Search Results (2,841)

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Dose-dense chemotherapy shortens the interval between chemotherapy cycles and has shown improved outcomes in high-risk breast cancer patients. We retrospectively evaluated the efficacy and safety of dose-dense chemotherapy in 80 breast cancer patients treated at our hospital from 2020 to 2024. The regimen included epirubicin and cyclophosphamide followed by paclitaxel or docetaxel, with pegfilgrastim support. The overall treatment completion rate was 82.5%. Of the 80 patients, 55 underwent neoadjuvant chemotherapy, and the pathological complete response rate was significantly higher in triple-negative breast cancer (59.1%) compared to that in luminal-type cancer (9.1%). Common adverse events included anemia, liver dysfunction, myalgia, and peripheral neuropathy. Febrile neutropenia occurred in 8.8% of patients, with some cases linked to pegfilgrastim body pod use, particularly in individuals with low subcutaneous fat. Notably, two patients developed pneumocystis pneumonia, potentially associated with steroid administration. Despite these toxicities, most were manageable and resolved after treatment. Our findings support the efficacy of dose-dense chemotherapy, particularly in triple-negative breast cancer, while highlighting the importance of individualized supportive care and vigilance regarding hematologic and infectious complications. Full article

Background and Clinical Significance: Hemophilia A presents a considerable challenge in cardiac surgery due to the elevated risk of perioperative bleeding, particularly during procedures involving cardiopulmonary bypass. Standard management typically involves standard half-life (SHL) factor VIII (FVIII) concentrates, which require frequent dosing. Extended half-life (EHL) FVIII products offer theoretical advantages, including prolonged action and reduced infusion frequency, but their use in cardiac surgery remains largely undocumented. Case Presentation: We report the case of a 73-year-old male with mild Hemophilia A who underwent successful aortic valve replacement using a 25 mm Carpentier-Edwards Magna Ease biological prosthesis. The patient was managed perioperatively with an anti-hemorrhagic protocol based on EHL recombinant FVIII. The surgery and postoperative course were uneventful, with no bleeding complications or need for transfusion. Conclusions: This case illustrates the potential role of EHL FVIII in safely managing hemophilic patients undergoing major cardiac surgery. Given the lack of existing reports in the literature, further studies are warranted to evaluate the efficacy and safety of EHL FVIII in this setting and to potentially optimize perioperative care protocols for this patient population. Full article

Weed management remains a critical challenge in the U.S. container ornamental production industry, where weeds not only compete with crops for limited resources but also harbor pests and pathogens, thereby diminishing plant quality and marketability. The paper explores the economic impact of weed infestations, herbicide resistance development, and the limited availability of selective herbicides for ornamental crops in the United States. This review synthesizes current chemical weed control tactics, focusing not only on both preemergence and postemergence herbicides commonly used in ornamental nurseries, but also organic alternatives and integrated weed management (IWM) approaches as complementary strategies by evaluating their effectiveness, crop safety, and usage. There is a critical need for research in the areas of alternative chemical options such as insecticides, miticides (e.g., Zerotol and Tetra Curb Max), and organic products for liverwort control in greenhouses. Although essential oils and plant-based extracts show some potential, their effectiveness and practical use remain largely unexplored. Full article

The management of acute lymphoblastic leukemia (ALL), the most common pediatric malignancy, critically relies on thiopurine therapy, such as 6-mercaptopurine (6-MP), during the maintenance phase. However, significant inter-individual response variety and high risk of myelosuppression often disrupt therapy efficacy. Pharmacogenetics offer crucial strategies to personalized therapy. While thiopurine methyltransferase (TPMT) was initially the primary focus, the discovery of nudix hydrolase 15 (NUDT15) appears as a more comprehensive determinant of thiopurine intolerance. This review aims to consolidate and critically evaluate the advancement achieved in unraveling the biological mechanism and clinical significance of NUDT15 pharmacogenetics in thiopurine therapy. Foundational studies showed the vital role of NUDT15 in the detoxification of active thiopurines, with common genetic variants (for instance, p. Arg139Cys) significantly disrupting its activity, leading to the accumulation of toxic metabolites. Observational studies consistently associated NUDT15 variants with severe myelosuppression, notably in Asian populations. Recent randomized controlled trials (RCTs) confirmed that NUDT15 genotype-guided dosing effectively reduces thiopurine-induced toxicity without interfering with the therapeutic outcome. Despite these advancements, challenges remain present, including the incomplete characterization of rare variants, limited data in the diverse Asian populations, and the need for standardized integration with metabolite monitoring. In conclusion, NUDT15 pharmacogenetics is essential for improving patient safety and thiopurine dosage optimization in the treatment of ALL. For thiopurine tailored medicine to be widely and fairly implemented, future research should focus on increasing genetic data across different populations, improving the dose adjustment algorithm, and harmonizing therapeutic guidelines. Full article

Background: Fixed-dose combinations have advanced in many therapeutic areas, including otorhinolaryngology, where hearing disorders are increasingly prevalent. Objectives: The present study focuses on developing and evaluating a new capsule combining nicergoline (NIC), piracetam (PIR), and hawthorn extract (HE) for the management of sensorineural hearing loss. Methods: The first phase methodology comprised preformulation studies (DSC, FTIR, and PXRD) to assess compatibility among active substances and excipients. Subsequently, four formulations were prepared and tested for flowability, dissolution behavior in acidic and neutral media, and stability under oxidative, thermal, and photolytic stress. Quantification of the active substances and flavonoids was performed using validated spectrophotometric and HPLC-UV methods. Results: Among the tested variants, the F1 formulation (4.5 mg NIC, 200 mg PIR, 50 mg HE, 2.5 mg magnesium stearate, 2.5 mg sodium starch glycolate, and 240.5 mg monohydrate lactose per capsule) displayed optimal technological properties, superior dissolution in acidic media, and was further selected for evaluation. The antioxidant activity of the formulation was confirmed through the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, Trolox Equivalent Antioxidant Capacity (TEAC), and iron chelation tests, and was primarily attributed to the flavonoid content of the HE. Acute toxicity tests in mice and rats indicated a high safety margin (LD₅₀ > 2500 mg/kg), while ototoxicity assessments showed no adverse effects on auditory function. Conclusions: The developed formulation displayed good stability, safety, and therapeutic potential, while the applied workflow could represent a model for the development of future fixed-dose combinations. Full article

Emerging transportation challenges necessitate cutting-edge technologies for real-time infrastructure and traffic monitoring. To create a dynamic digital twin for intersection monitoring, data gathering, performance assessment, and calibration of microsimulation software, this study presents a state-of-the-art platform that combines high-resolution LiDAR sensor data with VISSIM simulation software. Intending to track traffic flow and evaluate important factors, including congestion, delays, and lane configurations, the platform gathers and analyzes real-time data. The technology allows proactive actions to improve safety and reduce interruptions by utilizing the comprehensive information that LiDAR provides, such as vehicle trajectories, speed profiles, and lane changes. The digital twin technique offers unparalleled precision in traffic and infrastructure state monitoring by fusing real data streams with simulation-based performance analysis. The results show how the platform can transform real-time monitoring and open the door to data-driven decision-making, safer intersections, and more intelligent traffic data collection methods. Using the proposed platform, this study calibrated a VISSIM simulation network to optimize the driving behavior parameters in the software. This study addresses current issues in urban traffic management with real-time solutions, demonstrating the revolutionary impact of emerging technology in intelligent infrastructure monitoring. Full article

Background/Objectives: The advent of tyrosine kinase inhibitors (TKIs) revolutionized the management of chronic myeloid leukemia (CML), achieving survival rates near those of the general population. Despite this success, prolonged therapy presents challenges, including physical, emotional, and financial burdens. Treatment-free remission (TFR), defined as sustained deep molecular response (DMR) after discontinuing TKIs, has emerged as a viable clinical goal. This study evaluates real-world data from the Canary Islands Registry of CML (RCLMC) to explore outcomes, predictors, and the feasibility of TFR. Methods: This retrospective observational study included 393 patients diagnosed with CML-CP between 2007 and 2023. Molecular response was monitored according to international guidelines. Survival probabilities were estimated using the Kaplan–Meier method. Logistic regression analysis was performed to identify predictors of molecular relapses after TKI discontinuation. Results: Of the 383 patients who received TKI treatment, 58.3% achieved molecular response grade 2 (MR2) (BCR-ABL1 ≤ 1%), 95.05% achieved MR2, and 50.5% reached MR4 within the first year. Of the 107 patients attempting TFR, 73.2% maintained remission at 36 months. Relapses occurred in 24 patients, all regaining molecular response upon reintroduction of TKIs. No cases of disease progression were observed. Conclusions: Our findings support the feasibility and safety of TFR in a real-world clinical setting for well-selected patients, with outcomes consistent with international studies. The study underscores the importance of molecular monitoring and patient-specific strategies to optimize outcomes. Full article

Objective: Cervical pregnancy (CP) accounts for less than 1% of all ectopic pregnancies. The standard of management for CP is still under detailed investigation; however, among the known treatment methods, super-selective uterine artery embolization (UAE) and the use of methotrexate (MTX) have emerged as effective and minimally invasive options in recent years. Our aim is to present our center’s experience and provide available evidence evaluating the efficacy of UAE in the treatment of CP. Materials and Methods: This single-center and retrospective study evaluated the procedural and clinical outcomes of patients with CP who underwent endovascular uterine embolization with MTX between 2017 and 2024. Both procedural and clinical efficacy and safety, as well as the rate of complications and long-term outcomes, were noted. Results: A total of nine patients were diagnosed with CP (imaging examination included transvaginal ultrasound and/or magnetic resonance imaging) and referred for endovascular treatment. The mean age of the patients was 36.7 years, and the mean gestational age on admission was 9 weeks. In all cases, selective catheterization of supplying vessels and subsequent embolization with a mixture of methotrexate and gel sponge was carried out. The technical success rate was 100% with no complications. Follow-up ultrasound confirmed the disappearance of the flow signal around the intracervical gestational sac in all cases. Conclusions: In conclusion, this retrospective study demonstrated the procedural and clinical safety and efficacy of uterine artery embolization in patients with cervical pregnancy. This is why endovascular therapy should be proposed to these individuals and be included in treatment options discussed during multidisciplinary boards. Full article

This study investigates a novel heat pipe integrated cooling system designed for thermal management of Tesla’s 4680 cylindrical lithium–ion batteries in electric vehicles (EVs). Through a comprehensive approach combining experimental analysis, 1-D AMESim simulations, and 3-D Computational Fluid Dynamics (CFD) modeling, the thermal performance of various wick structures and working fluid filling ratios was evaluated. The experimental setup utilized a triangular prism chamber housing three surrogate heater blocks to replicate the heat generation of 4680 cells under 1C, 2C, and 3C discharge rates. Results demonstrated that a blended fabric wick with a crown-shaped design (Wick 5) at a 30–40% filling ratio achieved the lowest maximum temperature (T_max of 47.0°C), minimal surface temperature deviation (ΔT_surface of 2.8°C), and optimal thermal resistance (R_th of 0.27°C/W) under 85 W heat input. CFD simulations validated experimental findings, confirming stable evaporation–condensation circulation at a 40% filling ratio, while identifying thermal limits at high heat loads (155 W). The proposed hybrid battery thermal management system (BTMS) offers significant potential for enhancing the performance and safety of high-energy density EV batteries. This research provides a foundation for optimizing thermal management in next-generation electric vehicles. Full article

Reactive molecules, including oxygen and nitrogen species, serve dual roles in human physiology. While they function as essential signaling molecules under normal physiological conditions, they contribute to cellular dysfunction and damage when produced in excess by normal metabolism or in response to stressors. Oxidative/nitrosative stress is a pathological state, resulting from the overproduction of reactive species exceeding the antioxidant capacity of the body, which is implicated in several chronic human diseases. Antioxidant therapies aimed at restoring redox balance and preventing oxidative/nitrosative stress have demonstrated efficacy in preclinical models. However, their clinical applications have met with inconsistent success owing to efficacy, safety, and bioavailability concerns. This summative review analyzes the role of reactive species in human pathophysiology, the mechanisms of action of antioxidant protection, and the challenges that hinder their translation into effective clinical therapies in order to evaluate potential emerging strategies such as targeted delivery systems, precision medicine, and synergistic therapeutic approaches, among others, to overcome current limitations. By integrating recent advances, this review highlights the value of targeting reactive species in the prevention and management of chronic diseases. Full article

In many developing African countries, milk safety is often managed through traditional methods such as fermentation or boiling over firewood. While these approaches reduce some microbial risks, they present critical limitations. Firewood dependency contributes to deforestation, depletion of agricultural residues, and loss of soil fertility, which, in turn, compromise environmental health and food security. Solar pasteurization provides a reliable and sustainable method for thermally inactivating pathogenic microorganisms in milk and other perishable foods at sub-boiling temperatures, preserving its nutritional quality. This study aimed to evaluate the thermal and microbial performance of a low-cost solar milk pasteurization system, hypothesized to effectively reduce microbial contaminants and retain milk quality under natural sunlight. The system was constructed using locally available materials and tailored to the climatic conditions of the Savanna ecological zone in West Africa. A flat-plate glass solar collector was integrated with a 0.15 cm thick stainless steel cylindrical milk vat, featuring a 2.2 cm hot water jacket and 0.5 cm thick aluminum foil insulation. The system was tested in Navrongo, Ghana, under ambient temperatures ranging from 30 °C to 43 °C. The pasteurizer successfully processed up to 8 L of milk per batch, achieving a maximum milk temperature of 74 °C by 14:00 GMT. Microbial analysis revealed a significant reduction in bacterial load, from 6.6 × 10⁶ CFU/mL to 1.0 × 10² CFU/mL, with complete elimination of coliforms. These results confirmed the device’s effectiveness in achieving safe pasteurization levels. The findings demonstrate that this locally built solar pasteurization system is a viable and cost-effective solution for improving milk safety in arid, electricity-limited regions. Its potential scalability also opens avenues for rural entrepreneurship in solar-powered food and water treatment technologies. Full article

Background: The rationale for strict fluid fasting for pediatric and adult patients has been questioned recently. Point-of-care tools for the evaluation of gastric content have evolved over time, often using gastric ultrasound. Usually, the gastric antral cross-sectional area (CSA) is determined. A liberal fluid fasting regimen, that is, ingestion of liquid fluids until the call for theatre, does not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound. Anesthesia is safe, and no adverse events result from a liberal regimen. Methods: The ethics committee of LMU Munich approved the study (21-0903). Liberal fluid fasting in a geriatric orthopedic surgery department (LFFgertrud) is a sub-study within a project investigating perioperative neurocognitive disorders (Study Registration: DRKS00026801). After obtaining informed consent from 134 geriatric patients 70 years or older, we investigated the gastric antral cross-sectional area (CSA) prior to and postimplementation of liberal fluid management, respectively. Results: After the implementation of liberal fluid fasting, fasting times for solid food and liquids decreased from 8.8 (±5.5) to 1.8 (±1.8) hours (p < 0.0001). In 39 patients where CSA was obtained, a slight increase in fluid was encountered. No critical amount of gastric content was observed, and no adverse events occurred. Conclusions: A liberal fluid fasting concept was safe even for comorbid elderly patients in orthopedic surgery. Applying a gastric ultrasound may be helpful to increase safety. According to the incidence of complications encountered in our study, it seems indispensable. Full article

Background: Pain is a problem faced by critically ill surgical patients and has a major impact on their outcomes. Pain assessment is therefore essential for effective pain management, with a combination of pharmacological and non-pharmacological treatment. Clinical supervision, supported by models such as SafeCare, can improve professional development, safety and the quality of care in intensive care units. Objectives: This study aimed to: (1) assess current pain assessment practices in a polyvalent Intensive Care Unit (ICU) in the Porto district; (2) identify nurses’ training needs regarding the Clinical Supervision-Sensitive Indicator—Pain; and (3) evaluate the impact of clinical supervision sessions on pain assessment practices. Methods: A quantitative, quasi-experimental, cross-sectional study with a pre- and post-intervention design was conducted. Based on the SafeCare model, it included a situational diagnosis, 6 clinical supervision sessions (February 2023), and outcome evaluation via nursing record audits (November 2022 and May 2023) in 31 total critical ill patients. Pain was assessed using standardised tools, in line with institutional protocols. Data was analysed using Software Statistical Package for the Social Sciences v25.0. Results: Pain was highly prevalent in the first 24 h, decreasing during hospitalisation. Generalised acute abdominal pain predominated, with mild to moderate intensity, and was exacerbated by wound care and mobilisation/positioning. Pain management combined pharmacological and non-pharmacological treatment. There was an improvement in all the parameters of the pain indicator post-intervention. Conclusions: Despite routine assessments, gaps remained in reassessing pain post-analgesia and during invasive procedures. Targeted clinical supervision and ongoing training proved effective in improving compliance with protocols and supporting safer, more consistent pain management. Full article

Clozapine, a second-generation antipsychotic known for its effectiveness in treating resistant schizophrenia, is often linked with serious hematological side effects, particularly neutropenia and agranulocytosis. This review investigates the underlying pathophysiological mechanisms of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA), outlines associated risk factors, and evaluates current clinical management strategies. Clozapine’s pharmacological profile, marked by its antagonism of dopamine D4 and serotonin receptors, contributes to both its therapeutic advantages and hematological toxicity. Epidemiological data show a prevalence of CIN and CIA at approximately 3.8% and 0.9%, respectively, with onset typically occurring within the first six months of treatment. Key risk factors include older age, Asian and African American ethnicity, female sex, and certain genetic predispositions. The development of CIN and CIA may involve bone marrow suppression and autoimmune mechanisms, although the exact processes remain partially understood. Clinical presentation often includes nonspecific symptoms such as fever and signs of infection, necessitating regular hematological monitoring in accordance with established guidelines. Management strategies include dosage adjustments, cessation of clozapine, and the administration of granulocyte colony-stimulating factors (G-CSF). Advances in pharmacogenomics show promise for predicting susceptibility to CIN and CIA, potentially improving patient safety. This review emphasizes the importance of vigilant monitoring and personalized treatment approaches to reduce the risks associated with clozapine therapy. Full article