Search Results (2,633)

Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to surgical and percutaneous approaches, offering reduced morbidity and shorter recovery times. However, the effectiveness of EUS-guided drainage in post-surgical PPCs remains underexplored. Methods: This retrospective, single-center study evaluated the technical and clinical outcomes of EUS-guided drainage in patients with PPCs between October 2021 and December 2024. Patients were categorized as having post-pancreatitis or post-surgical PPCs. Technical success, clinical success, complications, recurrence rates, and the need for reintervention were assessed. Results: A total of 50 patients underwent EUS-guided drainage, including 42 (84%) with post-pancreatitis PPCs and 8 (16%) with post-surgical PPCs. The overall technical success rate was 100%, with clinical success achieved in 96% of cases. Lumen-apposing metal stents (LAMSs) were used in 84% of patients, including 7.1% as a dual-gate salvage strategy after the failure of double-pigtail drainage. The complication rate was 24%, with infection being the most common (16%). The recurrence rate was 25%, with no significant difference between post-pancreatitis and post-surgical cases. Patients with walled-off necrosis had a significantly higher reintervention rate (35%) than those with pseudocysts (18%; p = 0.042). Conclusions: EUS-guided drainage is a highly effective and safe intervention for PPCs, including complex post-surgical cases. The 100% technical success rate reinforces its reliability, even in anatomically altered post-surgical collections. While recurrence rates remain a consideration, EUS-guided drainage offers a minimally invasive alternative to surgery, with comparable outcomes in both post-pancreatitis and post-surgical patients. Future multi-center studies should focus on optimizing treatment strategies and reducing recurrence in high-risk populations. Full article

The accurate dosing of polyaluminum chloride (PAC) is essential for achieving effective coagulation in drinking water treatment, yet conventional methods such as jar tests are limited in their responsiveness and operational efficiency. This study proposes a hybrid modeling framework that integrates artificial neural networks (ANN) with genetic algorithms (GA) to optimize PAC dosage under variable raw water conditions. Operational data from 400 jar test experiments, collected between 2022 and 2024 at the Yanahurco water treatment plant (Ecuador), were used to train an ANN model capable of predicting six post-treatment water quality indicators, including turbidity, color, and pH. The ANN achieved excellent predictive accuracy (R² > 0.95 for turbidity and color), supporting its use as a surrogate model within a GA-based optimization scheme. The genetic algorithm evaluated dosage strategies by minimizing treatment costs while enforcing compliance with national water quality standards. The results revealed a bimodal dosing pattern, favoring low PAC dosages (~4 ppm) during routine conditions and higher dosages (~12 ppm) when influent quality declined. Optimization yielded a 49% reduction in median chemical costs and improved color compliance from 52% to 63%, while maintaining pH compliance above 97%. Turbidity remained a challenge under some conditions, indicating the potential benefit of complementary coagulants. The proposed ANN–GA approach offers a scalable and adaptive solution for enhancing chemical dosing efficiency in water treatment operations. Full article

Traffic accidents pose a significant threat to public safety, resulting in numerous fatalities, injuries, and a substantial economic burden each year. The development of predictive models capable of the real-time forecasting of post-accident impact using readily available data can play a crucial role in preventing adverse outcomes and enhancing overall safety. However, existing accident predictive models encounter two main challenges: first, a reliance on either costly or non-real-time data, and second, the absence of a comprehensive metric to measure post-accident impact accurately. To address these limitations, this study proposes a deep neural network model known as the cascade model. It leverages readily available real-world data from Los Angeles County to predict post-accident impacts. The model consists of two components: Long Short-Term Memory (LSTM) and a Convolutional Neural Network (CNN). The LSTM model captures temporal patterns, while the CNN extracts patterns from the sparse accident dataset. Furthermore, an external traffic congestion dataset is incorporated to derive a new feature called the “accident impact” factor, which quantifies the influence of an accident on surrounding traffic flow. Extensive experiments were conducted to demonstrate the effectiveness of the proposed hybrid machine learning method in predicting the post-accident impact compared to state-of-the-art baselines. The results reveal a higher precision in predicting minimal impacts (i.e., cases with no reported accidents) and a higher recall in predicting more significant impacts (i.e., cases with reported accidents). Full article

This review explores the advantages of ivabradine in the management of cardiac surgery patients, particularly highlighting its heart rate (HR)-reducing properties, its role in minimizing the impact of atrial fibrillation, and its contributions to improving left ventricular diastolic function, as well as reducing pain, stress, and anxiety. In parallel, studies provide evidence that ivabradine influences endothelial inflammatory responses through mechanisms such as biomechanical modulation. Unlike traditional beta-blockers that may induce hypotension, ivabradine selectively inhibits hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, allowing for effective HR reduction without compromising blood pressure stability. This characteristic is particularly beneficial for patients at risk of atrial fibrillation post-surgery, where HR control is crucial for cardiovascular stability. This is an area in which ivabradine appears to play a role prophylactically, possibly in combination with beta-blockers. Furthermore, ivabradine has been associated with enhanced diastolic parameters in left ventricular function, reflecting its potential to improve surgical outcomes in patients with compromised heart function. In addition to its cardiovascular benefits, it appears to alleviate psychological stress and anxiety, common in postoperative settings, by moderating the neuroendocrine response to stress, thereby reducing stress-induced hormone levels. Furthermore, it has notable analgesic properties, contributing to pain management through its action on HCN channels in both the peripheral and central nervous systems. Collectively, these findings indicate that ivabradine may serve as a valuable therapeutic agent in the perioperative care of cardiac surgery patients, addressing both physiological and psychological challenges during recovery. Full article

Castration remains a common surgical procedure in equids, yet postoperative complications such as hemorrhage, infection, and eventration persist, influencing surgical outcomes. This retrospective study introduced a novel modified semi-closed castration technique aimed at minimizing these complications. Eighty-five sexually intact mature male equids (including horses, ponies, and donkeys) underwent the described inguinal castration procedure under general anesthesia. The technique involved a carefully managed opening and subsequent secure closure of the parietal vaginal tunic, enabling direct inspection of tunic contents while reducing risks associated with fully open or closed approaches. The median surgery duration was 60 min (range, 45–95), with no intraoperative complications. Postoperatively, only two equids (2.35%) exhibited scrotal swelling, which was resolved rapidly with NSAIDs. No cases of hemorrhage, pyrexia, or infection occurred. Follow-up, conducted via owner interviews after a minimum of three months, confirmed complete recovery and primary intention healing in all patients, who returned to normal activity within two days post-surgery. Compared to previously documented complication rates ranging from 2% to 48%, the present approach demonstrates superior results. Additionally, this study proposes refining existing castration technique classifications, focusing explicitly on the vaginal tunic’s status post-procedure (open, semi-closed, closed) for clarity and consistency. This novel semi-closed inguinal technique effectively integrates inspection advantages with closed technique safety, offering significantly reduced complication rates and enhanced postoperative recovery profiles in equids undergoing castration. Full article

Objectives: Nasal reconstructive surgery following skin cancer resection is challenging, with esthetic concerns impacting patients’ quality of life. Non-surgical rhinoplasty may be an alternative to repeated surgeries. This study aimed to evaluate non-surgical rhinoplasty esthetic benefits and subjective patient outcomes after skin cancer resection. Methods: We conducted a retrospective study on patients with post-operative esthetic dissatisfaction after nasal skin cancer surgery, who underwent non-surgical rhinoplasty with hyaluronic acid. Subjective benefits were evaluated with the FACE-Q Rhinoplasty self-questionnaire at three consultations: before injection (baseline), and at one and two months after. Two-dimensional and three-dimensional Vectra H2 photographs were used to assess subjective esthetic concerns and objective volumetric changes. Results: The study included six female patients with an average age of 58.3 years. They had undergone, on average, five nasal surgeries for cancer. The mean FACE-Q scores were 53.3 (±10.31), 77.5 (±4.18), and 79.7 (±6.76), respectively, at baseline, one month, and two months. Significant differences were observed between baseline and one month (p < 0.001) and between baseline and two months (p < 0.001), but not between one and two months. The was a mean volumetric gain of 1.13 mL at one month and 1.19 mL at two months. Conclusions: This preliminary study suggested that hyaluronic acid-based non-surgical rhinoplasty could improve esthetic outcomes and quality of life in patients who had undergone nasal skin cancer surgery. These findings highlight a potential role for this minimally invasive technique in selected post-reconstructive cases, although the small sample size limited the generalizability of the results and underlined the need for further prospective evaluation. Full article

High-Intensity Focused Ultrasound (HIFU) is a non-invasive technology widely used in aesthetic dermatology for skin tightening and facial rejuvenation. This study aimed to evaluate the safety and efficacy of a modified HIFU device, More Young, compared to the standard 7D HIFU system through a randomized, single-blinded clinical trial. The More Young device features enhanced focal depth precision and energy delivery algorithms, including nine pre-programmed stabilization checkpoints to minimize treatment risks. A total of 100 participants with facial wrinkles and skin laxity were randomly assigned to receive either More Young or 7D HIFU treatment. Skin improvements were assessed at baseline and one to six months post-treatment using the VISIA^® Skin Analysis System (7th Generation), focusing on eight key parameters. Patient satisfaction was evaluated through the Global Aesthetic Improvement Scale (GAIS). Data were analyzed using paired and independent t-tests, with effect sizes measured via Cohen’s d. Both groups showed significant post-treatment improvements; however, the More Young group demonstrated superior outcomes in wrinkle reduction, skin tightening, and texture enhancement, along with higher satisfaction and fewer adverse effects. No significant differences were observed in five of the eight skin parameters. Limitations include the absence of a placebo group, limited sample diversity, and short follow-up duration. Further studies are needed to validate long-term outcomes and assess performance across varied demographics and skin types. Full article

Background/Objectives: The novel compound 221s (2,9), derived from danshensu and ACEI-active proline, exhibits antihypertensive effects (50/35 mmHg SBP/DBP reduction in SHRs) with potential cough mitigation. However, its excretion kinetics remain unstudied. This study investigates 221s (2,9) elimination in rats to bridge this knowledge gap. Methods: Excretion of unchanged 221s (2,9) was quantified in urine, feces, and bile of Sprague-Dawley rats after oral administration (30 mg/kg). Concentrations of unchanged 221s (2,9) in all matrices were quantified using developed UPLC-MS/MS that underwent methodological validation. Excretion amount, excretion velocity, and accumulative excretion rate of 221s (2,9) were calculated. Results: Urinary excretion exhibited rapid elimination kinetics, reaching peak cumulative excretion rates (138.81 ± 15.56 ng/h) at 8 h post-dosing and plateauing by 48 h (cumulative excretion: 1479.81 ± 155.7 ng). Fecal excretion displayed an accelerated elimination phase between 4 and 8 h (excretion rate: 7994.29 ± 953.75 ng/h), followed by a sustained slow-release phase, culminating in a cumulative output of 36,726.31 ± 5507 ng at 48 h. Biliary excretion was minimal and ceased entirely by 24 h. Notably, total recovery of unchanged drug across all matrices remained below 1% (urine: 0.020 ± 0.021%; feces: 0.73 ± 0.069%; bile: 0.00044 ± 0.00002%) at 72 h. Conclusions: This study provides the first definitive excretion data for 221s (2,9). Quantitative analysis via a validated UPLC-MS/MS method revealed that fecal excretion is the principal elimination pathway for unchanged 221s (2,9) in rats, with direct excretion of the parent compound accounting for <1% of the administered dose over 72 h. Future studies will employ extended pharmacokinetic monitoring and concurrent UPLC-MS/MS analysis of the parent drug and phase II conjugates to resolve the observed mass imbalance and elucidate contributions to total elimination. Full article

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Total knee arthroplasty is an extensive orthopedic surgery for patients with severe cases of osteoarthritis. This surgery restores the range of motion in the knee joint and allows for pain-free movement. Advancements in medical techniques used in the surgical zone and implant technology, as well as the management of operations and administration for around two decades prior, have hugely improved surgical outcomes for patients. In this study, advancements in TKA were examined through exploring aspects such as robotic surgery, new implants and materials, minimally invasive surgery, and post-surgery rehabilitation. This paper entails a review of the peer-reviewed literature published between 2005 and 2025 in the PubMed and Google Scholar databases. For predictors, we incorporated clinical relevance together with methodological soundness and relation to review questions to select relevant research articles. We used the PRISMA flowchart to illustrate the article selection system in its entirety. Since robotic surgical and navigation systems have been implemented, surgical accuracy has improved, there is an increased possibility of ensuring alignment, and the use of cementless and 3D-printed implants has increased, offering durable long-term fixation features. The trend in the current literature is that minimally invasive knee surgery (MIS) techniques reduce permanent pain after surgery and length of hospital stays for patients, though the long-term impact still needs to be established. There is various evidence outlining that the enhanced recovery after surgery (ERAS) protocols show positive results in terms of functional recovery and patient satisfaction. The integration of these new advancements enhances TKA surgeries and translates them into ‘need of patient’ procedures, ensuring improved results and increases in patient satisfaction. The aim of this study was to perform a comprehensive analysis of the existing literature regarding TKA advancement studies to identify current gaps and problems. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Background and Objectives: In recent years, there has been growing interest in the production of ingredients rich in dietary fiber and antioxidants, such as green banana flours. This study evaluated the effect of consumption of mixed green banana pulp (PF) and peel (PeF) flours on the body weight gain, adiposity, lipid profile, and intestinal morphology of Wistar rats. Methods: Male young rats were divided into four groups (n = 8) that received a standard diet (SD), or one of the following three test diets: M1 (SD + 90% PF/10% PeF), M2 (SD + 80% PF/20% PeF), or P (SD + 100% PF) for 28 days. Results: Rats from M1, M2, and P groups showed reduced body weight gain and adiposity and had lower contents of total cholesterol, LDL-c, VLDL-c, and triglycerides. Animals from M1 and M2 groups had an increase in cecum weight, fecal moisture, acetic acid concentration, and crypt depth and reduced fecal pH. Moreover, consumption of the M1, M2, and P diets increased the expression of proteins involved in intestinal functionality. Significant negative correlations were observed between consumption of resistant starch and soluble dietary fiber, from the flours, and weight gain (r = −0.538 and r = −0.538, respectively), body adiposity (r = −0.780 and r = −0.767, respectively), total cholesterol (r = −0.789 and r = −0.800, respectively), and triglycerides (r = −0.790 and r = −0.786, respectively). Conclusions: Mixed green banana pulp and peel flour proved to be a viable alternative as a food ingredient that can promote weight loss, improve lipid profile and intestinal morphology, and minimize post-harvest losses. Full article

This study proposes a laser texturing method to optimize adhesion and minimize residual stresses in CVD diamond films deposited on tungsten carbide (WC-Co). WC-5.8 wt% Co substrates were textured with quadrangular pyramidal patterns (35 µm) using a 1064 nm nanosecond-pulsed laser, followed by chemical treatment (Murakami’s solution + aqua regia) to remove surface cobalt. Diamond films were grown via HFCVD and characterized by Raman spectroscopy, EDS, and Rockwell indentation. The results demonstrate that pyramidal texturing increased the surface area by a factor of 58, promoting effective mechanical interlocking and reducing compressive stresses to −1.4 GPa. Indentation tests revealed suppression of interfacial cracks, with propagation paths deflected toward textured regions. The pyramidal geometry exhibited superior cutting post-deposition cooling time for stress relief from 3 to 1 h. These findings highlight the potential of laser texturing for high-performance machining tool applications. Full article

Background: Emotional safety is increasingly recognized as crucial for high-quality patient care, encompassing a patient’s sense of security, courteous treatment, being heard, and a peaceful environment. Purpose: The purpose of this study was to explore the perceptions of patients and providers (doctors and nurses) regarding emotional harm and safety in relation to hospitalized patients. Methods: We conducted a qualitative study in public-sector teaching hospitals in Peshawar, Pakistan. Data were collected after we obtained informed consent using individual interviews with 15 providers, namely, doctors (n = 7) and nurses (n = 8), and five focus group discussions (FGDs) with 25 hospitalized patients. Data from both the interviews and FGDs were analyzed using Braun and Clarke’s six-phase approach to thematic analysis. Results: The key themes revealed by the providers’ perspectives were factors contributing to emotional harm, staff-related factors, coping mechanisms and solutions, and the impact of prior experiences and involvement. The main themes that emerged from the patients’ perspectives were anxiety upon admission, the impact of communication, emotional stress due to treatment delays, systemic/bureaucratic challenges, financial burden, a lack of emotional support, and post-hospitalization concerns. The consistent perspectives shared by both patients and providers included the impact of systemic factors, communication issues, the role of staff attitude/behavior, financial concerns, and the influence of prior experiences. Conclusions: This study highlights the complex interplay of systemic, staff-related, and patient-specific factors. It suggests a need to improve communication, staff support, administrative processes, financial counseling, emotional support integration, and discharge planning to minimize harm and create a patient-centered environment. Full article

Magnetic nanoparticles (MNPs), especially iron oxide (Fe₃O₄), display distinctive superparamagnetic characteristics and elevated surface-area-to-volume ratios, facilitating improved physicochemical interactions with solutes and pollutants. These characteristics make MNPs strong contenders for use in water treatment applications. This research investigates the application of iron oxide MNPs synthesized via co-precipitation as innovative draw solutes in forward osmosis (FO) for treating synthetic produced water (SPW). The FO membrane underwent surface modification with sulfobetaine methacrylate (SBMA), a zwitterionic polymer, to increase hydrophilicity, minimize fouling, and elevate water flux. The SBMA functional groups aid in electrostatic repulsion of organic and inorganic contaminants, simultaneously encouraging robust hydration layers that improve water permeability. This adjustment is vital for sustaining consistent flux performance while functioning with MNP-based draw solutions. Material analysis through thermogravimetric analysis (TGA), scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy (FTIR) verified the MNPs’ thermal stability, consistent morphology, and modified surface chemistry. The FO experiments showed a distinct relationship between MNP concentration and osmotic efficiency. At an MNP dosage of 10 g/L, the peak real-time flux was observed at around 3.5–4.0 L/m²·h. After magnetic regeneration, 7.8 g of retrieved MNPs generated a steady flow of ~2.8 L/m²·h, whereas a subsequent regeneration (4.06 g) resulted in ~1.5 L/m²·h, demonstrating partial preservation of osmotic driving capability. Post-FO draw solutions, after filtration, exhibited total dissolved solids (TDS) measurements that varied from 2.5 mg/L (0 g/L MNP) to 227.1 mg/L (10 g/L MNP), further validating the effective dispersion and solute contribution of MNPs. The TDS of regenerated MNP solutions stayed similar to that of their fresh versions, indicating minimal loss of solute activity during the recycling process. The combined synergistic application of SBMA-modified FO membranes and regenerable MNP draw solutes showcases an effective and sustainable method for treating produced water, providing excellent water recovery, consistent operational stability, and opportunities for cyclic reuse. Full article