Search Results (1,387)

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

Forests play a crucial role in storing excess carbon released into the atmosphere. By mitigating climate change, forest carbon stocks play a vital role in achieving green transitions. However, limited information is available regarding the factors that affect forest carbon stocks. The primary objective of this analysis is to investigate the impact of green agricultural technologies and bioenergy on forest carbon stocks. The empirical investigation was conducted using the method of moments quantile regression (MMQR) technique. Results using the MMQR approach indicate that bioenergy is beneficial in augmenting forest carbon stores at all levels. A 1% increase in bioenergy is associated with an increase in forest carbon stocks ranging from 3.100 at the 10th quantile to 1.599 at the 90th quantile. In the context of developing economies, similar findings are observed; however, in developed economies, bioenergy only fosters forest carbon stocks at lower and middle quantiles. In contrast, green agricultural technologies have an adverse effect on forest carbon stocks. Green agricultural technologies have a significant negative impact on forest carbon stocks, particularly between the 10th and 80th quantiles, with their influence declining in magnitude from −2.398 to −0.619. This negative connection is observed in both developed and developing countries at most quantiles, except for higher quantiles in developed economies. Gross domestic product (GDP) has an adverse effect on forest carbon stores only in developing countries, whereas human capital diminishes forest carbon stocks in both developed and developing nations. Governments should provide support for the creators of bioenergy and agroforestry technologies so that forest carbon stocks can be increased. Full article

This study investigated pesticide residues in 580 vegetable samples collected from markets in Serbia, encompassing potatoes, carrots, celery, radishes, horseradish, ginger, onions, and leeks. In total, 33 distinct pesticides were detected using validated HPLC-MS/MS and GC-MS/MS analytical methods. Multiple residues were identified in 19 samples, while 29 samples exceeded established maximum residue levels (MRLs). Acute and chronic dietary risks were assessed for both adults and children. Although individual hazard quotients (HQs) for adults and children remained below the threshold of concern (HQ < 1), the cumulative acute risk reached up to 63.1% of the Acute Reference Dose (ARfD) for children and 51.1% ARfD for adults, with ginger and celery posing the highest risks. Similarly, cumulative chronic risks remained below the safety threshold, with the Acceptable Daily Intake (ADI) percentages reaching a maximum of 5.9% ADI for adults and increased vulnerability of 11.0% ADI among children. Monte Carlo simulations were applied to account for variability and uncertainty in chronic exposure estimates. The hazard index (HI) results showed that adverse health effects for both population groups remained within acceptable safety limits (HI < 1), although higher susceptibility was observed in children. Sensitivity analysis identified body weight and vegetable consumption rates as the most influential factors affecting chronic risk variability. Full article

Background/Objectives: Cannabidiol (CBD) is a non-intoxicating cannabinoid touted for a variety of medical benefits, including alleviation of anxiety. While legalization of hemp-derived products in the United States (containing ≤0.3% delta-9-tetrahydrocannabinol [d9-THC] by weight) has led to a rapid increase in the commercialization of hemp-derived CBD products, most therapeutic claims have not been substantiated using clinical trials. This trial aimed to assess the impact of 6 weeks of treatment with a proprietary hemp-derived, full-spectrum, high-CBD sublingual solution similar to those available in the marketplace in patients with anxiety. Methods: An open-label pilot clinical trial (NCT04286594) was conducted in 12 patients with at least moderate levels of anxiety. Patients self-administered a hemp-derived, high-CBD sublingual solution twice daily during the 6-week trial (target daily dose: 30 mg/day CBD). Clinical change over time relative to baseline was assessed for anxiety, mood, sleep, and quality of life, as well as changes in cognitive performance on measures of executive function and memory. Safety and tolerability of the study product were also evaluated. Results: Patients reported significant reductions in anxiety symptoms over time. Concurrent improvements in mood, sleep, and relevant quality of life domains were also observed, along with stable or improved performance on all neurocognitive measures. Few side effects were reported, and no serious adverse events occurred. Conclusions: These pilot findings provide initial support for the efficacy and tolerability of the hemp-derived, high-CBD product in patients with moderate-to-severe levels of anxiety. Double-blind, placebo-controlled studies are indicated to obtain robust data regarding efficacy and tolerability of these types of products for anxiety. Full article

Heavy metals are a major toxicological concern due to their adverse effects on human health, particularly in children exposed to contaminated areas. This study evaluated biomarkers of exposure in 253 children aged 6 to 12 from Magangue, Achi, and Arjona (Bolivar, Colombia), analyzing their relationship with neurotoxicity and hematological markers. The mean Pb concentrations at the study sites were 1.98 µg/g (Magangue) > 1.51 µg/g (Achi) > 1.24 µg/g (Arjona). A similar pattern was observed for Cd concentrations for Magangue (0.39 µg/g) > Achi (0.36 µg/g) > Arjona (0.14 µg/g). In contrast, Se concentrations followed a different trend for Arjona (0.29 µg/g) > Magangue (0.21 µg/g) > Achi (0.16 µg/g). The proportion of Se/Pb molar ratios > 1 was higher in Arjona (3.8%) than in Magangue (0.9%) and Achi (2.0%). For Se/Cd ratios, values > 1 were also more frequent in Arjona (70.7%), exceeding 20% in the other two locations. Significant differences were found among locations in red and white blood cell parameters and platelet indices. Neurotransmitter-related biomarkers, including serotonin, monoamine oxidase A (MAO-A), and acetylcholinesterase levels, also varied by location. Principal component analysis showed that Pb and Cd had high loadings on the same component as PLT, WBC, and RDW, and while Se loaded together with HGB, PDW, MCHC, MCH, and MCV, suggesting distinct hematological patterns associated with each element. Multiple linear regression analysis demonstrated a statistically significant inverse association between hair Pb levels and serotonin concentrations. Although MAO-A and Cd showed negative β coefficients, these associations were not statistically significant after adjustment. These findings highlight the potential impact of toxic element exposure on key hematological and neurochemical parameters in children, suggesting early biological alterations that may compromise health and neurodevelopment. Full article

Background/Objectives: Acrylamide is a probably carcinogenic to humans that naturally forms during the thermal processing of foods. An individual’s lifestyle—especially dietary habits and physical activity—may influence the severity of acrylamide’s adverse health effects. This study aimed to examine the relationship between adolescents’ dietary and exercise behaviors and their dietary acrylamide exposure and associated health risks. Methods: This descriptive and cross-sectional study was conducted with 370 high school students in Türkiye. Data were collected using the Nutrition Exercise Behavior Scale (NEBS) and a retrospective 24-h dietary recall questionnaire. Acrylamide exposure was calculated based on food intake to estimate carcinogenic (CR) and non-corcinogenic (target hazard quotient: THQ) health risks and analyzed in relation to NEBS scores. Results: Findings indicated that while adolescents are beginning to adopt healthy eating and exercise habits, these behaviors are not yet consistent. Emotional eating and unhealthy food choices still occur. Higher acrylamide exposure and risk values were observed in boys and underweight individuals. This can be explained mainly by the fact that boys consume more of certain foods—especially bread, which contains relatively higher levels of acrylamide—than girls do, and that underweight individuals have lower body weights despite consuming similar amounts of food as other groups. Bread products emerged as the primary source of daily acrylamide intake. Positive correlations were found between NEBS total and subscale scores and acrylamide exposure and health risk values. Conclusions: The study demonstrates a significant association between adolescents’ health behaviors and acrylamide exposure. These results underscore potential public health concerns regarding acrylamide intake during adolescence and emphasize the need for targeted nutritional interventions to reduce risk and promote sustainable healthy behaviors. Full article

Introduction: Congestive heart failure (CHF), a complex clinical syndrome characterized by the heart’s inability to pump blood effectively due to structural or functional impairments, is a growing public health concern, with profound implications for patients’ physical and emotional well-being. In India, the burden of CHF is rising due to aging demographics and increasing prevalence of lifestyle-related risk factors. Among the subtypes of CHF, heart failure with preserved ejection fraction (HFpEF), i.e., heart failure with left ventricular ejection fraction of ≥50% with evidence of spontaneous or provokable increased left ventricular filling pressure, and heart failure with reduced ejection fraction (HFrEF), i.e., heart failure with left ventricular ejection fraction of 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling, may present differing impacts on health-related quality of life (HRQoL), i.e., an individual’s or a group’s perceived physical and mental health over time, yet comparative data remains limited. This study assesses HRQoL among CHF patients using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), one of the most widely used health-related quality of life questionnaires for patients with heart failure based on physical and emotional dimensions and identifies sociodemographic and clinical variables influencing these outcomes. Methods: A cross-sectional analytical study was conducted among 233 CHF patients receiving inpatient and outpatient care at the Department of Cardiology at a quaternary care teaching hospital in coastal Karnataka in India. Participants were enrolled using convenience sampling. HRQoL was evaluated through the MLHFQ, while sociodemographic and clinical characteristics were recorded via a structured proforma. Statistical analyses included descriptive measures, independent t-test, Spearman’s correlation and stepwise multivariable linear regression to identify associations and predictors. Results: The mean HRQoL score was 56.5 ± 6.05, reflecting a moderate to high symptom burden. Patients with HFpEF reported significantly worse HRQoL (mean score: 61.4 ± 3.94) than those with HFrEF (52.9 ± 4.64; p < 0.001, Cohen’s d = 1.95). A significant positive correlation was observed between HRQoL scores and age (r = 0.428; p < 0.001), indicating that older individuals experienced a higher burden of symptoms. HRQoL also varied significantly across NYHA functional classes (χ² = 69.9, p < 0.001, ε² = 0.301) and employment groups (χ² = 17.0, p < 0.001), with further differences noted by education level, gender and marital status (p < 0.05). Multivariable linear regression identified age (B = 0.311, p < 0.001) and gender (B = –4.591, p < 0.001) as significant predictors of poorer HRQoL. Discussion: The findings indicate that patients with HFpEF experience significantly poorer HRQoL than those with HFrEF. Older adults and female patients reported greater symptom burden, underscoring the importance of demographic-sensitive care approaches. These results highlight the need for routine integration of HRQoL assessment into clinical practice and the development of comprehensive, personalized interventions addressing both physical and emotional health dimensions, especially for vulnerable subgroups. Conclusions: CHF patients, especially those with HFpEF, face reduced HRQoL. Key factors include age, gender, education, employment, marital status, and NYHA class, underscoring the need for patient-centered care. Full article

This study examines the impact of free trade zone (FTZ) establishment on regional economic resilience (RER) in China, using provincial-level panel data spanning from 2010 to 2022 and a multi-period difference-in-differences (DID) approach. The empirical results indicate that FTZ implementation significantly enhances regional economic resilience by 3.46%, with the development of green finance acting as a key moderating mechanism that amplifies this positive effect. Heterogeneity analysis uncovers notable disparities across policy cohorts and geographical regions: the first wave of FTZs demonstrates the most pronounced resilience-enhancing impact, whereas later cohorts exhibit weaker or even adverse effects. Coastal regions experience substantial benefits from FTZ policies, in contrast to statistically insignificant outcomes observed in inland areas. These findings suggest that strategically expanding the FTZ network, when paired with tailored implementation mechanisms and the integration of green finance, could serve as a powerful policy tool for post-COVID economic recovery. Importantly, by strengthening economic resilience through institutional openness and green investment, this study offers valuable insights into balancing economic growth with environmental sustainability. It provides empirical evidence to support the optimization of FTZ spatial governance and institutional innovation pathways, thereby contributing to the pursuit of sustainable regional development. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background: Overtime adversely affects physical and mental health, contributing to irritability, anxiety, reduced sleep, and even cardiovascular issues, ultimately lowering care quality and increasing turnover intentions. This study aimed to investigate whether prolonged overtime increases the risk of occupational burnout over time among healthcare workers. Methods: We conducted a four-year longitudinal observational study using secondary data from annual surveys (2021–2024) of healthcare workers at a medical university hospital in Taichung, Taiwan. Burnout was assessed using the personal burnout (PB) scale from the Copenhagen Burnout Inventory (CBI), with high PB levels (HPBL) defined as scores in the upper quartile of the 2021 baseline. Survival analysis utilizing the Kaplan–Meier method and Cox regression investigated burnout progression and the effects of overtime. Results: HPBL was defined as PB scores ≥45.83 (upper quartile in 2021). The proportions of HPBL were 30.28% (2021), 33.29% (2022), 36.75% (2023), and 32.51% (2024). Survival analysis confirmed that the risk of burnout increased over time, with the survival time estimated at 2.50 ± 0.03 years and lower survival probabilities observed among participants working overtime (Log-rank test, p < 0.0001). Multivariate logistics revealed overtime work, female gender, being a physician/nurse, and reduced sleep as independent risk factors for HPBL (OR = 3.14 for overtime, p < 0.001). These findings support the hypotheses on burnout progression and the impact of overtime. Conclusions: Overtime significantly heightens the risk of burnout, which worsens over time. Female sex, healthcare roles, obesity, and insufficient sleep are additional risk factors. Limiting overtime and proactive interventions are crucial to preventing burnout in healthcare workers. Full article

Background: Cardiovascular diseases, particularly hypertension, and gastrointestinal disorders represent major public health concerns in Mexico. Although a range of pharmacological treatments exists, their use is associated with adverse effects, highlighting the need for safer therapeutic alternatives. Species of the Ipomoea genus are widely employed in Mexican traditional medicine (MTM) for their purgative, anti-inflammatory, analgesic, and sedative properties. Particularly, Ipomoea purpurea is traditionally used as a diuretic and purgative; its leaves and stems are applied topically for their anti-inflammatory and soothing effects. This study aimed to determine their phytochemical composition and to evaluate the associated vasodilatory activity, modulatory effects on intestinal smooth-muscle motility, and toxicological effects of the methanolic (ME-Ip) and dichloromethane (DE-Ip) extracts obtained from the aerial parts of I. purpurea. Methods: The phytochemical composition of the ME-Ip and DE-Ip extracts of I. purpurea was assessed using UPLC-QTOF-MS and GC-MS, respectively. For both extracts, the vasodilatory activity and effects on intestinal smooth muscle were investigated using ex vivo models incorporating isolated rat aorta and ileum, respectively, whereas acute toxicity was evaluated in vivo. Results: Phytochemical analysis revealed, for the first time, the presence of two glycosylated flavonoids within the Ipomoea genus; likewise, constituents with potential anti-inflammatory activity were detected. The identified compounds in I. purpurea extracts may contribute to the vasodilatory, biphasic, and purgative effects observed in this species. The EC₅₀ values for the vasodilatory effects of the methanolic (ME-Ip) and dichloromethane (DE-Ip) extracts were 0.80 and 0.72 mg/mL, respectively. In the initial phase of the experiments on isolated ileal tissues, both extracts induced a spasmodic (contractile) effect on basal motility, with ME-Ip exhibiting higher potency (EC₅₀ = 27.11 μg/mL) compared to DE-Ip (EC₅₀ = 1765 μg/mL). In contrast, during the final phase of the experiments, both extracts demonstrated a spasmolytic effect, with EC₅₀ values of 0.43 mg/mL for ME-Ip and 0.34 mg/mL for DE-Ip. In addition, both extracts exhibited low levels of acute toxicity. Conclusions: The phytochemical profile and the vasodilatory and biphasic effects of the I. purpurea extracts explain, in part, the use of I. purpurea in MTM. The absence of acute toxic effects constitutes a preliminary step in the toxicological safety assessment of I. purpurea extracts and demonstrates their potential for the development of phytopharmaceutic agents as adjuvants for the treatment of cardiovascular and gastrointestinal disorders. Full article

Background and Objectives: This study aimed to evaluate the clinical effectiveness and safety of ultrasound-guided pharmacopuncture (UGP) in comparison to non-guided pharmacopuncture (NGP) for the treatment of acute cervical myofascial pain syndrome (C-MPS) in primary care settings. Materials and Methods: This multi-center, prospective observational study included 97 patients diagnosed with acute C-MPS. Participants received a single session of either UGP or NGP at one of seven primary care institutions. Pain intensity was measured using the Numerical Rating Scale (NRS), and cervical function was assessed through active Range of Motion (ROM) tests conducted before and after treatment. We conducted follow-up interviews within 48 h after treatment to monitor adverse events. Results: Both groups showed significant improvements in pain levels and cervical ROM after treatment. The UGP group showed a greater reduction in NRS scores compared to the NGP group (p < 0.001). Notable enhancements in cervical extension and rotation on the affected side were also observed in the UGP group (p < 0.01), whereas changes in flexion and lateral flexion were similar between the two groups. No serious adverse events were reported. Conclusions: UGP has shown superior pain reduction and a greater improvement in specific cervical motions compared to non-guided treatments, indicating enhanced precision and therapeutic efficacy. Furthermore, no serious adverse events were reported, suggesting that UGP is a safe and effective non-surgical intervention for acute C-MPS in real-world primary care settings. Full article

Advanced glycation end-products (AGEs) are formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids due to the consumption of high-carbohydrate diets; their production is also promoted by a sedentary lifestyle as well as cigarette smoking. Elevated levels of AGEs in the circulatory system and internal organs of the body are commonly observed in a number of cardiovascular diseases such as hypertension, diabetes, atherosclerosis, coronary artery disease, aortic aneurysm, atrial fibrillation, myocardial infarction, and heart failure, which are associated with the development of oxidative stress and myocardial inflammation. The adverse effects of AGEs on the cardiovascular system are elicited by both non-receptor mechanisms involving the cross-linking of extracellular and intracellular proteins, and by receptor-mediated mechanisms involving the binding of AGEs with advanced glycation end-product receptors (RAGEs) on the cell membrane. AGE–RAGE interactions along with the cross-linking of proteins promote the generation of oxidative stress, the production of inflammation, the occurrence of intracellular Ca²⁺-overload, and alterations in the extracellular matrix leading to the development of cardiovascular dysfunction. AGEs also bind with two other protein receptors in the circulatory system: soluble RAGEs (sRAGEs) are released upon the proteolysis of RAGEs due to the activation of matrix metalloproteinase, and endogenous secretory RAGEs (esRAGEs) are secreted as a spliced variant of endogenous RAGEs. While the AGE–RAGE signal transduction axis serves as a pathogenic mechanism, both sRAGEs and esRAGEs serve as cytoprotective interventions. The serum levels of sRAGEs are decreased in ischemic heart disease, vascular disease, and heart failure, as well as in other cardiovascular diseases, but are increased in chronic diabetes and renal disease. Several interventions which can reduce the formation of AGEs, block the AGE–RAGE axis, or increase the levels of circulating sRAGEs have been shown to exert beneficial effects in diverse cardiovascular diseases. These observations support the view that the AGE–RAGE axis not only plays a critical role in pathogenesis, but is also an excellent target for the treatment of cardiovascular disease. Full article

Background and Objectives: Digoxin is a pharmacological agent of natural origin that is still occasionally administered in the intensive care unit (ICU). The objective of this study was to assess the efficacy of routine therapeutic drug monitoring (TDM) of digoxin in ICU patients with heart failure. Materials and Methods: This retrospective, single-center study was conducted using data from the ICU database of the Silesian Center for Heart Diseases in Zabrze, Poland. A total of 980 ICU admissions between January 2018 and July 2023 were screened, and 103 patients met the inclusion criteria. Patients were excluded if they had not received digoxin during hospitalization, had only one digoxin level measurement, or did not meet the established criteria for heart failure. Results: Women required significantly lower doses of digoxin compared to men (0.171 ± 0.053 mg vs. 0.224 ± 0.080 mg; p < 0.001). Patients who died had significantly higher serum digoxin concentrations than survivors (1.33 ± 0.59 ng/mL vs. 1.03 ± 0.43 ng/mL; p = 0.003). Similarly, patients with liver failure had higher digoxin levels compared to those without liver dysfunction (1.31 ± 0.58 ng/mL vs. 1.06 ± 0.46 ng/mL; p = 0.016). A weak negative correlation was found between age and the administered dose (r = −0.20; p = 0.048), and a weak positive correlation was observed between serum digoxin concentration and NT-proBNP levels (r = 0.23; p = 0.048). Conclusions: Among ICU patients with multi-organ failure, those with concomitant liver dysfunction tended to reach higher serum digoxin concentrations. Routine therapeutic drug monitoring of digoxin in ICU patients appears beneficial and may help to optimize dosing and reduce adverse effects. Full article

This study examines the impact of vegetation structure on bird species richness and diversity across four urban parks in Chaoyang District, Beijing. Throughout the year, using the Point Count Method (PCM), a total of 68 bird species and 4279 individual observations were recorded, with surveys conducted across all four seasons to capture seasonal variations. The parks with more complex vegetation, such as those with a higher tree canopy cover of species like poplars, ginkgo, and Chinese pines, exhibited higher bird species richness. For example, Olympic Forest Park, with its dense vegetation structure, hosted 42 species, whereas parks with less diverse vegetation supported fewer species. An analysis using PERMANOVA revealed that bird communities in the four parks were significantly different from each other (F = 2.76, p = 0.04075), and every comparison between parks showed significant differences as well (p < 0.001). Variations in the arrangement and level of disturbance within different plant communities likely cause such differences. Principal component analysis (PCA) identified tree canopy cover and shrub density as key drivers of bird diversity. These findings underscore the importance of preserving urban green spaces, particularly those with a diverse range of native tree species, to conserve biodiversity and mitigate the adverse effects of urbanisation. Effective vegetation management strategies can enhance avian habitats and provide ecological and cultural benefits in urban environments. Full article