Search Results (22,583)

Background: Hepatic resection requires precise knowledge of vascular anatomy and remnant liver volume to guarantee both safety and efficacy. Three-dimensional (3D) models, either virtual or printed, have been proposed as tools to optimize surgical planning, education, and intraoperative navigation. Material and Methods: This retrospective observational study evaluated the impact of 3D model utilization (virtual and printed), in 89 patients who underwent elective hepatectomy at Infanta Elena University Hospital (Valdemoro, Madrid, Spain) between May 2018 and May 2023. The implementation of 3D modeling began to be routinely implemented as of November 2020. Patients were divided into two groups: those without 3D modeling (n = 40) and those with 3D modeling (n = 49). Results: Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in the 3D model group (median 175 mL vs. 262.5 mL; p < 0.001), with no statistically significant differences in operative time, complication rate (Clavien–Dindo classification), length of hospital stay, or in-hospital mortality. Multivariable analysis identified dyslipidemia, postoperative sodium delta, and postoperative increase in direct bilirubin as independent risk factors for complications, whereas albumin demonstrated a protective effect. Conclusions: Three-dimensional modeling improves anatomic orientation and reduces intraoperative blood loss, although it does not significantly modify classic perioperative outcomes. Its principal value appears to reside in preoperative planning and technical safety rather than direct clinical impact. Full article

Venous access selection represents a pivotal aspect of permanent pacemaker implantation, directly influencing both procedural safety and long-term device performance. Although the subclavian vein has been traditionally favored, its use is associated with notable risks, including pneumothorax, hemothorax, and crush syndrome. In contrast, axillary access has gained prominence, supported by observational studies and a small number of randomized trials demonstrating reduced pneumothorax rates, fewer arterial punctures, and potentially fewer long-term mechanical lead failures, particularly when ultrasound guidance is used. However, these findings are derived from heterogeneous studies with variable definitions, imaging protocols and operator experience, highlighting that evidence quality remains moderate. Contemporary advances—such as routine ultrasound guidance, micropuncture techniques, and structured training—have improved procedural consistency and safety, a trend reflected in recent guidelines. This review provides a focused appraisal of complication patterns, anatomical differences and patient-specific considerations to support individualized and evidence-aligned venous access selection in modern clinical practice. Full article

Background: Sentinel lymph node biopsy (SLNB) is the standard axillary staging procedure in clinically node-negative breast cancer but remains invasive, non-therapeutic and increasingly questioned in contemporary de-escalation algorithms. After neoadjuvant chemotherapy (NACT), however, the safety of omitting SLNB solely on the basis of a negative axillary ultrasound (AUS) is uncertain, particularly across molecular subtypes with heterogeneous chemosensitivity. This study evaluated the diagnostic performance of preoperative AUS after NACT and explored clinicopathological and biological factors associated with SLNB positivity in ultrasound-negative axillae. Methods: In this single-centre retrospective cohort, 135 women with invasive breast cancer who received NACT followed by surgery (2022–2024) were analysed. To avoid spectrum bias, 77 patients with clipped, cytologically or histologically proven node-positive disease at baseline were excluded from the main analysis. All patients underwent preoperative AUS and definitive axillary staging. Ninety-six women with ultrasound-negative axillae who proceeded to SLNB constituted the primary study population. Oestrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 and immunohistochemistry-based molecular subtype were recorded. Receiver operating characteristic (ROC) analysis and uni/multivariable logistic regression were used as exploratory tools to identify factors associated with SLNB positivity. Results: In the overall cohort, AUS sensitivity, specificity, negative predictive value and false-negative rate for axillary metastasis were 47.8%, 90.9%, 62.5% and 52.2%, respectively. Among ultrasound-negative axillae, SLNB was positive in 37.5%. Compared with SLNB-negative patients, those with SLNB metastases more frequently harboured an intratumoural ductal carcinoma in situ (DCIS) component, showed higher ER/PR expression and lower Ki-67, and were predominantly luminal A or luminal B/HER2−, whereas AUS performance appeared more favourable in HER2-enriched and triple-negative tumours. ROC-derived cut-offs for ER (82.5%), PR (25.0%) and Ki-67 (17.5%) provided only moderate discrimination (area under the curve 0.68–0.70). In multivariable analysis, absence of a DCIS component and low PR expression were independently associated with reduced odds of SLNB positivity, suggesting that DCIS and high PR may act as indicators of residual nodal risk in ultrasound-negative axillae. All estimates are limited by sample size and wide confidence intervals and should be interpreted as hypothesis-generating. Conclusions: Preoperative AUS alone cannot reliably exclude sentinel lymph node metastasis after NACT, particularly in luminal A and luminal B/HER2− tumours with strong hormone receptor expression and a low proliferative index. Until prospective, biology-stratified trials confirm the safety of omission, SLNB should not be withheld solely on the basis of a negative AUS in these subtypes. Axillary management after NACT should systematically integrate both imaging findings and tumour biology when considering further de-escalation of surgery. Full article

Background/Objectives: Cranioplasty (CP) is associated with high complication rates (20–50%), and the optimal choice between patient-specific implants (PSIs) and hand-molded (HM) alternatives remains debated. This systematic review and meta-analysis aims to compare surgical and postoperative outcomes between PSIs and HM implants. Methods: A systematic search was performed in three databases to identify studies reporting surgical site infection (SSI), implant removal, reoperation, operative time or cosmetic outcome for PSIs and/or HM implants. Two-arm studies of the same material were analyzed separately from pooled single- and two-arm studies. Results: 125 observational studies involving 10,034 patients were included. In two-arm comparisons, PSIs reduced implant removal for titanium (OR 0.34, p = 0.053) and PMMA (OR 0.56, p = 0.188), while SSI rates showed no meaningful difference between groups. In one-arm analyses, PSIs demonstrated lower explantation probabilities (titanium 6.1%, PMMA 7.9%) compared with HM alternatives (titanium 9.9%, PMMA 14.2%), alongside shorter operation times and fewer reoperations. Cosmetic outcomes consistently favored PSIs. Conclusions: PSIs demonstrate advantages in efficiency, durability, and esthetics compared with HM implants, supporting their preferential use where resources allow. HM implants remain a cost-effective option in resource-limited settings. Due to the observational nature of the included studies and differences in study populations across arms, the findings should be interpreted with caution. Full article

Background/Objectives: The treatment of Hematogenous Primary Septic Spinal Infection (HPSSI) typically involves either conservative management or surgical intervention. Previous studies have suggested that conservative treatment with antibiotics is the mainstay conventional procedure in treating HPSSI, but relevant conclusions remain controversial regarding mortality, recurrence, and hospital stay. There is a lack of systematic reviews and meta-analyses comparing conservative vs. surgical treatment specifically in non-TBC, non-fungal, and non-postsurgical HPSSI in adults. This systematic review and meta-analysis aim to systematically evaluate the therapeutic effectiveness of conservative versus surgical intervention for the management of HPSSI, through a meta-analysis of key outcomes including mortality, recurrence, and length of hospital stay. Methods: A comprehensive literature search was performed across four major databases: PubMed, Cochrane, Science Direct, and Scopus. Using defined inclusion and exclusion criteria, we identified twelve studies encompassing 1199 patients with hematogenous, primary, septic spinal infection, which was not post-surgical, not due to TBC, and not fungal, who were treated conservatively (n = 519) or surgically (n = 680) for inclusion in the meta-analysis. PRISMA guidelines were used for this analysis. The primary outcome analyzed was mortality; secondary outcomes were infection recurrence and length of hospital stay, comparing conservative treatment versus operative intervention for HPSSI. Results: Mortality rates for surgical versus conservative treatment varied across five studies. Some studies reported significantly lower mortality with surgical intervention vs. conservative treatment (2.3–6% vs. 17.8–18%), while others showed no difference (11% for both treatments). This meta-analysis indicates that surgical treatment does not significantly alter mortality rates compared to conservative management, although study heterogeneity is considerable. Infection recurrence was reported in three studies, with rates ranging from 5 to 16.4% for conservative treatment and 5 to 11.6% for surgical intervention. These differences were not statistically significant in studies that provided group-specific data. Findings on hospital length of stay were mixed: two studies reported shorter stays for surgical patients (23.9–33.4 days vs. 40.5–51.2 days), while another study found no meaningful difference between the groups. Across multiple studies, advanced age, frailty, higher comorbidity burden, and neurological impairment were consistently identified as independent predictors of increased mortality, irrespective of treatment modality. Although some data suggest a short-term survival advantage associated with surgical intervention, the overall mortality outcomes remain heterogeneous across the literature. Conclusions: Overall, the findings of this meta-analysis remain inconclusive regarding which treatment—surgical or conservative—is more advantageous in reducing mortality, infection recurrence, and hospital stay. The variability across studies highlights the influence of patient selection, treatment protocols, and local clinical practices. To enhance our understanding and improve outcomes in HPSSI, future randomized controlled trials are essential. These studies should incorporate clear selection criteria, standardized terminology for spinal infection subgroups, and homogenous patient populations with well-defined comorbidities to allow for meaningful data comparisons. Additionally, emphasis should be placed on early diagnosis, rapid identification of causative pathogens, using modern diagnostic tools, and timely initiation of appropriate treatment—whether surgical or conservative—to optimize patient outcomes, including reduced mortality, lower recurrence rates, and shorter hospitalizations. Full article

Background: Sepsis remains a major cause of morbidity and mortality in intensive care units (ICUs). Although various scoring systems and biomarkers have been studied, the prognostic significance of early dynamic changes in laboratory parameters remains unclear. This study aimed to investigate the prognostic value of 48 h changes in routinely monitored biomarkers for in-hospital mortality in septic patients. Methods: This retrospective, single-center study was conducted in the Anesthesiology and Reanimation ICU of a tertiary teaching hospital. A total of 174 adult patients (≥18 years) diagnosed with sepsis according to SEPSIS-3 criteria between January 2017 and December 2022 were included. Laboratory data were recorded at ICU admission and after 48 h. Patients who died within 48 h or had missing follow-up data were excluded. Receiver operating characteristic (ROC) analysis and logistic regression models were used to assess the prognostic performance of clinical and laboratory parameters. Results: The median age was 71 years, and 58% of patients were male. Comorbidities were present in 76% patients, and malignancy was associated with higher mortality (p = 0.012). The overall in-hospital mortality rate was 58.6%. Inappropriate empirical antibiotic therapy significantly increased mortality risk (p = 0.001). Non-survivors had higher baseline SOFA and APACHE II scores. At 48 h, mortality was associated with increased procalcitonin, lactate, and CRP/albumin ratio and greater albumin decline. ROC analysis identified procalcitonin ≤ 28% decrease, lactate > 23% increase, albumin > 7% decrease, and CRP/albumin ratio > 31% increase as optimal cutoffs. Multivariate analysis revealed SOFA score > 6, inappropriate antibiotic therapy, procalcitonin ≤ 28% decrease, lactate > 23% increase, and platelet > 37% decrease as independent mortality predictors. The change in albumin level was included in the model but was not statistically significant. Conclusions: Forty-eight–hour biomarker changes, particularly in lactate and platelet count, may provide complementary prognostic information to baseline SOFA scores and may support early risk stratification in sepsis. These findings should be considered exploratory and require confirmation in prospective multicenter studies before clinical implementation. Full article

The operational integrity of L415 pipeline steel, a critical component of China’s energy network, is severely threatened by the unique acidic red soil environments prevalent in Southern China. A significant knowledge gap exists regarding its specific failure mechanisms, particularly the interplay between Anodic Dissolution (AD) and Hydrogen Embrittlement (HE) in driving Stress Corrosion Cracking (SCC). This study systematically investigates the corrosion and SCC behavior of L415 steel in a simulated environment that replicates the typical soil chemistry of the Gannan region in Southern China. Results revealed that corrosion kinetics are highly dependent on environmental chemistry, with corrosion rates escalating nearly four-fold from 0.0505 mm/a to a severe 0.1949 mm/a, driven by the synergy of low pH and high SO₄²⁻ concentration. This behavior is governed by the integrity of the corrosion product film, where aggressive environments form porous, unprotective layers with low charge transfer resistance. Slow strain rate tensile (SSRT) tests confirmed that the steel’s susceptibility to SCC is strongly promoted by acidity. Critically, the dominant SCC mechanism was environment-dependent, transitioning from Hydrogen Embrittlement (HE) to intergranular cracking in the most acidic environment, and a mixed AD-HE mechanism causing transgranular cracking in high-chloride conditions. These findings provide a direct mechanistic link between soil chemistry and failure mode, offering a crucial scientific basis for developing environment-specific integrity management strategies for pipelines in these challenging terrains. Full article

Background/Objectives: Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes. However, its metabolic consequences on newborns remain inadequately characterized. This study investigated amino acid, carnitine, and acylcarnitine profiles in neonates born to mothers with ICP. Methods: This retrospective study encompassed 299 neonates born to mothers with ICP. For comparative analysis, term infants without additional complications (ICP-term, n = 150) were compared with term controls (n = 150). Capillary blood samples collected at 24–48 h of life as part of newborn screening were analyzed using LC–MS/MS for acylcarnitine and amino acid profiles. Results: The ICP cohort exhibited a high preterm delivery rate (46.2%), with maternal bile acids negatively correlating with gestational age (r = −0.266, p < 0.001). No inborn errors of metabolism were observed. Elevated levels of amino acids (alanine, leucine/isoleucine, valine, tyrosine, arginine, glycine, and ornithine) and specific acylcarnitines (C5, C5-OH, C10:1, and C18:2), along with decreased levels of amino acids (argininosuccinic acid and glutamic acid) and specific acylcarnitines (C3, C5-DC, C6-DC, C14, C14:1, C16, C16:1, and C18:1-OH), were observed in ICP-term neonates (p < 0.05). Receiver operating characteristic curve analysis identified ornithine (area under the curve [AUC] = 0.74) and leucine/isoleucine (AUC = 0.73) as strong discriminators. A multivariable model integrating multiple metabolites achieved high accuracy (AUC = 0.86 ± 0.03). Conclusions: This first comprehensive characterization of neonatal metabolic alterations in ICP reveals amino acid metabolism, fatty acid oxidation, and mitochondrial function disruptions, suggesting fetal adaptation to a cholestatic intrauterine environment. Metabolomic profiling may improve understanding of maternal–fetal interactions and inform strategies for risk stratification and long-term monitoring. Full article

Accurate and reliable short-term wind speed forecasting plays a crucial role in efficient operation and integration of wind energy generation. This research study introduces an innovative deep hybrid model that combines Convolutional Neural Networks (CNN) with Double Bidirectional Long Short-Term Memory (DBiLSTM) networks to enhance wind speed forecasting accuracy in Australia. Thirteen years of hourly wind speed data were collected from two wind-rich potential sites in Tasmania, Australia. The CNN component effectively captures local temporal patterns, while the DBiLSTM layers model long-range dependencies in both forward and backward directions. The proposed CNNDBiLSTM model was compared against three traditional benchmark models: Multiple Linear Regression (MLR), Support Vector Regression (SVR), and Categorical Boosting (CatBoost). The proposed framework can effectively support wind farm planning, operational reliability, and grid integration strategies within the renewable energy sector. A comprehensive evaluation framework across both Australian study sites (Flinders Island Airport, Scottsdale) showed that the CNNDBiLSTM consistently outperformed the baseline models. It achieved the highest correlation coefficients (r = 0.987–0.988), the lowest error rates (RMSE = 0.392–0.402, MAE = 0.294–0.310), and superior scores across multiple efficiency metrics (ENS, WI, LM). The CNNDBiLSTM demonstrated strong adaptability across coastal and inland environments, showing potential for real-world use in renewable-energy resource forecasting. The wind speed analysis and forecasting show Flinders with higher and consistent wind speed as a more viable option for large-scale wind energy generation than Scottsdale in Tasmania. Full article

Cognitive performance during diving is challenged by hyperbaric conditions, where inert gas narcosis, oxygen partial pressure, and carbon dioxide retention may impair accuracy and reaction time. Breathing gas mixtures such as heliox and trimix are proposed to reduce these effects, but controlled evidence at recreational depths remains limited. Our study investigated short-term effects of hyperbaric exposure at 4 ATA (equivalent to 30 m of seawater) on cognitive functioning and whether the severity of impairment varies across breathing gas mixtures: air, trimix and heliox. Each participant completed neuropsychological testing at three stages: before exposure (1 ATA), during exposure (4 ATA), and after decompression (1 ATA). Our findings concerned accuracy in the Simon task: the participants breathing heliox had a significantly lower error rate at 4 ATA (1.12%) compared with baseline (1.89%), whereas the error rate nearly doubled for the participants breathing air (from 2.3% to 4.38%). This brings us to the conclusion that breathing heliox minimises errors under cognitive conflict, supporting an accuracy-preserving strategy, while breathing air promotes speed at the cost of mistakes. Given that operational safety depends more on preventing errors than on preserving speed, heliox emerges as the preferable breathing gas mixture for diving, even at recreational depths. Full article

Despite the continuous development of wind power forecasting methods, forecasting errors remain unavoidable, especially during extreme weather events. However, current research on quantifying these errors is quite limited. This paper proposes an adaptive error risk early warning method that can directly predict the magnitude of forecast errors and classify and warn of risks, thereby achieving proactive risk management. This method comprises three core designs. First, mechanism-based feature engineering captures the driving factors of error generation, including numerical weather prediction bias, atmospheric instability, and meteorological dynamics, all of which are key factors leading to forecast bias. Second, a stacked ensemble method integrates quantile regression, random forest, and gradient booster, utilizing complementary learning capabilities to handle high-dimensional non-stationary error patterns. Third, K-means clustering establishes a dynamic risk threshold that adapts to changes in seasonal error distribution, overcoming the limitations of fixed thresholds. Validation using actual wind farm operation data demonstrates significant improvements: the proposed ensemble model reduces the Root Mean Square Error (RMSE) by 2.5% compared to the best single model, and the dynamic threshold mechanism increases the High-Risk Recall rate from 89.7% to 96.9%. These results confirm that the method can effectively warn of high-error events and provide timely and actionable decision support to enhance grid stability and security. Full article

Aiming at the problem that low-quality images and low-precision control points lead to scale differences between the survey area model and the real model in UAV (Unmanned Aerial Vehicle) vision-based 3D deformation monitoring, which impairs the accuracy of deformation monitoring, this paper develops a spatial 3D scale for providing high-precision scale information and proposes a UAV vision-based deformation monitoring method with 3D scale constraints, thereby improving the deformation monitoring accuracy in large-scale survey areas. Experimental results show that compared with the monitoring method using only control points as constraints, the proposed method achieves accuracy (RMSE) improvement rates of 38.6% and 48.1% in the horizontal and elevation directions respectively during four phases of UAV operations, and the 3D deformation accuracy (RMSE) improvement rate remains at approximately 42.3% during seven phases of UAV operations. This verifies the effectiveness and reliability of the UAV vision-based deformation monitoring method with 3D scale constraints. Full article

Accurate prediction of shrimp body weight is critical for optimizing harvest timing, feed management, and stocking density decisions in intensive aquaculture. While prior studies emphasize environmental factors, operational management variables—particularly harvesting metrics—remain understudied. This study quantified the predictive importance of harvesting-related variables using 5 years of industrial-scale operational data from 12 ponds (5479 cleaned records, 34.94% retention rate). We trained seven machine learning models and applied three independent feature importance methods: consensus importance ranking, SHAP explainability analysis, and Pearson correlations. Main findings: Operational variables (days of culture: 2.833 SHAP, stocking density: 1.871, cumulative feed: 1.510) ranked substantially above environmental variables (temperature: 0.123, pH: 0.065, dissolved oxygen: 0.077). Partial harvest frequency showed bimodal clustering, indicating two distinct viable operational strategies. The Weighted Ensemble model achieved the highest performance (R² = 0.829, RMSE = 4.23 g, MAE = 3.12 g). Model stability analysis via 10-fold GroupKFold cross-validation showed that the Artificial Neural Network (ANN) exhibited the tightest confidence bounds (0.708 g width, 27.7% coefficient of variation), indicating exceptional consistency. This is the first study to systematically analyze the importance of harvesting variables using SHAP explainability, revealing that operational management decisions may yield greater returns than marginal environmental control investments. Our findings suggest that operational optimization may be more impactful than environmental fine-tuning in well-managed systems. Full article

This paper presents an experimental and computational investigation of novel, ejector-based, Coandă-surface-assisted tip leakage mitigation schemes. The predicted changes in the key performance metrics are presented after explaining the aerodynamic concept development for the novel tip geometries. The performance metrics are the stage total-to-total isentropic efficiency, tip-gap mass flow rate, and a figure of merit based on rotor exit total pressure. The schemes are based on direct geometric modifications to the turbine blade tip, effectively promoting an effective redirection of tip leakage fluid via specific channels. The proposed ejector channels operate in conjunction with strategically located Coandă surfaces to alter the path of the leakage fluid, promoting an effective leakage fluid delivery into the blade’s wake. Multiple schemes are assessed, including single-ejector, single-ejector with “hybrid” squealer, double-channeled, and triple-channeled designs. The designs are evaluated computationally for the HP stage of the Axial Flow Turbine Research Facility AFTRF at Penn State University. Extensive experimental validation of the baseline flow computations for the HP stage is also presented. Upper-bound efficiency gains of 0.49% and mass flow reductions of 14.80% compared to an untreated flat tip for the large-scale turbine test rig AFTRF are reported. Evaluation of the current tip designs in a high-speed turbine cascade environment with a transonic exit flow has also been completed. The detailed results from the high-speed investigation and heat transfer impact are in the process of being published. Implementation in the high-speed environment of the same design concepts also returned non-negligible performance gains. Full article

The design of the chemical structure of ion-conductive membranes is critical to enhance proton/vanadium ion selectivity and the performance of vanadium redox flow batteries (VRFBs). Herein, camphorsulfonic acid is proposed as a novel proton-conductive group and grafted on polybenzimidazole (PBICa). The pendant sulfonic acid group on the end of the grafted side chains is flexible to promote the aggregation of ionic clusters at even a relatively low ion-exchange capacity (IEC) of 2.14 mmol g⁻¹. The formation of these high-quality clusters underscores the remarkable efficacy of this structural strategy in driving nanoscale phase separation, which is a prerequisite for creating efficient proton-conducting pathways. The bulky and non-coplanar architecture of the camphorsulfonic acid group helps to increase the proportion of free volume compared with the conventional sulfonated polybenzimidazole, which not only promotes water uptake to facilitate proton transport but also exerts a sieving effect to effectively block vanadium ion permeation. The well-formed ionic clusters, together with the expanded free volume architecture, endow the membrane with both high proton conductivity (30.5 mS cm⁻¹) and low vanadium ion permeability (0.15 × 10⁻⁷ cm² s⁻¹), achieving excellent proton/vanadium ion selectivity of 9.85 × 10⁹ mS s cm⁻³, which is about 5.6-fold that of a Nafion 212 membrane. Operating at 200 mA cm⁻², the PBICa-based VRFB achieves an energy efficiency of 78.4% and a discharge capacity decay rate of 0.32% per cycle, outperforming the Nafion 212-based battery (EE of 76.9%, capacity decay of 0.79% per cycle). Full article