoPhos) to determine the most effective material for N and P removal. The aim of the study is to discover the best zeolite for chemical adsorption in eutrophic waters by comparing their adsorption capacities and pollutant removal efficiencies along with SEM, TEM, and X-RD spectrographs. Slovakian ZeoPhos has been identified as the best-performing material for long-term and efficient water treatment systems for eutrophication management. Full article

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes. Full article

Generative Adversarial Networks (GANs) using Long Short-Term Memory (LSTM) provide a computationally cheaper approach for text generation compared to large language models (LLMs). The low hardware barrier of training GANs poses a threat because it means more bad actors may use them to mass-produce prompt attack messages against LLM systems. Thus, to better understand the threat of GANs being used for prompt attack generation, we train two well-known GAN architectures, SeqGAN and RelGAN, on prompt attack messages. For each architecture, we evaluate generated prompt attack messages, comparing results with each other, with generated attacks from another computationally cheap approach, a 1-billion-parameter Llama 3.2 small language model (SLM), and with messages from the original dataset. This evaluation suggests that GAN architectures like SeqGAN and RelGAN have the potential to be used in conjunction with SLMs to readily generate malicious prompts that impose new threats against LLM-based systems such as chatbots. Analyzing the effectiveness of state-of-the-art defenses against prompt attacks, we also find that GAN-generated attacks can deceive most of these defenses with varying levels of success with the exception of Meta’s PromptGuard. Further, we suggest an improvement of prompt attack defenses based on the analysis of the language quality of the prompts, which we found to be the weakest point of GAN-generated messages. Full article

The brown planthopper, Nilaparvata lugens (Stål, 1854), is the most devastating pest of rice (Oryza sativa L.). Although insecticides are used to control this pest, host plant resistance is a more effective and economic solution. Therefore, identification of N. lugens-resistant genes and elucidation of their underlying resistance mechanisms are critical for developing elite rice cultivars with enhanced and durable resistance. Research has shown that in the long-term evolutionary arms race, rice has developed complex defense systems against N. lugens, while N. lugens has developed diverse and sophisticated strategies to overcome the plant’s defenses. This review emphasizes recent advances in the molecular interactions between rice and the N. lugens, particularly focusing on the resistance mechanisms of 17 cloned major N. lugens resistance genes, which have significantly improved our understanding of the molecular basis of rice–N. lugens interactions. We also highlight the roles of several N. lugens salivary components in activating or suppressing rice defense responses. These insights provide a foundation for developing sustainable and effective strategies to manage this devastating pest of rice. Full article

This paper examines the effect of digital innovation on cost stickiness in manufacturing firms, focusing on the underlying mechanisms and contextual factors. Using data from Chinese A-share listed manufacturing firms from 2012 to 2023, we find that, first, for each one-unit increase in the level of digital technology, the cost stickiness index of enterprises decreases by an average of 0.4315 units, primarily through digital process innovation and digital business model innovation, whereas digital product innovation does not exhibit a statistically significant impact. Second, manufacturing servitization and the optimization of human capital structure are identified as key mediating mechanisms. Digital innovation promotes servitization by transitioning firms from product-centric to service-oriented business models, thereby reducing fixed costs and improving resource flexibility. It also optimizes human capital by increasing the proportion of high-skilled employees and reducing labor adjustment costs. Third, the effect of digital innovation on cost stickiness is found to be heterogeneous. Firms with high financing constraints benefit more from the cost-reducing effects of digital innovation due to improved resource allocation efficiency. Additionally, mid-tenure executives are more effective in leveraging digital innovation to mitigate cost stickiness, as they balance short-term performance pressures with long-term strategic investments. These findings contribute to the understanding of how digital transformation reshapes cost behavior in manufacturing and provide insights for policymakers and firms seeking to achieve sustainable development through digital innovation. Full article