Search Results (6,092)

Many advantages have been reported with the use of machine perfusion (MP) to rescue extended criteria donor (ECD) grafts, improving both short- and long-term post-liver transplantation (LT) outcomes. Acute kidney injury (AKI) is a common post-LT complication associated with these grafts and may compromise patient outcomes and increase LT-related costs. The aim of the study was to analyze the incidence of AKI in recipients of MP-treated grafts compared with those receiving conventionally cold-stored (SCS) grafts, both before and after a propensity score matching (PSM). From a prospectively maintained database, LT recipients of MP-treated grafts were compared with SCS grafts transplanted in the same study period (January 2022–May 2025). PSM was performed based on donor risk index (DRI), macrosteatosis (≥ or <30%), and recipient NaMELD score using a 3:1 (MP vs. SCS) ratio. Of the 177 consecutive LTs, 30 were performed with MP-treated grafts (MP group) and 147 using SCS (SCS group). The MP group displayed more marginal characteristics: older age (72 vs. 62 years, p = 0.02), higher proportion of DCD (10% vs. 0, p = 0.04), and higher frequency of moderate steatosis (macro ≥ 30%, 10% vs. 2.7%, p = 0.09). AKI rates were similar between groups (63% vs. 45.6%, p = 0.16), as was the distribution across AKI stages. After PSM, donor and recipient characteristics were balanced, and AKI rates remained similar between groups (58.6% vs. 47.1%, p = 0.39). Donor diabetes and recipient age were independent predictors of AKI in multivariate analysis (donor diabetes OR 3.29, 95% CI 1.347–8.030; recipient age: OR 1.06, 95% CI 1.015–1.097, both p < 0.05). MCP-1 and TNF-α levels measured in the perfusate fluid within the first minutes of perfusion were positively correlated with post-LT creatinine peak (MCP-1, p = 0.00023, R = 0.58; TNF-α, p = 0.0004, R = 0.57). In conclusion, machine perfusion remains a valuable strategy for rescuing ECD liver grafts. In the current era—characterized by increasing use of machine-perfused grafts and extended criteria donors—recipients demonstrate postoperative renal outcomes comparable to those receiving conventionally preserved grafts. Full article

As unmanned aerial vehicles (UAVs) are increasingly utilized in urban inspection and emergency rescue missions, path planning under strong wind conditions persists as a critical challenge. Traditional algorithms frequently exhibit deficiencies in environmental adaptability or encounter difficulties in balancing exploration and exploitation. This paper presents a dynamic-proportion Bat–Cuckoo Search (BA-CS) Hybrid Algorithm enhanced with wind field perception to tackle the challenges of UAV path planning in urban environments with strong winds, specifically addressing the issues of insufficient environmental adaptation and the exploration–exploitation imbalance. The algorithm integrates a dual-feedback mechanism that dynamically modifies the ratio of the BA/CS subpopulations in accordance with real-time iteration progress and population diversity. By incorporating wind field perception into population initialization, interpopulation information exchange, and wind resistance perturbation strategies, it attains efficient path optimization under multiple constraints. Experimental results under strong winds with speeds ranging from 10.8 to 13.8 m/s indicate that the proposed algorithm generates paths that are smooth, continuous, and entirely collision-free. It achieves a superior average wind resistance cost of 0.92, which is 9.8%, 17.1%, and 52.6% lower than those of the A*, RRT, and PSO algorithms, respectively. With a planning time of 3.95 s, it satisfies the path wind resistance stability requirements stipulated in the GB/T 38930-2020 standard, providing an effective solution for UAV inspection and emergency rescue operations in urban wind scenarios. Full article

Background: Pain management in patients with severe burns remains one of the most complex challenges in perioperative care. Burn-related pain is multifactorial, resulting from tissue destruction, intense inflammation, surgical procedures, and repeated dressing changes. Opioids remain the cornerstone of analgesia; however, prolonged use is associated with tolerance, dependence, adverse effects, and prolonged hospitalization. Multimodal and opioid-sparing strategies, including regional anesthesia, may improve postoperative outcomes by enhancing analgesia while reducing systemic drug exposure. This study aimed to evaluate the effectiveness of a standardized regional anesthesia protocol in reducing postoperative pain and opioid requirements in burn patients undergoing lower-limb escharectomy and autologous skin grafting. Methods: We conducted a retrospective, single-center analysis of 25 adult patients with deep thermal burns of the lower limbs who underwent escharectomy and split-thickness skin grafting. All patients received a combined ultrasound-guided sciatic popliteal block and adductor canal block on both the burned limb and the donor site. Ropivacaine 0.375% with clonidine was administered without exceeding a total dose of 3.0 mg/kg. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and opioid consumption was recorded as rescue doses in intravenous morphine equivalents. Secondary outcomes included perioperative complications and 30-day hospital readmission. Results: Regional anesthesia provided effective postoperative pain control. Thirty-two percent of patients reported no pain (NRS 0), 52% reported mild pain (NRS 1–3), and 16% reported moderate pain (NRS 4–6). No patient reported severe pain (NRS 7–10). Only four patients (16%) required rescue opioids. No perioperative complications or block-related adverse events occurred, and no patient required hospital readmission within 30 days. Conclusions: In this cohort, regional anesthesia was associated with satisfactory postoperative analgesia and minimal opioid requirements. By reducing opioid exposure, this approach may help improve patient comfort and potentially limit opioid-related adverse effects. Larger prospective studies are needed to confirm these findings and to assess long-term outcomes. Full article

Background: Comprehensive conservative management (CCM) is a possible option in end-stage clinical disease, requiring multidisciplinary support and offering survival comparable to dialysis while improving quality of life in frail patients. Despite its potential benefits, CCM is often underutilized because nephrologists may perceive it as less effective compared to dialysis. We present two case reports of hemodialysis failure and of successful CCM. Case presentation: We present two case reports of elderly female patients—referred to as Patient 1 and Patient 2—who had multiple comorbidities but preserved urine output. Both patients, in accordance with their medical team, chose to discontinue hemodialysis due to poor treatment tolerance and declining overall health. They were successfully managed with CCM, leading to follow-up that revealed survival beyond 24 months, improvements in metabolic complications and quality of life, and a reduction in hospitalizations. Conclusions: These case reports demonstrate the effectiveness of dietary and medical management for end-stage kidney disease, particularly when dialysis negatively affects patients’ clinical conditions and quality of life. They also highlight the importance of considering CCM as a preferable option for frail elderly patients facing kidney failure. Full article

Background and Objectives: Scalp nerve block (SNB) is hypothesized to attenuate the physiological response to skull pinning more effectively than local anesthetic (LA) infiltration. This study aimed to compare the two techniques using Bispectral index (BIS) as a primary surrogate measure of cortical arousal. Materials and Methods: In this prospective observational study, patients undergoing elective craniotomy received either bilateral SNB (Group S, n = 53) or LA infiltration (Group LA, n = 35) based on anesthesiologist preference. Depth of anesthesia was monitored via BIS. The primary outcome was the change in BIS after skull pin insertion. A ΔBIS > 20% from baseline triggered rescue medication (remifentanil/propofol). Secondary outcomes included hemodynamic parameters and rescue requirements. Results: There was a significant main effect of time on BIS values (p < 0.001), indicating that BIS values changed significantly across measurement points. Post-hoc examination of parameter estimates revealed that the Group LA showed significantly greater increases in BIS values compared to the Group S at T1 (p = 0.030) and T3 (p = 0.024). No significant between-group differences in BIS changes were observed at T5, T10, or T15 time points (p > 0.05). Hemodynamic responses (mean arterial pressure and heart rate) were also transiently but significantly higher in Group LA at these time points (p < 0.001). The most clinically notable finding was that significantly more patients in Group LA required rescue medication (p < 0.001), indicating a greater frequency of clinically significant physiological trespass. Conclusions: Compared to LA infiltration, SNB was associated with statistically significant reductions in immediate BIS and hemodynamic responses to skull pinning. The key potential clinical implication is the corresponding reduction in the need for rescue anesthetic intervention. These findings support SNB as a technique for enhancing physiological stability, though the direct impact on patient-centered outcomes requires further study. BIS may serve as a useful adjunctive indicator of the cortical response to noxious stimuli. Full article

Peripheral inflammation is increasingly recognized as a critical driver of sustained neuroinflammation and cognitive dysfunction in neurodegenerative and inflammation-associated disorders. Systemic inflammatory mediators can compromise blood–brain barrier integrity, activate glial cells, and initiate maladaptive neuroimmune cascades that disrupt hippocampal–prefrontal circuits underlying learning and memory. Here, we investigated whether early systemic administration of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) mitigates inflammation-driven cognitive deficits in a chronic lipopolysaccharide (LPS) mouse model. Adult mice received daily LPS injections for seven days to induce persistent systemic and central inflammation, which was confirmed by serum and hippocampal cytokine analyses in a separate cohort at the time of MSC administration, followed by intravenous MSC treatment immediately after cessation of the inflammatory insult. Behavioral testing revealed significant impairments in spatial working memory, recognition memory, and associative learning. These deficits were accompanied by pronounced microglial activation, immune cell accumulation, astrocytosis, and a shift toward a pro-inflammatory cytokine milieu with suppression of IL-10 in the hippocampal CA1 region and medial prefrontal cortex. Early MSC treatment attenuated glial reactivity, reduced pro-inflammatory cytokines, restored IL-10 expression, and partially rescued cognitive performance. Collectively, these findings identify a post-inflammatory therapeutic window in which early MSC-based immunomodulation can rebalance neuroimmune signaling and limit inflammation-induced hippocampal–prefrontal circuit dysfunction, highlighting a clinically relevant strategy for targeting cognitive impairment associated with chronic systemic inflammation. Full article

Time-varying formation tracking of networked unmanned aerial vehicle (UAV) systems plays a crucial role in cooperative missions such as encirclement, cooperative surveillance, and search-and-rescue operations, where human operators are often involved and system reliability is challenged by actuator faults and external disturbances. Motivated by these practical considerations, this paper investigates a human-in-the-loop time-varying formation tracking problem for networked UAV systems subject to compound actuator faults and external disturbances. To address this problem, a novel two-layer control architecture is developed, comprising a distributed observer and a fault-tolerant controller. The distributed observer enables each UAV to estimate the states of the human-in-the-loop leader using only local information exchange, while the fault-tolerant controller is designed to preserve formation tracking performance in the presence of compound actuator faults. By incorporating dynamic iteration regulation and adaptive laws, the proposed control scheme ensures that the formation tracking errors converge to a bounded neighborhood of the origin. Rigorous Lyapunov-based analysis is conducted to establish the stability, convergence, and robustness of the resulting closed-loop system. Numerical simulations further demonstrate the effectiveness of the proposed method in achieving practical time-varying formation tracking under complex fault scenarios. Full article

Airway management is central to the care of critically ill patients, yet it remains one of the most challenging interventions in emergency departments and intensive care units. Patients often present with severe physiological instability, limited cardiopulmonary reserve, and high acuity, while clinicians often work under constraints related to time for preparation, equipment availability, trained workforce, monitoring, and access to advanced rescue techniques. These challenges are particularly pronounced in low- and middle-income countries and other resource-limited or austere environments, where the margin for error is narrow and delays or repeated attempts in airway management may rapidly precipitate hypoxemia, hemodynamic collapse, or cardiac arrest. Although contemporary airway guidelines emphasize structured preparation and rescue pathways, many assume resources that are not consistently available in such settings. This narrative review discusses pragmatic, context-adapted strategies for airway management in constrained environments, with emphasis on physiology-first preparation, appropriate oxygenation and induction techniques, simplified rapid-sequence intubation, and the judicious use of basic airway adjuncts, supraglottic devices, and video laryngoscopy, where available. Adapted difficult airway algorithms, front-of-neck access in the absence of surgical backup, human factors, team training, and ethical considerations are also addressed. This review aims to support safer and effective airway management for critically ill patients in resource-limited emergency and intensive care settings. Full article

The adoption of novel technologies such as Unmanned Aerial Vehicles (UAVs) in Search and Rescue (SAR) operations remains limited. As a result, their full potential is not yet realized. Although UAVs have been deployed on an ad hoc basis, typically under manual control by dedicated operators, assisted and fully autonomous configurations remain largely unexplored. In this study, three SAR frameworks are systematically evaluated within a unified benchmarking framework: conventional ground missions, UAV-assisted missions, and fully autonomous UAV operations. As the key performance indicator, the target localization time was quantified and used as the means of comparison amongst frameworks. The conventional and assisted frameworks were experimentally tested through physical hardware in a controlled outdoor setting, wherein simulated callouts occurred via rescue teams. The autonomous swarm framework was simulated in the form of a multi-agent Reinforcement Learning (RL) method via the use of the Proximal Policy Optimization (PPO) algorithm. This enabled the optimization of the decentralized cooperative actions that could occur for efficient exploration of a partially observed three-dimensional environment. Our results demonstrated that the autonomous swarm significantly outperformed the conventional and assisted approaches in terms of speed and coverage. Finally, a detailed depiction of the framework’s integration into an operational system is provided. Full article

Maritime emergency communication facilities are essential for establishing land-sea connectivity and supporting disaster rescue operations. However, current systems often struggle with slow deployment, link instability, and insufficient coverage. To overcome these limitations, this paper proposes a method utilizing aircraft equipped with communication payloads for rapid network construction in target sea areas, aiming to satisfy the dual demands of quick response and stable transmission. A critical component of this framework is the optimal selection of aircraft bases. Addressing the distinct coverage capabilities of different platforms, we construct a multi-objective optimization model for base location. This model integrates a hierarchical coverage mechanism involving multiple aircraft types and is solved using the proposed Hybrid Adaptive Multi-objective Optimization (HAMO) algorithm. Experimental validation in the Bohai Sea region demonstrates the feasibility and effectiveness of the proposed model. Full article

Extended Reality (XR) technologies have matured into powerful tools for training in high-stakes domains, from emergency response to search and rescue. Yet current systems often struggle to balance real-time AI-driven personalisation with the need for human oversight and calibrated trust. This article synthesizes the programmatic contributions of a multi-study doctoral project to advance a design-and-evaluation framework for trustworthy adaptive XR training. Across six studies, we explored (i) recommender-driven scenario adaptation based on multimodal performance and physiological signals, (ii) persuasive dashboards for trainers, (iii) architectures for AI-supported XR training in medical mass-casualty contexts, (iv) theoretical and practical integration of Human-in-the-Loop (HITL) supervision, (v) user trust and over-reliance in the face of misleading AI suggestions, and (vi) the role of interaction modality in shaping workload, explainability, and trust in human–robot collaboration. Together, these investigations show how adaptive policies, transparent explanation, and adjustable autonomy can be orchestrated into a single adaptation loop that maintains trainee engagement, improves learning outcomes, and preserves trainer agency. We conclude with design guidelines and a research agenda for extending trustworthy XR training into safety-critical environments. Full article

This article examines the subject of SME failures due to financial distress in emerging economies by focusing on Uganda as a case study. It adopts a convergent doctrinal and empirical approach, drawing on existing black letter law and literature alongside some of the empirical data obtained from a survey of SME business owners impacted by financial distress, a survey of accredited insolvency practitioners and exchanges from a stakeholder workshop on SME insolvencies in Uganda. The article examines existing legal, regulatory and procedural frameworks on corporate rescue and the identified gaps exacerbating SME failures in unpacking why, despite the availability of these frameworks, business rescue as the policy objective of Uganda’s insolvency law has yet to be fully achieved. The article devises a recommended toolkit that if adopted, may guide the approaches needed to improve SME rescue, and meet legal and statutory objectives of Uganda’s insolvency frameworks to enhance economic stability. Full article

Background/Objectives: The hepcidin–ferroportin (Fpn1) axis is central to intestinal iron absorption, and dysregulation of this axis underlies all known forms of iron disorders. Hemochromatosis, the most common iron overload disorder in humans, results from systemic iron accumulation due to decades of uncontrolled intestinal absorption. Despite major advances in medicine in recent years, strategies for iron overload management are still lagging as they primarily rely on iron chelation and repeated phlebotomies. Fpn1, the cellular iron exporter, is ubiquitously expressed and plays a critical role in maintaining systemic iron homeostasis. Methods: To investigate the specific contribution of intestinal Fpn1 to systemic iron overload, we employed a CRISPR-based adenoviral hepcidin knockout mediated mouse iron overload model, combined with intestine-specific deletion of Fpn1. Results: An initial time-dependent experiment establishes the efficiency of hepcidin knockout (KO) by as early as 1 week of adenovirus injection. At 2 weeks of injection, a perfect reciprocal relationship between hepcidin gene suppression and liver iron levels (5–7-fold induction from the baseline) was established. Finally, intestine-specific Fpn1 deletion effectively prevented iron accumulation in hepcidin KO mice, as evidenced by nearly 4-fold lower liver iron levels compared to hepcidin KO animals with intact intestinal Fpn1. Conclusions: In summary, our results demonstrate that ablation of intestinal Fpn1 is sufficient to attenuate systemic iron accumulation in this mouse model of hemochromatosis. These findings suggest that selective targeting of intestinal Fpn1 may represent a promising strategy for the management of iron overload. Full article

Online pet adoption profiles, which present images of available pets, can create powerful first impressions. Research about factors influencing pet adoptability online is limited and has mainly focused on dogs, yet cats are also in need of homes. People may judge a cat’s behaviour based on physical factors, like coat colour, eye shape, and pupil size. This study aimed to determine whether those physical traits relate to cat adoptability and, if so, whether they might do this through influencing perceptions of cuteness and specific behaviours. Australian adults (N = 624) were surveyed online using a single cat image that was modified to have all possible combinations of four different coat colours, three eye shapes, and three pupil sizes. Adoptability scores varied significantly with the cat’s coat colour and eye shape, but not pupil size. Black cats with walnut-shaped eyes had the highest adoptability ratings. A stepwise multiple regression determined seven variables influencing adoptability scores, including the degree to which the image was rated as cute, friendly, shy, active, difficult, playful, and devoted. Cuteness had the strongest influence, explaining 34% of the model variance. Multiple two-way ANOVAs compared these seven variables across combinations of coat colour and eye shape, with black cats being perceived as significantly more friendly and playful. This information may help animal adoption agencies understand how cats’ physical features can be utilised in online profiles to enhance adoption outcomes. Full article

Infectious Bronchitis Virus is one of several major viral infections in poultry, affecting the respiratory, reproductive, and renal systems and causing significant economic losses worldwide. Current vaccines, including the H120 strain, provide limited cross-protection against emerging variants, underscoring the need for improved vaccine strategies. In this study, the complete genome of IBV H120 was divided into 12 fragments, synthesized, and assembled using the Golden Gate Assembly (GGA) method. The recombinant virus (rH120) was successfully rescued in chicken fibroblast cells and propagated in embryonated specific-pathogen-free (SPF) chicken eggs. Growth kinetics in embryonated SPF chicken eggs revealed similar replication patterns between rH120 and the original H120 strain. In broiler chickens, rH120 replicated efficiently, as confirmed by viral RNA detection in throat and cloacal swabs, and induced a stronger antibody response by 14 days post-infection. The rH120 virus proved to be genetically stable, infectious, and immunogenic, indicating that GGA-based reverse genetics is an effective system for IBV vaccine development. Full article