Search Results (11,046)

Background/Objectives: Studies have demonstrated significant morbidity and mortality associated with airway management, especially when provided outside of the operative setting. The goal of this study was to compare baseline measurements of airway management procedures between anesthesia providers (CRNAs and anesthesiologists) and respiratory therapists using high-fidelity manikins. Methods: This prospective study assessed anesthesia providers and respiratory therapists performing direct laryngoscopy (DL), video laryngoscopy (VL), and LMA placement. The same Laerdal SimMan high-fidelity manikin (Laerdal, Stavanger, Norway) was used in all assessments, with the detection of end-tidal “carbon dioxide” serving as evidence of success for each procedure. Each procedure was performed twice, once under “Healthy Patient” SimMan settings, and once under the “Limited Cervical Range of Motion (ROM)” (DL), “Pharyngeal Obstruction” (VL), and “Full Tongue Edema” (LMA) settings, respectively, to simulate a moderately difficult airway. The order in which the techniques were performed was randomized for each participant. Completion time and number of attempts were recorded for each procedure and compared between the groups. Results: Sixty-two providers (30 anesthesia providers and 32 respiratory therapists) were enrolled. There were no significant differences in average time to completion for any procedure, except respiratory therapists took longer than anesthesia providers in VL with simulated pharyngeal obstruction (p = 0.0004). There were no differences in number of attempts needed for successful completion. Conclusions: This study demonstrates that while completion times for DL and LMA placement were similar amongst provider groups, average time to completion of VL for respiratory therapists was longer under difficult simulated settings. These results reflect potential areas of improvement for other provider groups that may have airway privileges at their respective institutions. Full article

Background: Transjugular intrahepatic portosystemic shunt (TIPS) has emerged as a feasible therapeutic option for cirrhotic patients with portal vein thrombosis (PVT). This study aimed to assess the long-term outcomes and factors associated with TIPS dysfunction in cirrhotic patients with PVT over an 18-year period in our institution. Methods: A retrospective study was conducted at Hospital Universitario Reina Sofía (Córdoba, Spain), including adult and pediatric cirrhotic patients with PVT who underwent TIPS between January 2006 and December 2024. Patient characteristics, procedural techniques, and clinical outcomes were evaluated. The primary outcomes were TIPS insertion success rate, primary patency, and dysfunction (stenosis or occlusion). Bivariate comparisons, logistic regression and receiver-operating characteristic (ROC) analyses were performed to identify potential predictors of TIPS dysfunction. Survival analyses using the Kaplan–Meier method and log-rank test, complemented by Cox regression, were also conducted. Results: A total of 36 patients (mean age, 44.8 ± 20.1 years old; 22.2% women; 19.4% children) were included, with a mean follow-up of 66.3 ± 45.9 months and nine deaths (one attributable to the procedure). The primary success rate of TIPS placement was 100%, and mean primary patency was 40.3 ± 40.2 months. TIPS dysfunction occurred in 30.3% of patients. Logistic regression identified age as the only significant predictor of TIPS dysfunction (OR = 0.949; 95%CI, 0.907–0.985, p = 0.011). ROC analysis demonstrated an AUC of 0.737 (95%CI, 0.547–0.927), with an optimal age cut-off of 21 (equivalent to 18 years; sensitivity = 91.3%, specificity = 50%). When age was dichotomized into adult versus pediatric groups, the OR was 0.095 (95%CI, 0.011–0.560), consistent with survival analyses (log-rank p = 0.007; HR = 4.85; 95%CI 1.36–16.88, p = 0.015). Conclusions: TIPS is an effective treatment for cirrhotic patients with PVT, achieving high technical success and long-term patency. However, it is not exempt from complications, including death, and potential dysfunction remains a concern, particularly in pediatric patients. Further prospective studies with larger cohorts are warranted to refine patient selection and optimize outcomes. Full article

Introduction: The objective of this study was to analyze and compare the outcomes of two surgical techniques in the emergency management of obstructed colorectal carcinoma. Methods: This is a retrospective analysis of patients’ data from a tertiary referral university hospital. The medical records of patients who underwent emergency surgery for obstructed colorectal cancer between May 2014 and August 2019 were evaluated. The cases were divided primarily into two groups: Primary Resection and Anastomosis (PRA) and Hartmann’s Procedure (HP). The clinical characteristics, peri-operative outcomes and oncological results including early postoperative complications, morbidity and mortality (30-day, 1-year and 5-year survival) were compared between groups. Results: In this retrospective study, 110 patients with obstructing colorectal cancer undergoing emergency surgery were analyzed. Patients were divided into two groups: 65 cases of Primary Resection and Anastomosis (PRA) and 45 cases of Hartmann’s Procedure (HP). PRA patients had significantly shorter hospital stays (8.7 ± 4.1 vs. 11.2 ± 5.2 days, p = 0.02), lower complication rates (33% vs. 66%, p = 0.003), and superior survival outcomes, with a 5-year survival rate of 33.8% compared to 22.2% in the HP group (p = 0.003). Subgroup analysis revealed significant differences, including higher complication rates and repeat surgery requirements in patients with a diverting ostomy or undergoing resection without anastomosis. Conclusion: PRA demonstrated favorable perioperative and long-term outcomes compared to HP in the emergency management of obstructing colorectal cancer. These findings highlight the potential benefits of avoiding permanent stoma formation when appropriate patient selection criteria are met. Full article

Objectives: This study investigates the effectiveness of dexamethasone when utilized as an adjunct agent in enhancing the outcomes of a pericapsular nerve group (PENG) block compared to its systemic administration for managing pain in patients having surgery for femoral fractures. Methods: This study enrolled 44 patients who received a PENG block following spinal anesthesia. Two groups were formed by stratifying the patients, involving those in whom dexamethasone was received through perineural administration (Group P, n = 22) and those in whom it was received through systemic administration (Group S, n = 22). Information concerning the demographic features of the patients, along with operative and postoperative details, was meticulously documented for analysis. The patients’ pain levels were recorded using the numerical rating scale (NRS) at multiple time points. Results: In the perineural dexamethasone group, the length of time of sensory and motor blockade and the time elapsed until the initial analgesic requirement were longer (p < 0.001). The consumption of tramadol and the pain scores measured were noted to be decreased. (p < 0.001). There were no notable distinctions regarding patient mobilization or the length of inpatient stay. Conclusions: The perineural administration of dexamethasone in PENG block procedures may provide more effective analgesia for surgeries involving femoral neck fractures. By minimizing the use of systemic opioids, it may also help mitigate potential side effects. These findings indicate that perineural dexamethasone could serve as a beneficial adjuvant agent for patients undergoing femoral neck fracture surgeries. Full article

Background/Objectives: The external validity of sarcopenia screening questionnaires in the elderly has been examined in several conditions but rarely evaluated in patients with rheumatoid arthritis (RA). This study aimed to determine the performance of five Thai versions of sarcopenia screening questionnaires (SARC-F [Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls], SARC-CalF [SARC-F plus calf circumference], MSRA [Mini Sarcopenia Risk Assessment]-7, MSRA-5, and modified MSRA-5 questionnaires) in Thai RA patients, and evaluate the correlations among these instruments. Methods: In this cross-sectional study, consecutive adult RA patients (aged ≥20 years) from an outpatient rheumatology clinic completed the five sarcopenia screening questionnaires listed above. Sarcopenia was defined according to criteria of the 2019 Asian Working Group for Sarcopenia (AWGS). Appendicular skeletal muscle mass, grip strength, and physical performance were assessed using bioelectrical impedance analysis, a hand dynamometer, and a 6 m gait speed test, respectively. The cut-off values used for each sarcopenia screening questionnaire were pre-specified according to their respective established thresholds. Results: Of 299 RA patients (89.0% female, mean age of 61.3 ± 11.6 years, median [interquartile range] disease duration of 12.8 [8.2, 20.0] years), 37.5% and 27.4% of them had sarcopenia and severe sarcopenia, respectively. The areas under the receiver operating characteristic (ROC) curve for the SARC-F, SARC-CalF, MSRA-7, MSRA-5, and modified MSRA-5 questionnaires were 0.60, 0.74, 0.65, 0.62, and 0.65, respectively, with sensitivities of 34.8%, 73.2%, 77.7%, 68.8%, and 72.3% and specificities of 84.5%, 75.4%, 51.3%, 55.1%, and 58.3%, respectively. SARC-F demonstrated moderate correlations with the other questionnaires: SARC-CalF (r = 0.57), MSRA-7 (r = −0.52), MSRA-5 (r = −0.55), and modified MSRA-5 (r = −0.65), all with a p-value of <0.001. Conclusions: Sarcopenia is common among Thai RA patients. SARC-CalF had the best balance of sensitivity and specificity and is likely the most suitable sarcopenia screening questionnaire for Thai RA patients. Full article

Road-marking operations generate alkaline wash water with intense color and soluble cationic additives. A new biomass adsorption material (LML) was developed to address dye pollution in road-marking wash water effectively. Enzymatically hydrolyzed lignin was used as the raw material for the first time. L-lysine was modified to the structure of the lignin benzene ring using a simple one-step synthesis method, which endowed lignin with a large number of active carboxyl and amino functional groups to improve its adsorption capacity. The adsorption performance of LML for methylene blue in water was also investigated. The experimental results show that the LML has a high dye removal rate under alkaline conditions. The fitted adsorption model shows that the saturated adsorption capacity of LML for methylene blue (MB) is 129.4 mg g⁻¹ and malachite green (MG) is 244.9 mg g⁻¹, which is in line with the Langmuir isotherm adsorption model. The adsorption process is endothermic, which means that the adsorption capacity increases with increasing temperature. Kinetic studies showed that the adsorption process reached equilibrium within 120 min following a pseudo-second-order kinetic model. The cycle experiment shows that the removal efficiency of the adsorbent for dyes can still reach 90% after five cycles, indicating a good practical application value for the polishing of road-marking wash water. Full article

The high cost of wind turbine maintenance has intensified the need for reliable fault detection and condition monitoring methods. While Supervisory Control and Data Acquisition (SCADA) systems provide valuable operational data, the raw signals often contain noise, outliers, and missing or redundant entries, which can compromise analysis accuracy. This study presents a novel cluster-based outlier removal approach for SCADA data preprocessing, featuring a unique flexibility to include or exclude negative power values—a factor rarely investigated but potentially critical for fault detection performance. The method applies the K-Means++ unsupervised clustering algorithm to group data points along the wind speed–power curve. The number of clusters is determined heuristically using the elbow method, while outliers are identified through Mahalanobis distance with thresholds derived from Chebyshev’s inequality theorem. The approach was validated using SCADA data from a wind farm in Portugal and further assessed with a CUSUM test-based structural change detection method to study how preprocessing choices—outlier thresholds (5% vs. 1%) and inclusion/exclusion of negative power values—affect early fault identification. Results demonstrate reliable fault detection up to 14 days before failure, retaining over 99% of the original dataset. This work provides key insights into preprocessing impacts on model reliability and offers an open-source Python implementation for reproducibility. Full article

Background/Objectives: To investigate the role of hepatobiliary phase (HBP) signal intensity (SI) on Gadoxetic acid (GA)-enhanced liver magnetic resonance imaging (MRI) in improving the diagnostic accuracy of the histological grade of fibrosis in patients with chronic hepatitis B (CHB). Methods: This retrospective study enrolled patients with CHB who underwent biopsies from the highest and lowest intensity areas identified on HBP images obtained from GA-enhanced MRI. The patients were divided into two groups based on segmental SIs: Group 1 (maximum SI) and Group 2 (minimum SI). An ultrasound-guided tru-cut biopsy was performed in these two segments. Forty patients undergoing histopathological examination were included in the study. Group comparisons were examined using Chi-square and independent-sample t-tests, and receiver operating characteristic curve analysis (ROC) was performed to determine the cutoff values of the SI for modified histologic activity index (mHAI) and fibrosis grading. Results: There were no histopathological differences between the groups (p > 0.05), but significant inflammation and fibrosis were observed in hepatic segments with an SI value of <617 (p < 0.001). The ROC results showed that the predictive cutoff value of SI for mHAI and fibrosis grading were 606 (AUC: 0.83, 95% CI 0.737–0.921, p < 0.001) and 599 (AUC: 0.85, 95% CI 0.766–0.935, p < 0.001), respectively. Conclusions: In patients with CHB, performing a biopsy from the liver segment with the lowest SI on GA-enhanced MRI increases the diagnostic accuracy for assessing the histological severity of hepatic inflammation and fibrosis. Full article

The rapid expansion of satellite networks for advanced communication and space exploration has ensured that robust cybersecurity for inter-satellite links has become a critical challenge. Traditional security models rely on centralized trust authorities, and node-specific protections are no longer sufficient, particularly when system failures or attacks affect groups of satellites or agent clusters. To address this problem, we propose a blockchain-enabled decentralized zero-trust model based on post-quantum cryptography (BEDZTM-PQC) to improve the security of satellite communications via continuous authentication and anomaly detection. This model introduces a group-based security framework, where satellite teams operate under a zero-trust architecture (ZTA) enforced by blockchain smart contracts and threshold cryptographic mechanisms. Each group shares the responsibility for local anomaly detection and policy enforcement while maintaining decentralized coordination through hierarchical federated learning, allowing for collaborative model training without centralizing sensitive telemetry data. A post-quantum cryptography (PQC) algorithm is employed for future-proof communication and authentication protocols against quantum computing threats. Furthermore, the system enhances network reliability by incorporating redundant communication channels, consensus-based anomaly validation, and group trust scoring, thus eliminating single points of failure at both the node and team levels. The proposed BEDZTM-PQC is implemented in MATLAB, and its performance is evaluated using key metrics, including accuracy, latency, security robustness, trust management, anomaly detection accuracy, performance scalability, and security rate with respect to different numbers of input satellite users. Full article

Sediment plumes threatening benthic ecosystems are one of the environmental hazards associated with seafloor interventions such as bottom trawling, cabling, dredging, and marine mining operations. This study focuses on sediment plume release from hypothetical future deep-sea mining activities, emphasizing its interaction with turbulent ocean currents in regions characterized by complex seafloor topography. In such environments, turbulent lee waves may significantly enhance the scattering of released sediments, pointing to the clear need for appropriate impact assessment frameworks. Global-scale models are limited in their ability to resolve sufficiently high Reynolds numbers to accurately represent turbulence generated by seafloor topography. To overcome these limitations and effectively assess lee wave dynamics, models must incorporate the full physics of turbulence without simplifying the Navier–Stokes equations and must operate with significantly finer spatial discretization while maintaining a domain large enough to capture the full topographic signal. Considering a seamount in the Lofoten Basin of the Norwegian Sea as an example, we present a novel numerical analysis that explores the interplay between lee wave turbulence and sediment plume dispersion using a high-resolution Large Eddy Simulation (LES) framework. We show that the turbulence occurs within semi-horizontal channels that emerge beyond the topographic highs and extend into sheet-like tails close to the seafloor. In scenarios simulating sediment release from various sites on the seamount, our model predicts distinct behavior patterns for different particle sizes. Particles with larger settling velocities tend to deposit onto the seafloor within 50–200 m of release sites. Conversely, particles with lower settling velocities are more susceptible to turbulent transport, potentially traveling greater distances while experiencing faster dilution. Based on our scenarios, we estimate that the plume concentration may dilute below 1 ppm at about 2 km distance from the release site. Although our analysis shows that mixing with ambient seawater results in rapid dilution to low concentrations, it appears crucial to account for the effects of topographic lee wave turbulence in impact assessments related to man-made sediment plumes. Our high-resolution numerical simulations enable the identification of sediment particle size groups that are most likely affected by turbulence, providing valuable insights for developing targeted mitigation strategies. Full article

Background/Objectives: Pressure injuries (PIs) are an increasing public health concern, particularly affecting hospitalised patients with limited mobility and chronic illnesses, such as those undergoing cardiac surgery. The EuroSCORE II index, a validated model for predicting operative risk in cardiac surgery, can serve as an accurate PI risk assessment tool for cardiac surgery patients. Methods: A cross-sectional study was conducted on patients undergoing cardiac surgery over a six-month period. The sample consisted of patients selected according to the calculated EuroSCORE II index and admitted for elective surgical procedures. The Braden Scale was used for the standard preoperative and postoperative PI risk assessment. Categorical variables are shown as frequencies with corresponding percentages. Continuous variables are presented as median and interquartile range. Group differences in continuous variables according to EuroSCORE II were analysed using the Mann–Whitney U test, with the Hodges–Lehmann estimator of the median difference and the corresponding 95% confidence interval. Results: The assessment showed that patients with a medium and high EuroSCORE II index (>4.0) were significantly older (M = 73; IQR: 68–77), with a higher preoperative Braden score (M = 20; IQR: 17–21), longer intraoperative total time (M = 6; IQR: 5–7) and overall longer duration of hospitalisation (M = 14; IQR: 10–21). A statistically significant difference (p = 0.043) was observed in the occurrence of PI after the procedure. Within the group of patients with a medium/high EuroSCORE II index, the recorded frequency of PI after the procedure was 30.8%, compared to the group of patients with a low EuroSCORE II index, among whom the observed frequency was 17.6%. Conclusions: The findings of this study show that a higher EuroSCORE II index is significantly associated with an increased risk and incidence of PI in patients undergoing cardiac surgery, highlighting its potential use as a predictive tool for postoperative PI risk stratification. Full article

Safety and security are major priorities in modern society. Especially for vulnerable groups of individuals, such as the elderly and patients with disabilities, providing a safe environment and adequate alerting for debilitating events and situations can be critical. Wearable devices can be effective but require frequent maintenance and can be obstructive or stigmatizing. Video monitoring by trained operators solves those issues but requires human resources, time and attention and may present certain privacy issues. We propose optical flow-based automated approaches for a multitude of situation awareness and event alerting challenges. The core of our method is an algorithm providing the reconstruction of global movement parameters from video sequences. This way, the computationally most intensive task is performed once and the output is dispatched to a variety of modules dedicated to detecting adverse events such as convulsive seizures, falls, apnea and signs of possible post-seizure arrests. The software modules can operate separately or in parallel as required. Our results show that the optical flow-based detectors provide robust performance and are suitable for real-time alerting systems. In addition, the optical flow reconstruction is applicable to real-time tracking and stabilizing video sequences. The proposed system is already functional and undergoes field trials for cases of epileptic patients. Full article

Background/Objectives: The Glutamate Chemical Exchange Saturation Transfer (GluCEST) technique is an advanced imaging modality that enables non-invasive glutamate quantification using MRI. Methods: This study evaluated glutamate dynamics in Parkinson’s disease (PD) using a unilateral PD rat model, in which Wistar rats received 6-hydroxydopamine (6-OHDA) injections into the medial forebrain bundle, selectively eliminating dopaminergic neurons in the substantia nigra–striatum pathway. Results: The PD rat model exhibited a significant GluCEST increase (MTR Values: 3.0 ppm) compared to the sham-operated group, which was suppressed by administration of L-DOPA, a dopamine precursor drug (Sham: 0.9 ± 0.4%, PD: 2.0 ± 0.2%, Sham L-DOPA: 0.9 ± 0.5%, PD_L-DOPA: 0.8 ± 0.7%, p < 0.01). Additionally, magnetic resonance spectroscopy-derived glutamate data were consistent with GluCEST findings (Sham: 1.4 ± 0.03, PD: 1.7 ± 0.06, Sham_L-DOPA: 1.4 ± 0.12, PD_L-DOPA: 1.4 ± 0.10, p < 0.01). Conclusions: These findings suggest that GluCEST and magnetic resonance spectroscopy are valuable for assessing abnormal glutamate dynamics in the 6-OHDA-induced rat PD model. Furthermore, GluCEST may detect suppressed glutamate secretion following L-DOPA treatment, underscoring its potential for monitoring disease progression and therapeutic responses in PD. Full article

This study investigated how banks’ balance sheet fundamentals shape their credit growth using panel co-integration methods and two estimation methods—pooled mean group (PMG) and dynamic fixed effects (DFE). Both approaches yielded consistent core results. First, weaker asset quality, proxied by higher non-performing loans (NPLs), was strongly and negatively related to credit growth: PMG produced a large negative long-run coefficient, and DFE’s error-correction form confirmed a significant adverse effect, consistent with higher provisioning, thinner capital buffers, and lower risk-taking. Second, capitalization (equity to assets) supported long-run growth under PMG, while DFE—imposing common slopes—did not, suggesting heterogeneous capitalization effects across banks that PMG captured but DFE muted. Third, operating expense intensity showed a positive long-run association with credit growth in both models, consistent with expansionary spending accompanying durable lending rather than costs causing lending. Long-run effects for liquidity and market-risk sensitivity were weaker or mixed: liquidity’s role was imprecise, and market-risk sensitivity was positive in PMG but not significant in DFE, again pointing to cross-sectional heterogeneity. Error-correction terms were large, negative, and highly significant in both models, indicating rapid convergence—near full adjustment within one period, with slight overshooting in DFE. Short-run results showed that higher liquidity and temporary cost spikes dampened contemporaneous growth. Policy implications emphasize sustained oversight of asset quality and prudent capital planning to support long-run credit supply. Full article

Fungal endophytes can be identified in a wide range of plant species which help to protect from both abiotic and biotic stressors. This research focused on using high-throughput sequencing (HTS) analysis to gain insight into the foliar endophytic fungal diversity between Morinda tinctoria and Pithecellobium dulce. The study obtained a total of 118,547 sequencing reads, which were grouped into 266 Operational Taxonomic Units (OTUs) with a 97% similarity threshold. M. tinctoria had more OTUs than P. dulce. Alpha diversity results show that both plant species support varied microbial communities with similar but distinct biodiversity profiles. The Shannon index revealed that M. tinctoria had considerably more fungal diversity than P. dulce. The correlation matrix and PCoA depicts the pairwise correlations between several soil metrics such as the total nitrogen level, entire phosphorus, overall potassium, and the electrical conductivity, total carbon from organic matter, pH levels, manganese, iron, zinc, copper, and boron. The OTUs were classified into 5 phyla, 18 classes, 40 orders, 70 families, and 36 genera, where the phylum Ascomycota has a relative abundance of (50–55%), followed by Basidiomycota at (55–60%). The most abundant genera were Wallemia (30–35%), Saitozyma (30–40%), and Talaromyces (20–25%), with average relative abundances. Unassigned genera show a significant proportion of fungal taxa that are still taxonomically unclear. A comparative analysis has been performed between the two plants, M. tinctoria has a higher fungal diversity, which is frequently associated with increased ecological stability, disease resistance, and better functional relationships with the host plant. Full article