Search Results (380)

Background: RSV remains a leading cause of infant hospitalization worldwide, and the recently approved nirsevimab could represent an effective and safe prophylactic strategy to prevent severe infections in the general neonatal population. Objectives: We conducted a retrospective observational monocentric pilot study in a mixed preterm/term birth cohort to add real-world evidence of the efficacy and safety of nirsevimab in preventing severe RSV infection. Methods: We included a total of 2035 consecutive infants admitted to the Neonatal Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy, from November 2024 to April 2025. We evaluated 30-day safety profiles and season-wide RSV infection rates, and the outcomes were also compared to newborns’ birth rate in the two previous seasons (2022–2023 and 2023–2024). Results: After the introduction of nirsevimab, a lower RSV infection rate was reported compared to previous seasons, and no adverse effects were observed. Compared to previous seasons, the clinical outcomes were more favorable, as only one unvaccinated neonate with RSV infection required invasive ventilation. Conclusions: In this real-world analysis, we demonstrated a good short-term safety profile of nirsevimab, as well as a potentially high efficacy in the general neonatal population with lower RSV infection incidence. However, future studies are needed to better assess its long-term safety and season-wide efficacy. Full article

Background/Objectives: Evidence-based nursing practice (EBNP) is essential in high-acuity settings such as intensive care units (ICUs) and emergency departments (EDs), where nurses are frequently required to make time-critical, high-stakes clinical decisions that directly influence patient safety and outcomes. Despite its recognized importance, the implementation of EBNP remains inconsistent, with frontline nurses often facing barriers to accessing and applying current evidence. Methods: This descriptive, cross-sectional study systematically mapped and prioritized clinical questions generated by ICU and ED nurses at a tertiary hospital in South Korea. Using open-ended questionnaires, 204 clinical questions were collected from 112 nurses. Each question was coded and classified according to the Nursing Interventions Classification (NIC) taxonomy (8th edition) through a structured cross-mapping methodology. Inter-rater reliability was assessed using Cohen’s kappa coefficient. Results: The majority of clinical questions (56.9%) were mapped to the Physiological: Complex domain, with infection control, ventilator management, and tissue perfusion management identified as the most frequent areas of inquiry. Patient safety was the second most common domain (21.6%). Notably, no clinical questions were mapped to the Family or Community domains, highlighting a gap in holistic and transitional care considerations. The mapping process demonstrated high inter-rater reliability (κ = 0.85, 95% CI: 0.80–0.89). Conclusions: Frontline nurses in high-acuity environments predominantly seek evidence related to complex physiological interventions and patient safety, while holistic and community-oriented care remain underrepresented in clinical inquiry. Utilizing the NIC taxonomy for systematic mapping establishes a reliable framework to identify evidence gaps and support targeted interventions in nursing practice. Regular protocol evaluation, alignment of continuing education with empirically identified priorities, and the integration of concise evidence summaries into clinical workflows are recommended to enhance EBNP implementation. Future research should expand to multicenter and interdisciplinary settings, incorporate advanced technologies such as artificial intelligence for automated mapping, and assess the long-term impact of evidence-based interventions on patient outcomes. Full article

Educational buildings, including schools, nurseries and universities, face stricter regulation and design control on indoor air quality (IAQ) and thermal conditions than other built environments, as these may affect children’s health and wellbeing. In this scoping review, wide-ranging health, performance, and absenteeism consequences of poor—and benefits of good—IAQ and thermal conditions are evaluated, focusing on source control, ventilation and air purification interventions. Economic impacts of interventions in educational buildings have been evaluated to enable the assessment of tangible building-related costs and savings, alongside less easily quantifiable improvements in educational attainment and reduced healthcare. Key recommendations are provided to assist decision makers in pathways to provide clean air, at an optimal temperature for students’ learning and health outcomes. Although the role of educational buildings can be challenging to isolate from other socio-economic confounders, secondary short- and long-term impacts on attainment and absenteeism have been demonstrated from the health effects associated with various pollutants. Sometimes overlooked, source control and repairing existing damage can be important cost-effective methods in minimising generation and preventing ingress of pollutants. Existing ventilation standards are often not met, even when mechanical and hybrid ventilation systems are already in place, but can often be achieved with a fraction of a typical school budget through operational and maintenance improvements, and small-scale air-cleaning and ventilation technologies, where necessary. Full article

Background/Objectives: Guillain–Barré syndrome (GBS) is a rare autoimmune peripheral neuropathy that affects both the myelin sheaths and axons of the peripheral nervous system. It is the leading cause of acute neuromuscular paralysis worldwide, with an annual incidence of less than two cases per 100,000 people. Although most patients recover, a small proportion do not regain mobility and even remain dependent on mechanical ventilation. In this study, we refer to the analysis of samples collected from GBS patients at different defined time points during hospital recovery and performed by a medical or research group. Methods: The conditions for whole blood collection, peripheral blood mononuclear cell isolation, and serum collection from GBS patients and volunteer donors are explained. Aliquots of these human samples have been used for red blood cell phenotyping, transcriptomic and proteomic analyses, and serum biochemical parameter studies. Results: The initial sporadic preservation of human samples from GBS patients and control volunteers enabled the creation of a biobank collection for current and future studies related to the diagnosis and treatment of GBS. Conclusions: In this article, we describe the laboratory procedures and the integration of a GBS biobank collection, local medical services, and academic institutions collaborating in its respective field. The report establishes the intra-disciplinary and inter-institutional network to conduct long-term longitudinal studies on GBS. Full article

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

Bronchopulmonary dysplasia (BPD) remains a significant complication of preterm birth, characterized by impaired alveolar and vascular development, chronic lung inflammation, and long-term respiratory morbidity. Corticosteroids, both systemic and inhaled, have been widely investigated as potential therapeutic agents due to their anti-inflammatory properties and their emerging role in modulating oxidative stress. This narrative review explores the current evidence regarding the use of inhaled and systemic corticosteroids in the prevention and management of BPD, analyzing their efficacy, safety profiles, and long-term outcomes. While systemic corticosteroids, particularly dexamethasone, have demonstrated benefits in reducing ventilator dependence and lung inflammation, concerns regarding adverse neurodevelopmental effects have limited their routine use. Inhaled steroids have been proposed as a safer alternative, but their role in altering the disease trajectory remains controversial. A better understanding of the optimal timing, dosage, and patient selection is essential to maximize benefits while minimizing risks. Future research should focus on optimizing dosing strategies and identifying subgroups of preterm infants who may derive the greatest benefit from corticosteroid therapy. Full article

Pulmonary hemorrhage (PH) is a life-threatening complication predominantly affecting preterm infants, particularly those with very low birth weight (VLBW) and fetal growth restriction (FGR). Typically occurring within the first 72 h of life, PH is characterized by acute respiratory deterioration and significant morbidity and mortality. This review synthesizes current evidence on the multifactorial pathogenesis of PH, highlighting the roles of immature pulmonary vasculature, surfactant-induced hemodynamic shifts, and left ventricular diastolic dysfunction. Key risk factors include respiratory distress syndrome (RDS), hemodynamically significant patent ductus arteriosus (hsPDA), sepsis, coagulopathies, and genetic predispositions. Diagnostic approaches incorporate clinical signs, chest imaging, lung ultrasound, and echocardiography. Management strategies are multifaceted and include ventilatory support—particularly high-frequency oscillatory ventilation (HFOV)—surfactant re-administration, blood product transfusion, and targeted hemostatic agents. Emerging therapies such as recombinant activated factor VII and antifibrinolytics show promise but require further investigation. Preventive measures like antenatal corticosteroids and early indomethacin prophylaxis may reduce incidence, particularly in high-risk populations. Despite advancements in neonatal care, PH remains a major contributor to neonatal mortality and long-term neurodevelopmental impairment. Future research should focus on individualized risk stratification, early diagnostic tools, and optimized treatment protocols to improve outcomes. Multidisciplinary collaboration and innovation are essential to advancing care for this vulnerable population. Full article

Particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), and heavy metals (HMs) present in polluted air are strongly associated with an increased risk of respiratory diseases. In our study, we grouped cities based on their pollution levels using a method called Ward’s cluster analysis and looked at the increased cancer risk from PM₁₀-bound harmful substances for adult men and women living in Polish cities. The analysis was based on data from 8 monitoring stations where concentrations of PM₁₀, PAHs, and HMs were measured simultaneously between 2018 and 2022. The cluster analysis made it possible to distinguish three separate agglomeration clusters: cluster I (Upper Silesia, Wroclaw) with the highest concentrations of heavy metals and PAHs, with mean levels of lead 14.97 ± 7.27 ng·m⁻³, arsenic 1.73 ± 0.60 ng·m⁻³, nickel 1.77 ± 0.95 ng·m⁻³, cadmium 0.49 ± 0.28 ng·m⁻³, and ∑PAHs 15.53 ± 6.44 ng·m⁻³, cluster II (Warsaw, Łódź, Lublin, Cracow) with dominant road traffic emissions and low emissions, with average levels of lead 8.00 ± 3.14 ng·m⁻³, arsenic 0.70 ± 0.17 ng·m⁻³, nickel 1.64 ± 0.96 ng·m⁻³, and cadmium 0.49 ± 0.28 ng·m⁻³, and cluster III (Szczecin, Tricity) with the lowest concentration levels with favourable ventilation conditions. All calculated ILCR values were in the range of 1.20 × 10⁻⁶ to 1.11 × 10⁻⁵, indicating a potential cancer risk associated with long-term exposure. The highest ILCR values were reached in Upper Silesia and Wroclaw (cluster I), and the lowest in Tricity, which was classified in cluster III. Our findings suggest that there are continued preventive actions and stricter air quality control. The results confirm that PM₁₀ is a significant carrier of airborne carcinogens and should remain a priority in both environmental and public health policy. Full article

Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads to long-term disability. A critical concern in these patients is the frequent development of chronic critical illness, compounded by metabolic disturbances and malnutrition that hinder recovery. Objective: This study aimed to compare changes in nutritional status parameters under standard enteral nutrition protocols and clinical outcomes in prolonged/chronic critically ill patients with TBI or stroke versus such a population of patients without TBI or stroke. Methods: This matched prospective–retrospective cohort study included intensive care unit (ICU) patients with TBI or stroke from the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and patients without these conditions from the eICU-CRD database. Inclusion criteria comprised age 18–74 years, ICU stay >5 days, and enteral nutrition. Patients with re-hospitalization, diabetes, acute organ failure, or incomplete data were excluded. Laboratory values and clinical outcomes were compared between the two groups. Propensity score matching (PSM) was used to balance baseline characteristics (age, sex, and body mass index). Results: After PSM, 29 patients with TBI or stroke and 121 without were included. Univariate analysis showed significant differences in 21 laboratory parameters and three hospitalization outcomes. On day 1, the TBI/stroke group had higher hemoglobin, hematocrit, lymphocytes, total protein, and albumin, but lower blood urea nitrogen (BUN), creatinine, and glucose. By day 20, they had statistically significantly lower calcium, BUN, creatinine, and glucose. This group also showed less change in lymphocytes, calcium, and direct bilirubin. Hospitalization outcomes showed longer mechanical ventilation duration (p = 0.030) and fewer cases of acute kidney injury (p = 0.0220) in the TBI/stroke group. Conclusions: TBI and stroke patients exhibit unique metabolic patterns during prolonged/chronic critical illness, differing significantly from other ICU populations in protein/glucose metabolism and complication rates. These findings underscore the necessity for specialized nutritional strategies in neurocritical care and warrant further investigation into targeted metabolic interventions. Full article

Background/Objectives: Mechanical ventilation management is a critical competency for intensive care unit (ICU) nurses; however, traditional training methods are often insufficient to prepare nurses for the complexities of alarm management and clinical decision-making. This study aimed to evaluate the effectiveness of a 360-degree virtual reality (VR)-based mechanical ventilation nursing education program for ICU nurses in Korea. Methods: A quasi-experimental pre-test–post-test design was employed with 65 ICU nurses (32 in the experimental group and 33 in the control group). Data were collected from May to October 2023. The VR-based program, developed using the ADDIE instructional design model, incorporated simulation-based scenarios focusing on ventilator alarm management and clinical reasoning. Outcome measures included knowledge of ventilation nursing, self-efficacy, clinical reasoning, learning immersion, turnover intention, and educational satisfaction. Data were analyzed using normality tests, descriptive statistics, independent t-tests, and paired t-tests. Results: The experimental group demonstrated significantly greater improvements in knowledge (Δ = 5.54), self-efficacy (Δ = 0.94), clinical reasoning (Δ = 0.76), and learning immersion (Δ = 0.88) compared to the control group (all p < 0.001), where Δ denotes the change score (post-test minus pre-test). Post-test assessments were conducted immediately after the intervention. Educational satisfaction was also significantly higher in the experimental group (p < 0.001). No significant difference was observed in turnover intention between the groups, suggesting a limited short-term impact on this outcome. Conclusions: A 360-degree VR-based education program effectively enhanced key competencies among ICU nurses. While these findings reflect short-term outcomes, future research is warranted to assess the long-term effects and sustainability of VR-based learning in ICU continuing education. Full article

Limited data exist on the underlying physiological phenomena of aerobic training; the impulse oscillometry method, allowing the assessment of small airways and lung periphery in addition to standard lung function testing, might be a useful addition to rehabilitation programs. Background/Objectives: This study aimed to determine the immediate effect of a structured low-intensity aerobic training program on small airway function in healthy volunteers to explore potential implications for long-term COPD care. Methods: Thirty-six healthy volunteers were recruited between May 2024 and January 2025; each participant underwent a lung function testing session, followed by low/moderate-intensity aerobic exercise, and, after 15 min, by a second impulse oscillometry assessment. Results: There was a statistically significant reduction in airway resistance following the physical exertion for the whole group (mean difference 0.03 kPa/L/s, 95%CI 0–0.6 kPa/L/s); significantly lower values were recorded for the reactance component X5 (0.02 kPa/L/s, 95%CI 0–0.4 kPa/L/s) for the normal weight subgoup (n = 24). These results, corroborated with literature data, suggest optimization of the distribution of the airflow and possibly alteration of the elastic properties of the thoracic structures following even low-intensity effort. Conclusions: Low-intensity upper body strength and aerobic training seem to have an immediate respiratory beneficial effect on healthy volunteers manifested as a reduction in airway resistance. The underlying mechanism might be related to improved contractility of respiratory muscles, but changes in lung parenchyma elasticity may also be involved, possibly reflecting modifications of ventilation heterogeneity. Impulse oscillometry may be superior to spirometry in monitoring the effects of aerobic training, considering the additional data it provides, and could be used to optimize and personalize rehabilitation protocols. Full article

The temperature of a surrounding rock mass decreases continuously due to the ventilation in its roadway, and the range of the rock mass with the temperature decreasing is called a Heat-Regulating Ring. Considering the steady-state temperature field, a steady-state heat conduction model of the Heat-Regulating Ring is established, and a formula of the radius and temperature of the Heat-Regulating Ring is obtained. It is found that the radius of the Heat-Regulating Ring is related to the thermal conductivity of the rock, the surface heat transfer coefficient of the tunnel, the radius of the ventilation tunnel, the original rock temperature, the rock wall temperature, and the air temperature. As assessed through field experiments and numerical simulation experiments, the error between the theoretical values and the simulation-derived values for the heat conduction model is very small, and the theoretical formula has a universal applicability. After long-term ventilation, the section shape and the radius of the ventilation tunnel have little effect on the Heat-Regulating Ring’s radius. The wind speed increases from 1 m/s to 5 m/s, and the radius of the Heat-Regulating Ring increases from 26.9 m to 28.4 m. When the ventilation wind speed reaches a certain value, although the wind speed is still increasing, the temperature value of the Heat-Regulating Ring is basically unchanged, or the change amplitude is very small. When the wind speed is 5 m/s, after 1800 days of ventilation, the radius of the Heat-Regulating Ring along the roadway is 27.9 m to 28.4 m. Full article

Background: Splenectomy remains necessary in selected oncologic and hematologic indications but is associated with significant postoperative morbidity and mortality. The data on outcomes in this high-risk population remain limited, particularly in mixed cohorts. Methods: We conducted a retrospective cohort study including all patients undergoing splenectomy for oncologic or hematologic causes between 2009 and 2022 at a cancer referral center. The primary outcomes were the occurrence of major complications at day 90 and the 1-year all-cause mortality. Multivariate logistic regression was used to identify independent predictors. Results: Among the 8503 ICU admissions from surgical wards, 204 splenectomies were performed; 179 patients were analyzed. The median age was 64 years, and 100 patients (55.9%) were female. Splenectomy was performed for hematologic malignancies in 76 cases (42.5%) and for oncologic causes in 103 cases (57.5%). Laparotomy was used in 154 cases (86.0%), and metastasectomy was performed in 54 patients (30.2%). At day 90, 86 patients (48.0%) developed a major complication: 12 deaths (6.7%), 44 surgical complications (24.6%), and 71 episodes of sepsis (39.7%). In a multivariate analysis, weight loss (OR 3.39, 95% CI [1.32–8.70], p = 0.011), laparotomy (OR 4.38 [1.09–17.60], p = 0.038), and a higher SAPS II score (OR 1.08 per point [1.03–1.13], p = 0.003) were associated with complications, while metastasectomy was protective (OR 0.23 [0.08–0.67], p = 0.007). At one year, the mortality reached 22.4%. Independent predictors of death were sepsis at one year (OR 5.04, 95% CI [1.30–25.96], p = 0.029), the Charlson Comorbidity Index (OR 1.30 per point, 95% CI [1.04–1.68], p = 0.030), invasive mechanical ventilation (OR 14.94, 95% CI [2.83–118.93], p = 0.003), and a performance status >1 (OR 7.84, 95% CI [2.38–27.75], p < 0.001). Encapsulated bacteria were not isolated; sepsis was mainly due to Gram-negative and enterococcal organisms. Conclusions: Splenectomy in onco-hematologic patients is associated with high rates of sepsis and mortality. In addition to surgical factors, frailty, immune status, and infection independently contribute to the patients’ outcomes. These results support risk-adapted perioperative strategies and long-term infectious surveillance in immunocompromised patients. Full article

Preserving heritage sites is a complex challenge that requires multidisciplinary approaches, combining scientific accuracy with cultural and historical sensitivity. In alignment with UNESCO’s conservation guidelines, this study investigated the airflow dynamics and wind-induced structural effects within ancient architecture using advanced computational fluid dynamics (CFD). The study site was the Na Phra Meru Historical Temple in Ayutthaya, Thailand, where the shear stress transport $k-\omega$ turbulence model was applied to analyze distinctive airflow patterns. A high-precision 3D computational domain was developed using Faro focus laser scanning technology, with the CFD results being validated based on onsite experimental data. The findings provided critical insights into the temple’s ventilation behavior, revealing strong correlations between turbulence characteristics, wind speed, temperature, and relative humidity. Notably, the small slit windows generated complex flow mixing, producing a large internal recirculation zone spanning approximately 70% of the central interior space. In addition to airflow distribution, the study evaluated the aerodynamic forces and rotational moments acting on the structure based on five prevailing wind directions. Based on these results, winds from the east and northeast generated the highest aerodynamic loads and rotational stresses, particularly in the lateral and vertical directions. Overall, the findings highlighted the critical role of airflow and wind-induced forces in the deterioration and long-term stability of heritage buildings. The study demonstrated the value of integrating CFD, environmental data, and structural analysis to bridge the gap between conservation science and engineering practice. Future work will explore further the interactions between wall moisture and the multi-layered pigments in mural paintings to inform preservation practices. Full article

Ammonia is emerging as a promising zero-carbon marine fuel due to its high hydrogen density, low storage pressure, and long-term stability, making it well-suited for supporting sustainable maritime energy systems. However, its adoption introduces serious safety challenges, as its toxic, flammable, and corrosive properties pose greater risks than many other alternative fuels, necessitating rigorous risk assessment and safety management. This study presents a comprehensive investigation of potential ammonia leakage scenarios that may arise during the fuel gas supply process within confined compartments of marine vessels, such as the fuel preparation room and engine room. The simulations were conducted using FLACS-CFD V22.2, a validated computational fluid dynamics tool specialized for flammable gas dispersion and explosion risk analysis in complex geometries. The model enables detailed assessment of gas concentration evolution, toxic exposure zones, and overpressure development under various leakage conditions, providing valuable insights for emergency planning, ventilation design, and structural safety reinforcement in ammonia-fueled ship systems. Prolonged ammonia exposure is driven by three key factors: leakage occurring opposite the main ventilation flow, equipment layout obstructing airflow and causing gas accumulation, and delayed sensor response due to recirculating flow patterns. Simulation results revealed that within 1.675 s of ammonia leakage and ignition, critical impact zones capable of causing fatal injuries or severe structural damage were largely contained within a 10 m radius of the explosion source. However, lower overpressure zones extended much further, with slight damage reaching up to 14.51 m and minor injury risks encompassing the entire fuel preparation room, highlighting a wider threat to crew safety beyond the immediate blast zone. Overall, the study highlights the importance of targeted emergency planning and structural reinforcement to mitigate explosion risks in ammonia-fueled environments. Full article