Search Results (6,630)

Background: Preventing postoperative infections in hand surgery is an important factor for achieving sustainable results of surgical procedures. To prevent infections, especially when implants are used, preoperative prophylactic antibiotics are applied in adherence to predominantly national guidelines, which are not specifically tailored to hand surgery. However, several studies related to elective soft tissue hand surgery indicate that the preoperative use of antibiotics does not reduce the incidence of postoperative infections. Evidence regarding their efficacy in osteosynthesis of the hand and wrist remains limited. Methods: In this retrospective study, we analyzed 542 adult patients who underwent hand or wrist osteosynthesis between 2016 and 2019 at our university center. They were enrolled in an antibiotic treatment group and a control group without antibiotic treatment. The prophylaxis group (P) underwent surgery in the main operating theater under intravenous anesthesia, whereas the non-prophylaxis group (NP) was treated under WALANT (Wide Awake Local Anesthetic No Tourniquet) in an outpatient operating theater without receiving preoperative antibiotics. Theater construction and installation were otherwise similar, and both were classified as grade 1 theaters. We applied propensity modeling and inverse probability of treatment weighting (IPTW) to achieve balanced treatment groups with respect to risk factors for infection, and we calculated the odds ratio of prophylaxis and infection. Inclusion factors for risk of infection were age, female sex, smoking, diabetes, metabolic disease, inflammatory disease, substance abuse, cardiovascular disease, hepatopathy, renal disease, polytrauma, open fracture, being a manual worker, and occupational accidents. To assess the severity of the cases, we considered whether the fractures were intraarticular, multi-fragmentary, or open, and we collected data on the types of surgical implants that were used. Results: No significant association was found between antibiotic prophylaxis and postoperative infection rate (infection rate P: 3.86%; NP: 3.27%; unadjusted OR: 1.19; adjusted OR after IPTW: 1.09). In terms of risk factors, there was an insignificant trend of higher infection rates in the subgroups smoking, cardiovascular disease, open fracture, occupational accident, and open fixations. Conclusions: In this cohort, routine use of preoperative antibiotics in hand osteosynthesis did not reduce infection rates. The effectiveness of the widespread standardized application of prophylactic antibiotics to reduce the risk of postoperative infections in osteosynthesis of the hand and wrist remains debatable. Our findings set the basis for further prospective studies aiming at clearer guidelines for evidence-based perioperative patient care. Full article

Background/Objectives: The increasing adoption of laparoscopic liver resection (LLR) and changes in clinical management may influence access to curative treatments for patients on the liver transplant waiting list. We aimed to analyze temporal trends in LLR use and to explore the association between the proportion of LLR and the dropout rate from the intention-to-treat (ITT) population. A secondary objective was to assess the risk of dropout or death versus curative treatment (transplantation or resection) in patients with hepatocellular carcinoma (HCC) compared with non-HCC candidates using a competing-risk model. Methods: We performed a retrospective cohort study of all patients listed for liver transplantation between 2015 and 2023. Annual rates of LLR and dropout were calculated, and their correlation was evaluated using Spearman’s rho. The risk of dropout/death and competing curative events (OLT, resection, or thermal ablation) was assessed using Fine–Gray competing-risk regression, adjusted for HCC status. Results: From 2015 to 2023, LLR accounted for a progressively increasing proportion of liver resections. A significant negative correlation was observed between annual LLR rates and dropout rates (ρ = −0.78, p = 0.008), indicating fewer ITT failures with greater LLR adoption. In the competing-risk analysis, HCC patients had a significantly lower subdistribution hazard for dropout/death (SHR 0.27, 95% CI 0.18–0.42, p < 0.001) and a higher probability of receiving a curative treatment (SHR 1.65, 95% CI 1.40–1.94, p < 0.001). Conclusions: The increased use of LLR was associated with improved access to curative therapies and a reduced dropout risk on the liver transplant waiting list. HCC patients showed a more favorable competing-risk profile compared with non-HCC candidates. Full article

This study asks whether Ethereum’s proof-of-stake (PoS) incentives not only make economic sense on paper but also feel attractive to real validators who may be loss-averse and sensitive to risk. We take a canonical Eth2 slot-level model of rewards, penalties, costs, and proposer-conditional maximal extractable value (MEV) and overlay a prospect-theoretic valuation that captures reference dependence, loss aversion, diminishing sensitivity, and probability weighting. This Prospect-Theoretic Incentive Mechanism (PT-IM) separates the “money edge” (expected accounting return) from the “felt edge” (behavioral value) by mapping monetary outcomes through a prospect value function and comparing the two across parameter ranges. The mechanism is parametric and modular, allowing different MEV, cost, and penalty profiles to plug in without altering the base PoS model. Using stylized numerical examples, we identify regions where cooperation that pays in expectation can remain unattractive under plausible loss-averse preferences, especially when penalties are salient or MEV is volatile. We discuss how these distortions may affect validator participation, economic security, and the tuning of rewards and penalties in Ethereum’s PoS. Integrating behavioral valuation into crypto-economic design thus provides a practical diagnostic for adjusting protocol parameters when economics and perception diverge. Full article

Multimodal imaging plays a central role in optimizing the evaluation and management of myocardial ischemia by leveraging the complementary strengths of echocardiography, cardiac magnetic resonance imaging (CMR), single photon emission computed tomography (SPECT), positron emission tomography (PET), and invasive coronary angiography (ICA). Noninvasive functional imaging is typically recommended for patients with intermediate to high pre-test probability of coronary artery disease, while coronary computed tomography angiography (CCTA) is preferred for low to intermediate risk. Stress echocardiography is valuable for detecting wall motion abnormalities and is particularly effective in multivessel or left main disease, where perfusion techniques may miss balanced ischemia. CMR offers high spatial resolution and quantitative assessment of myocardial blood flow (MBF), while SPECT and PET quantify ischemic burden, with PET providing superior accuracy for MBF and microvascular disease. ICA remains the gold standard for defining the presence, location, and severity of epicardial coronary stenosis. It is indicated when noninvasive imaging reveals high-risk features, when symptoms are refractory to medical therapy, or when noninvasive results are inconclusive. While ICA offers high spatial resolution, it alone cannot assess the hemodynamic significance of intermediate lesions, nor the coronary microvasculature. Adjunctive invasive hemodynamic and provocative coronary testing (e.g., Fractional Flow Reserve—FFR, invasive Coronary Flow Reserve—CFR, Index of Microcirculatory Resistance—IMR, acetylcholine test) provide essential insights, especially in ischemia with nonobstructive coronary arteries. Given its procedural risks, ICA should be reserved for cases where it will impact management. Intravascular imaging may be used to further characterize lesions. In summary, modality selection should be individualized based on patient characteristics, comorbidities, contraindications, and the need for anatomical versus physiological data. Integrating noninvasive and invasive modalities provides a comprehensive, patient-centered approach to ischemia evaluation. Full article

Regulatory agencies worldwide have implemented stringent measures to monitor and reduce Salmonella contamination in poultry products. Rapid quantitative detection methods enable producers to identify contamination early, implement corrective actions, and enhance food safety. This study aimed to develop and optimize a surface plasmon resonance (SPR) biosensor for the quantitative detection of Salmonella Typhimurium in ground chicken. The sensor surface was functionalized with a well-characterized monoclonal antibody specific to Salmonella flagellin, and an SPR workflow was established for quantitative analysis. Ground chicken samples were inoculated with four S. Typhimurium strains at contamination levels ranging from −0.5 to 3.5 Log CFU/g and enriched at 42 °C for 10 or 12 h prior to SPR analysis. Contamination levels were confirmed using the Most Probable Number (MPN) method. Linear regression analysis indicated that optimal quantification was achieved after 10 h of enrichment (R² ≥ 0.86), whereas extended enrichment (12 h) did not improve performance. The limit of quantification (LOQ) was below 1 CFU/g. A strong positive correlation (R² ≥ 0.85) was observed between SPR and MPN results, demonstrating consistency between the two methods. These findings highlight SPR as a rapid, reliable, and cost-effective alternative to conventional methods for Salmonella quantification. By delivering accurate results within a single day, SPR enhances testing efficiency and supports the production of safer poultry products, thereby reducing public health risks associated with Salmonella contamination. Full article

Background/Objectives: The role of extended pelvic lymph node dissection (ePLND) in prostate cancer remains uncertain. Sentinel lymph node (sLN) mapping improves diagnostic precision, yet some patients have no detectable sentinel nodes (“untraceable” sLNs). This study evaluates whether untraceable sLNs predict the absence of lymph node invasion (LNI) and can guide surgical decision-making during radical prostatectomy (RP) with ePLND. Methods: Patients with intermediate- or high-risk prostate cancer and with no radiologically evident LNI were included in the study. A ^99mTc-nanocolloid was used as an sLN tracer. RP with sLN dissection and ePLND was performed <20 h after injection. Patients were categorized into two groups: Group 1, traceable sLNs and Group 2, untraceable sLNs (no radiological or intraoperative signal). Results: A total of 53 patients were included. LNI was present in 10 patients (18.9%). Group 1 had 41 patients (77.4%), and Group 2 had 12 patients (22.6%). None of the patients in Group 2 had LNI following ePLND, whereas 10 of 41 patients (24.4%) in Group 1 were node-positive (p = 0.016). Baseline clinical and pathological characteristics were comparable between groups. A total of 17/53 of men (32.1%) experienced biochemical recurrence, overall, with higher observed events in Group 1 (15/41, 36.6%) vs. Group 2 (2/12, 16.7%). However, this difference did not reach statistical significance (p = 0.2). Conclusions: A proportion of PCa patients have no radiologically or intraoperatively detectable sLNs, and none of the patients with untraceable sLNs exhibited LNI following ePLND. These findings suggest that untraceable sLNs may correlate with an extremely low probability of nodal invasion and could serve as a criterion for safely omitting ePLND in selected patients. Full article

Diabetic foot ulcers (DFUs) are a leading cause of morbidity worldwide along with the risk of other chronic health issues. Hyperglycemia has been shown to alter immune regulation at the wound site and potentially contributes to non-healing DFUs. However, the effects of hyperglycemia on the expression of mediators of inflammation and angiogenesis (CD36), immune regulation (TLR-7 and CD69), and inflammation/tissue repair (CD274) regarding wound healing are unknown. This study aims to investigate the effects of hyperglycemia on the gene and protein expression of CD36, CD69, CD274, and TLR-7 during wound healing using a rat model of induced diabetes. The expression of these mediators was examined using cutaneous tissues from rat models of diabetes with cutaneous wounds. Skin samples (n = 7 each, control and healed) from the control and diabetic rats were analyzed using hematoxylin and eosin as well as trichrome staining, immunohistochemistry, and PCR. In vitro studies were conducted using rat fibroblasts. Hyperglycemia significantly increases the expression of CD36, CD69, and CD274 and increases TLR-7 expression but not significantly in diabetic tissues compared to control tissues. In vitro studies corroborate the findings in tissues. The modulation of these mediators by hyperglycemia suggests their probable role in delayed wound healing, and these mediators may be potential therapeutic targets to promote wound healing in DFUs. Full article

Objective: This study aimed to identify predictive factors for adherent perinephric fat (APF), or sticky fat, in patients undergoing laparoscopic partial nephrectomy (LPN), with particular emphasis on evaluating male gender as an independent risk factor beyond the Mayo Adhesive Probability (MAP) Score. Materials and Methods: A retrospective analysis was performed on 197 patients who underwent LPN for localized renal tumors between December 2019 and September 2025. Demographic, clinical, radiological, intraoperative, and postoperative variables were collected. Sticky fat was defined intraoperatively. MAP scores were calculated using posterior perinephric fat thickness and fat stranding. Statistical analyses included Mann–Whitney U and Chi-square tests, as well as univariate and multivariate logistic regression (Backward LR method). ROC analysis was used to determine predictive performance. Results: The mean age was 61.3 ± 13.1 years, and 63.5% of patients were male. Sticky fat was observed in 41.6% of cases. Male gender (71.3% vs. 52.4%, p = 0.007), older age (62.9 vs. 58 years, p = 0.031), and higher MAP scores (p = 0.005) were significantly associated with sticky fat. Multivariate analysis identified male gender (OR = 1.97; 95% CI: 1.07–3.61; p = 0.029) and MAP score (OR = 1.27; 95% CI: 1.04–1.56; p = 0.021) as independent predictors. Combining MAP score and gender improved predictive accuracy (AUC = 0.645). Conclusions: Male gender independently predicts APF, and combining gender with MAP score enhances preoperative assessment and surgical planning. Full article

Landfills are vital waste management techniques in South Africa but are significant sources of greenhouse gases (GHGs) and air pollutants that can threaten nearby communities. This study provides a novel integrated assessment approach by combining high-resolution TROPOMI satellite observations with AERMOD dispersion modelling. This study investigates the dispersion characteristics and potential health impacts of landfill gas (LFG) emissions from the Thohoyandou landfill. Unlike previous studies that rely solely on modelling or field measurements, this work offers the first satellite-validated landfill gas dispersion analysis in South Africa. The modelling results indicated that the highest hourly concentrations reached 456,056 µg/m³ for CH₄ and 735,108 µg/m³ for CO₂, while annual maximum concentrations were 15,699 µg/m³ and 30,590 µg/m³, respectively. Health risk assessments were performed for 26 volatile organic compounds and hazardous air pollutants (VOCs/HAPs) using the USEPA methodology. Most individual hazard quotient (HQ) values were below 1, except for 1,1,2-trichloroethane (HQ = 1.27). The cumulative HQ of 1.86 suggested a potential non-carcinogenic risk for nearby residents. Carcinogenic risk analysis identified 13 compounds, with hydrogen sulphide posing the highest probability of cancer risk. The findings reveal that LFG emissions may adversely affect air quality and present both non-carcinogenic and carcinogenic health risks to populations living or working near the landfill. Full article

Objective: Postoperative pulmonary complications (PPCs) remain a significant source of morbidity and mortality in patients undergoing minimally invasive cardiothoracic procedures. Noninvasive ventilation (NIV) is frequently employed as adjunctive therapy to manage respiratory insufficiency. This study evaluated the implementation of prophylactic NIV immediately following extubation after minimally invasive direct coronary artery bypass (MIDCAB) surgery. Methods: A total of 454 consecutive patients undergoing MIDCAB were included. In total, 139 patients received prophylactic NIV (P-NIV)—postoperative management, 315 patients formed a historical control group treated according to the previous standard of care. Clinical outcomes assessed postoperative pulmonary complications, in-hospital mortality, and one-year survival. Results: The incidence of PPCs was significantly lower in the P-NIV group compared with the control cohort (6.5% vs. 14.9%; p = 0.012). Unadjusted analyses demonstrated a significant reduction in the odds of PPCs with P-NIV (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.17–0.85). Using inverse probability of treatment weighting, prophylactic NIV was associated with an absolute reduction of 8.0 percentage points in PPC risk across the entire cohort (average treatment effect [ATE], −0.080; 95% CI, −0.136 to −0.024; z = −2.80; p = 0.005). Kaplan–Meier analysis demonstrated significantly improved one-year survival in the P-NIV group (log-rank p = 0.047). Conclusions: The implementation of prophylactic NIV following MIDCAB was associated with a greater than 50% reduction in the odds of PPCs in both unadjusted and adjusted analyses and improved one-year survival. These results support the adoption of routine prophylactic NIV in the postoperative management of patients undergoing minimally invasive coronary surgery. Full article

Objectives: Infective endocarditis (IE) is a feared and life-threatening complication, requiring a multidisciplinary approach. Prosthetic valve endocarditis (PVE) accounts for 20–30% of IE, is one of the most severe forms of IE, and is associated with high morbidity and mortality. We aim to compare and analyze baseline characteristics, microbiology, clinical presentation, complications, and prognosis between biological and mechanical PVE; we also carried out a subgroup analysis of patients aged 45–65 at the time of onset of prosthetic surgery. Methods: The present study is a post hoc analysis of a prospective multicenter cohort of patients with PVE between January 2008 and December 2023. Patients were divided into two groups regarding the type of prosthesis, mechanical vs. biological. Results: A total of 1544 patients were included. 733 (47.47%) patients with mechanical PVE (mPVE) and 811 (52.52) with biological PVE (bPVE). We found that bPVE appeared earlier than mPVE, had more healthcare-related infections and paravalvular complications. Both groups had similar clinical presentations; moreover, there was no difference in surgical indication and if surgery was performed. On the other hand, mPVE has a higher incidence of Staphylococcus aureus (SA) and Gram-negative bacteria, while bPVE has more coagulase-negative staphylococci. Multivariable logistic regression identified the following independent risk factors of mortality: EuroSCORE I, age, mPVE, SA, IE comprising two valves, and severe sepsis. mPVE had a higher mortality on admission, probably due to a higher incidence of septic shock and CNS embolism. The subgroup analysis of patients between 45 and 65 years at the time of prosthesis implantation showed similar results. Conclusions: The present analysis shows that bPVE appears earlier than mPVE, even in the subgroup of patients aged 45–65. bPVE has more healthcare-related infections and more paravalvular complications. After adjusting for baseline differences, mPVE had higher in-hospital mortality. Full article

Flooding is one of Africa’s most impactful natural disasters, significantly affecting human lives, infrastructure, and economies. This study examines the spatial and temporal distribution of historical flood events across the continent from 1927 to 2020, with a focus on fatalities, affected populations, and economic damage. Data from the Emergency Events Database (EM-DAT), the fifth generation of bias-corrected European Centre for Medium-Range Weather Forecasts Reanalysis (ERA5), and the Climate Hazards Group InfraRed Precipitation with Stations (CHIRPS) observational datasets were used to calculate extreme precipitation indices—Consecutive Wet Days (CWD), annual precipitation on very wet days (R95PTOT), and Annual Maximum Precipitation (AMP). Spatial analysis tools and the Mann–Kendall test were used to assess trends in flood occurrences, while Pearson correlation analysis identified key meteorological drivers across 16 African capital cities for 1981–2019. A flood frequency analysis was conducted using Weibull, Gamma, Lognormal, Gumbel, and Logistic probability distribution models to compute flood return periods for up to 100 years. Results reveal a significant upward trend with a slope above 0.50 floods per year in flood frequency and impact over the period, particularly in regions such as West Africa (Nigeria, Ghana), East Africa (Ethiopia, Kenya, Tanzania), North Africa (Algeria, Morocco), Central Africa (Angola, Democratic Republic of Congo), and Southern Africa (Mozambique, Malawi, South Africa). Positive trends (at 99% significance level with slopes ranging between 0.50 and 0.60 floods per year) were observed in flood-related fatalities, affected populations, and economic damage across Regional Economic Communities (RECs), individual countries, and cities of Africa. The CWD, R95PTOT, and AMP indices emerged as reliable predictors of flood events, while non-stationary return periods exhibited low uncertainties for events within 20 years. These findings underscore the urgency of implementing robust flood disaster management strategies, enhancing flood forecasting systems, and designing resilient infrastructure to mitigate growing flood risks in Africa’s rapidly changing climate. Full article

Background: SARS-CoV-2 infection could trigger hypercoagulation and hyperinflammation that may predispose patients to cerebrovascular events. The long-term risk of stroke among COVID-19 patients remains unclear. This study investigated the long-term risks of ischemic stroke and transient cerebral ischemia (TCI) among patients with and without COVID-19. Methods: We conducted an observational cohort study in the Montefiore Health System (February 2020–January 2024), with 52,117 COVID+ and 837,395 COVID− patients without prior cerebrovascular events. Demographics, comorbidities, insurance, unmet social needs, and median income were adjusted for using inverse probability weighting. Cox-proportional regression hazard ratios (HR) and their 95% confidence intervals were computed for ischemic stroke and TCI. Results: Compared to COVID− controls, ischemic stroke risk was higher among hospitalized COVID+ patients (HR = 1.32 [1.12–1.55]) and non-hospitalized COVID+ patients (1.21 [1.05–1.39]). Compared to COVID− controls, TCI risk was similar among hospitalized COVID+ patients (1.00 [0.75–1.33]), but higher among non-hospitalized COVID+ patients (2.15 [1.81–2.56]). Conclusions: Hospitalized and non-hospitalized COVID-19 patients had a higher long-term risk of ischemic stroke while only non-hospitalized COVID-19 patients had a higher long-term risk of TCI. These findings underscore the needs for long-term monitoring of cerebrovascular risk factors in COVID-19 survivors. Full article

Tailings dams, critical for storing mine waste and water, must maintain stability and functionality throughout their lifespan. Their design and risk assessment are complicated by significant uncertainties stemming from multivariable parameters, including material properties, loading conditions, and operational decisions. Traditional dam design and risk assessment procedures often rely on first-order probabilistic approaches, which fail to capture the complex, multi-layered nature of these uncertainties fully. This paper reviews the current tailings dam design practice and proposes the application of Bayesian networks (BNs) to analyse the epistemic and aleatory uncertainty inherent in tailings dam design parameters and risk assessment. By representing these uncertainties explicitly, BNs can facilitate more robust and targeted design strategies. The proposed approach involves several key steps, including parameterisation—design input variable probability density function and uncertainty, knowledge elicitation, and model assessment and integration. This methodology provides a sophisticated and comprehensive approach to accounting for the full spectrum of uncertainties, thereby enhancing the reliability of tailings dam designs and risk management decisions. Full article

The rapid growth of distributed photovoltaic (PV) resources is transforming distribution networks into active systems with highly variable net loads, while the rising frequency and severity of extreme weather events is increasing outage risk and restoration challenges. In this context, utilities require reliability assessment tools that jointly represent operational variability and climate-driven stressors beyond stationary assumptions. This paper presents a weather-aware probabilistic framework to quantify the reliability of active distribution networks with high PV penetration. The approach synthesizes realistic residential demand and PV time series at 15-min resolution, models extreme weather as a low-probability/high-impact escalation of component failure rates and restoration uncertainty, and computes IEEE Std 1366–2022 indices (SAIFI, SAIDI, ENS) through Monte Carlo simulation. The methodology is validated on a modified IEEE 33-bus feeder with parameter values representative of urban/suburban overhead networks. Compared with classical reliability modeling, the proposed framework captures in a unified pipeline the joint effects of load/PV stochasticity, weather-dependent failure escalation, and repair-time dispersion, providing a consistent statistical interpretation supported by kernel density estimation and convergence diagnostics. The results show that (i) extreme weather shifts the distributions of SAIFI, SAIDI and ENS to the right and thickens upper tails (higher exceedance probabilities); (ii) PV penetration yields a non-monotonic response with measurable improvements up to intermediate levels and saturation/partial degradation at very high penetrations; and (iii) compound risk is nonlinear, as the mean ENS surface over $(r_{\mathrm{PV}},P_{\mathrm{ext}})$ exhibits a valley at moderate PV and a ridge for large storm probability. A tornado analysis identifies the base failure rate, storm escalation factor and storm exposure as dominant drivers, in line with resilience literature. Overall, the framework provides an auditable, scenario-based tool to co-design DER hosting and resilience investments. Full article