Search Results (1,083)

Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article

Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset. Full article

Background/Objectives: Endovascular thrombectomy has become a mainstay in the treatment of acute ischemic stroke caused by large vessel occlusion. Among the multiple factors that influence outcomes, the choice of anesthetic technique—general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA)—remains controversial. This narrative review aims to critically examine and synthesize current evidence comparing the efficacy and safety of different anesthetic strategies in endovascular stroke treatment. Methods: A structured search of the PubMed^® database was conducted using the terms “stroke treatment”, “endovascular stroke treatment”, “anesthesia”, “general anesthesia”, “conscious sedation”, and “local anesthesia”. The search focused on clinical trials involving human subjects published in English. Studies were included if they compared at least two anesthetic techniques during thrombectomy and reported outcomes such as neurological recovery, mortality, or complication rates. Reviews, case reports, and animal studies were excluded. Results: Several randomized controlled trials and observational studies show comparable functional outcomes between GA and CS, though CS may confer advantages in early neurological recovery and reduced complications. Local anesthesia, though less studied, may offer favorable outcomes in selected patients. General anesthesia appears to be associated with greater hemodynamic variability and a higher risk of post-procedural infections, particularly in unsuccessful interventions. Maintaining stable blood pressure and minimizing ventilation duration are crucial to improving patient prognosis. Conclusions: While both GA and CS are viable options during thrombectomy, CS and LA may provide a safer profile in selected patients by preserving hemodynamic stability and reducing infectious risk. Personalized anesthetic strategies and further high-quality trials are warranted. Full article

Background: Gastrointestinal (GI) cancer patients face a four-fold higher suicide risk than the general US population. This study explores psychosocial aspects of GI cancer patient experiences, assessing suicidal ideation and behavior, mental distress during treatment phases, and psychosocial factors on mental health. Methods: A two-phase mixed-methods approach involved a web-based survey and follow-up interviews. Quantitative data analysis validated mental health and suicidal ideation constructs, and correlation analyses were performed. The patient journey was charted from diagnosis to treatment. Results: Two hundred and two individuals participated, with 76 from the rural Appalachian region and 78 undergoing treatments. Quantitative analysis showed a higher prevalence of passive suicidal ideation than active planning. The post-treatment recovery period was the most emotionally challenging. Qualitative data emphasized emotional support and vulnerability to isolation. Care quality concerns included individualized treatment plans and better communication. Patients also needed clear, comprehensive information about treatment and side effects. The in-depth interview with four GI cancer patients revealed a healthcare system prioritizing expedient treatment over comprehensive care, lacking formal psychological support. AI emerged as a promising avenue for enhancing patient understanding and treatment options. Conclusions: Our research advocates for a patient-centric model of care, enhanced by technology and empathetic communication. Full article

This work studies and analyzes the transition from a linear to a circular economy through wastewater treatment and resource recovery. As wastewater volumes grow, sustainable management becomes critical. This study highlights the reuse of treated effluent, beneficial sludge utilization, and energy generation via anaerobic digestion. Wastewater treatment plants should be envisioned as hubs for recovering water, materials, and energy, rather than disposal facilities. Emphasizing resource efficiency, the circular economy approach offers viable solutions to challenges related to resource scarcity, climate change, and ecological impact. Full article

Opioid use disorder (OUD) is a chronic disease that remains difficult to treat, even with significant improvements in available medications. While current treatments work well for some, they often do not account for the unique needs of individual patients, leading to less-than-ideal results. Precision medicine offers a new path forward by tailoring treatments to fit each person’s genetic, psychological, and social needs. This review takes a close look at medications for OUD, including methadone, buprenorphine, and naltrexone, as well as long-acting options that may improve adherence and convenience. Beyond medications, the review highlights the importance of addressing mental health co-morbidities, trauma histories, and social factors like housing or support systems to create personalized care plans. The review also explores how emerging technologies, including artificial intelligence and digital health tools, can enhance how care is delivered. By identifying research gaps and challenges in implementing precision medicine into practice, this review emphasizes the potential to transform OUD treatment. A more individualized approach could improve outcomes, reduce relapse, and establish a new standard of care focused on recovery and patient well-being. Full article

In agricultural practice, in addition to determining the nitrogen (N_f) dose, it is necessary to effectively control its effect on currently grown crops. Meeting these conditions requires not only the use of phosphorus (P) and potassium (K), but also nutrients such as magnesium (Mg) and sulfur (S). This hypothesis was verified in a single-factor field experiment with winter wheat (WW) carried out in the 2015/2016, 2016/2017, and 2017/2018 growing seasons. The experiment consisted of seven variants: absolute control (AC), NP, NPK-MOP (K as Muriate of Potash), NPK-MOP+Ki (Kieserite), NPK-KK (K as Korn–Kali), NPK-KK+Ki, and NPK-KK+Ki+ES (Epsom Salt). The use of K as MOP increased grain yield (GY) by 6.3% compared to NP. In the NPK-KK variant, GY was 13% (+0.84 t ha⁻¹) higher compared to NP. Moreover, GYs in this fertilization variant (FV) were stable over the years (coefficient of variation, CV = 9.4%). In NPK-KK+Ki+ES, the yield increase was the highest and mounted to 17.2% compared to NP, but the variability over the years was also the highest (CV ≈ 20%). The amount of N in grain N (GN) increased progressively from 4% for NPK-MOP to 15% for NPK-KK and 25% for NPK-KK+Ki+ES in comparison to NP. The nitrogen harvest index was highly stable, achieving 72.6 ± 3.1%. All analyzed NUE indices showed a significant response to FVs. The PFP-N_f (partial factor productivity of N_f) indices increased on NPK-MOP by 5.8%, NPK-KK by 12.9%, and NPK-KK+Ki+ES by 17.9% compared to NP. The corresponding N_f recovery of N_f in wheat grain was 47.2%, 55.9%, and 64.4%, but its total recovery by wheat (grain + straw) was 67%, 74.5%, and 87.2%, respectively. In terms of the theoretical and practical value of the tested indexes, two indices, namely, NUP (nitrogen unit productivity) and NUA (nitrogen unit accumulation), proved to be the most useful. From the farmer’s production strategy, FV with K applied in the form of Korn–Kali proved to be the most stable option due to high and stable yield, regardless of weather conditions. The increase in the number of nutritional factors optimizing the action of nitrogen in winter wheat caused the phenomenon known as the “scissors effect”. This phenomenon manifested itself in a progressive increase in nitrogen unit productivity (NUP) combined with a regressive trend in unit nitrogen accumulation (NUA) in the grain versus the balance of soil available Mg (Mg_b). The studies clearly showed that obtaining grain that met the milling requirements was recorded only for NUA above 22 kg N t⁻¹ grain. This was possible only with the most intensive Mg treatment (NPK-KK+Ki and NPK-KK+Ki+ES). The study clearly showed that three of the six FVs fully met the three basic conditions for sustainable crop production: (i) stabilization and even an increase in grain yield; (ii) a decrease in the mass of inorganic N in the soil at harvest, potentially susceptible to leaching; and (iii) stabilization of the soil fertility of P, K, and Mg. Full article

Objectives: COVID-19, caused by the SARS-CoV-2 virus, has infected over 777 million individuals and led to approximately 7 million deaths worldwide. Despite significant efforts to develop effective therapies, treatment remains largely supportive, especially for severe complications like acute respiratory distress syndrome (ARDS). Numerous compounds from diverse pharmacological classes are currently undergoing preclinical and clinical evaluation, targeting both the virus and the host immune response. Methods: Despite the large number of articles published and after a preliminary attempt was published, we discarded the option of a systematic review. Instead, we have done a description of therapies with these results and a tentative mechanism of action. Results: Preliminary studies and early-phase clinical trials have demonstrated the potential of Mesenchymal Stem Cells (MSCs) in mitigating severe lung damage in COVID-19 patients. Previous research has shown MSCs to be effective in treating various pulmonary conditions, including acute lung injury, idiopathic pulmonary fibrosis, ARDS, asthma, chronic obstructive pulmonary disease, and lung cancer. Their ability to reduce inflammation and promote tissue repair supports their potential role in managing COVID-19-related complications. This review demonstrates the utility of MSCs in the acute phase of COVID-19 and postulates the etiopathogenic role of mitochondria in Long-COVID. Even more, their combination with other therapies is also analyzed. Conclusions: While the therapeutic application of MSCs in COVID-19 is still in early stages, emerging evidence suggests promising outcomes. As research advances, MSCs may become an integral part of treatment strategies for severe COVID-19, particularly in addressing immune-related lung injury and promoting recovery. However, a full pathogenic mechanism may explain or unify the complexity of signs and symptoms of Long COVID and Post-Acute Sequelae (PASC). Full article

Effective control of the parasitic mite Varroa destructor in honey bee (Apis mellifera) colonies relies on integrated pest management (IPM) strategies to prevent mite populations from reaching economic injury levels. Formulations of oxalic acid combined with glycerin may provide a viable summer treatment option in continental Northern climates. This study evaluated the efficacy of oxalic acid and glycerin strips compared to oxalic acid dribble and 65% formic acid when applied in mid-August. Mite levels and colony health parameters were assessed, and honey samples from oxalic acid-treated colonies were analyzed for residue levels. Results showed that the oxalic acid and glycerin strips had a moderate acaricidal efficacy (55.8 ± 3.2%), which was significantly higher than those of 65% formic acid (42.6 ± 3.2%) and oxalic acid dribble (39.5 ± 4.3%), which did not differ between them, suggesting potential for summer mite control. No significant adverse effects on cluster size, worker mortality, queen status, or colony survival were observed. Oxalic acid and glycerin increased the proportion of spotty brood patterns at early timepoints after treatment, but recovery was noted after 45 days of starting the treatment. Similar effects on brood were observed with 65% formic acid 14 days after starting the treatment, with recovery by 28 and 45 days after starting the treatment. No significant differences in oxalic acid residues in honey from the control and treatment colonies were found. Oxalic acid and glycerin strips might help control varroa mite populations, delaying their exponential growth and helping reduce economic losses for beekeepers, but this treatment should be considered as part of an IPM strategy and not a stand-alone method for V. destructor control. Full article

Intracerebral hemorrhage (ICH), a severe stroke subtype common in the elderly, often results in high morbidity and mortality, with limited treatment options for long-term recovery. While glial scar formation is increasingly recognized as key to central nervous system (CNS) repair, its role and characteristics in the aging brain post-ICH remain unclear. This study investigated glial scar formation after ICH (100 μL autologous blood injected into the right basal ganglia model) in aged Fischer 344 rats and assessed the effects of deferoxamine (DFX) treatment. Histological and immunohistochemical analyses were conducted on days 7, 28, and 60 post-ICH using cell-specific and iron-related markers, with DFX administered at 100 mg/kg daily for 14 days in separate groups. Over time, the lesion core showed increased hemosiderin accumulation and astrogliosis. By day 60, the area of astrogliosis corresponded to an area with persistent neuronal loss (DARPP-32-negative). Glial composition shifted from microglia dominance on day 28 to astrocyte predominance by day 60. DFX treatment reduced iron deposition, astrogliosis, and DARPP-32-negative regions while enhancing oligodendrocyte presence. Iron-related markers (HO-1, ferritin, Perls’ staining) and PDGFRβ-positive fibrotic cells were concentrated in the scar core. These findings provide novel insights into scar formation after ICH in aged rats and suggest DFX as a potential therapy to improve outcomes in elderly stroke patients. Full article

Cheese production is an ancient practice that is associated with the food and cultural identity of different peoples. There are over 500 cheese types globally, including 207 with protected denomination of origin (PDO) and 70 with protected geographical indication (PGI) status in the European Union (EU). Each cheese has various biochemical compositions, production methods, and maturation environments. This study has provided a critical review of the environmental impacts of cheese production, focusing on energy consumption, greenhouse gas (GHG) emissions, and the integration of renewable energy sources as sustainable strategies for this sector. Based on case studies and life cycle assessment (LCA) methodologies, the analysis revealed significant variability in energy use (3.0 to 70.2 MJ/kg) and GHG emissions (up to 22.13 kg CO₂ eq/kg), influenced by factors such as the cheese type, production complexity, system boundaries, and the technological or geographical context. Particular attention was given to heat treatment, refrigeration, and maturation processes, which contribute substantially to the overall energy footprint. The paper also discusses the methodological challenges in LCA studies, including the role of co-product allocation and database limitations. Finally, strategic renewable energy options, such as biogas recovery and solar thermal integration, are discussed as sustainable alternatives to reduce the environmental footprint of the dairy sector and support its sustainability. Full article

Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients. Full article

Skeletal muscle atrophy is a debilitating condition characterized by the loss of muscle mass and function. It is commonly associated with aging, chronic diseases, disuse, and prolonged glucocorticoid therapy. Oxidative stress and catabolic signaling pathways play significant roles in the progression of muscle degradation. Despite its clinical relevance, few effective therapeutic options are currently available. In this study, we investigated the protective effects of an ethanolic extract of Glycine Semen Preparata (GSP), i.e., fermented black soybeans, using in vitro and in vivo models of dexamethasone (Dexa)-induced muscle atrophy. In C2C12 myoblasts and myotubes, GSP significantly attenuated both oxidative stress-induced and Dexa-induced damages by reducing reactive oxygen species levels and by suppressing the expression of the muscle-specific E3 ubiquitin ligases MuRF1 and Atrogin-1. Moreover, GSP upregulated key genes involved in muscle regeneration (Myod1 and Myog) and mitochondrial biogenesis (PGC1α), indicating its dual role in muscle protection and regeneration. Oral administration of GSP to mice with Dexa-induced muscle atrophy resulted in improved muscle fiber integrity, increased proportion of large cross-sectional area fibers, and partial recovery of motor function. Isoflavone aglycones, such as daidzein and genistein, were identified as active compounds that contribute to the beneficial effects of GSP through antioxidant activity and gene promoter enhancement. Thus, GSP is a promising nutraceutical that prevents or mitigates muscle atrophy by targeting oxidative stress and promoting myogenesis and mitochondrial function. Further studies are warranted to standardize the bioactive components and explore their clinical applications. Full article

As in the case with other metals, tungsten is an element with a number of uses in different fields, which is why its recovery from both primary and secondary materials continues to be of great interest. Various hydrometallurgical processes, considered as unit operations, can be used for the recovery, separation and concentration of tungsten from any source, with ease of scaling-up a potential factor when considering the best process for practical use. The present work reviewed investigations into the use of such unit operations for the recovery of tungsten which were published during 2024 and the first half of 2025. Because most if not all of these investigations were conducted on a laboratory scale, there is still much room for improvement before deciding on the best option for tungsten recovery. In all cases, however, this recovery is based on a series of steps from leaching to separation technologies (ion exchange resins, liquid–liquid extraction, etc.) to the tungsten end-product. Full article

Background and Objectives: Low-pressure pneumoperitoneum (PP) during robot-assisted radical prostatectomy (RARP) has been shown to improve postoperative recovery in patients with non-obesity. However, its efficacy in individuals with obesity remains unclear. This study aimed to evaluate postoperative outcomes in patients with obesity undergoing RARP with low-pressure (7 mmHg) versus standard-pressure (12 mmHg) PP. Materials and Methods: In this retrospective cohort study, 130 patients with obesity (BMI > 30 kg/m²) undergoing RARP were divided into low-pressure (n = 60) and standard-pressure (n = 70) groups. Postoperative recovery was assessed using the Quality of Recovery-15 (QoR-15) questionnaire on postoperative days (POD) 1, 3, and 30. Secondary outcomes included surgical workspace (SWS) scores, operative time, blood loss, intraoperative and postoperative complications, hospital stay, and pathological results. ANCOVA and chi-square tests were used for analysis. Results: QoR-15 scores were significantly higher in the low-pressure group on POD1 (123.58 vs. 111.41), POD3 (128.37 vs. 116.41), and POD30 (132.88 vs. 125.61; p < 0.001). Operative time (98.5 vs. 71.57 min; p < 0.001) and blood loss (129 vs. 97.07 mL; p = 0.039) were higher in the low-pressure group. SWS scores were lower in the low-pressure group (p < 0.001). There were no significant differences between groups in complication rates, hospital stay, or positive surgical margins. Conclusions: In patients with obesity undergoing RARP, low-pressure PP improves postoperative recovery without increasing complications. Despite longer operative times and higher blood loss, this approach is a viable option to enhance recovery in this population. Full article