Search Results (10,128)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Background: Mediastinal staging plays a critical role in guiding treatment decisions for non-small cell lung cancer (NSCLC). While mediastinoscopy has been the gold standard for assessing mediastinal lymph node involvement, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative with comparable diagnostic accuracy. This systematic review evaluates the diagnostic performance, safety, cost-effectiveness, and feasibility of EBUS-TBNA versus mediastinoscopy for mediastinal staging. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines, including searches in Medline, Scopus, EMBASE, and Cochrane databases for studies published from 2010 onwards. A total of 1542 studies were identified, and after removing duplicates and applying eligibility criteria, 100 studies were included for detailed analysis. The extracted data focused on sensitivity, specificity, complications, economic impact, and patient outcomes. Results: EBUS-TBNA demonstrated high sensitivity (85–94%) and specificity (~100%), making it an effective first-line modality for NSCLC staging. Mediastinoscopy remained highly specific (~100%) but exhibited slightly lower sensitivity (86–90%). EBUS-TBNA had a lower complication rate (~2%) and was more cost-effective, while mediastinoscopy provided larger biopsy samples, essential for molecular and histological analyses. The need for general anaesthesia, longer hospital stays, and increased procedural costs make mediastinoscopy less favourable as an initial approach. Combining both techniques in select cases enhanced overall staging accuracy, reducing false negatives and improving diagnostic confidence. Conclusions: EBUS-TBNA has become the preferred first-line mediastinal staging method due to its minimally invasive approach, high diagnostic accuracy, and lower cost. However, mediastinoscopy remains crucial in cases requiring posterior mediastinal node assessment or larger tissue samples. The integration of both techniques in a stepwise diagnostic strategy offers the highest accuracy while minimizing risks and costs. Given the lower hospitalization rates and economic benefits associated with EBUS-TBNA, its widespread adoption may contribute to more efficient resource utilization in healthcare systems. Full article

Aqueous redox flow batteries (ARFBs) have attracted significant attention in the field of electrochemical energy storage due to their high intrinsic safety, low cost, and flexible system configuration. However, the advancement of this technology is still hindered by several critical challenges, including capacity decay, structural optimization, and the design and application of key materials as well as their performance within battery systems. Addressing these issues requires systematic theoretical foundations and scientific guidance. Numerical modeling has emerged as a powerful tool for investigating the complex physical and electrochemical processes within flow batteries across multiple spatial and temporal scales. It also enables predictive performance analysis and cost-effective optimization at both the component and system levels, thus accelerating research and development. This review provides a comprehensive overview of recent progress in the modeling of ARFBs. Taking the all-vanadium redox flow battery as a representative example, we summarize the key multiphysics phenomena involved and introduce corresponding multi-scale modeling strategies. Furthermore, specific modeling considerations are discussed for phase-change ARFBs, such as zinc-based ones involving solid–liquid phase transition, and hydrogen–bromine systems characterized by gas–liquid two-phase flow, highlighting their distinctive features compared to vanadium systems. Finally, this paper explores the major challenges and potential opportunities in the modeling of representative ARFB systems, aiming to provide theoretical guidance and technical support for the continued development and practical application of ARFB technology. Full article

Accurate finite element (FE) models are essential for the safety assessment of civil engineering structures. However, obtaining reliable model parameters for existing bridges remains challenging due to the inability to conduct static load tests without disrupting traffic flow. To address this, this study proposes an FE model updating framework that integrates the response surface method and the nutcracker optimization algorithm (NOA). This framework is characterized by the incorporation of ambient vibration data into parameter optimization, thereby enhancing model accuracy. The stochastic subspace identification method is first adopted to extract the bridge’s natural frequencies from vibration data. The response surface method is then employed to construct a response surface function that approximates the FE model. The NOA is subsequently applied to iteratively optimize this response surface function, ensuring rapid convergence and the precise adjustment of the FE model parameter. To validate the effectiveness of the proposed framework, a continuous beam–arch composite bridge with a span of 204.783 m was selected as a case study. The results indicate that the proposed method reduced the average frequency error from 5.58% to 2.75% by updating the model parameters. While the whale optimization algorithm required 21 iterations and the grey wolf optimizer needed 41 iterations to converge near the minimum, the NOA achieved this in merely 13 iterations, demonstrating the NOA’s superior convergence speed. Furthermore, the NOA significantly outperformed both the whale optimization algorithm and the grey wolf optimizer in reducing the error of the first transverse vibration frequency. 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

Background: RSV remains a leading cause of infant hospitalization worldwide, and the recently approved nirsevimab could represent an effective and safe prophylactic strategy to prevent severe infections in the general neonatal population. Objectives: We conducted a retrospective observational monocentric pilot study in a mixed preterm/term birth cohort to add real-world evidence of the efficacy and safety of nirsevimab in preventing severe RSV infection. Methods: We included a total of 2035 consecutive infants admitted to the Neonatal Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy, from November 2024 to April 2025. We evaluated 30-day safety profiles and season-wide RSV infection rates, and the outcomes were also compared to newborns’ birth rate in the two previous seasons (2022–2023 and 2023–2024). Results: After the introduction of nirsevimab, a lower RSV infection rate was reported compared to previous seasons, and no adverse effects were observed. Compared to previous seasons, the clinical outcomes were more favorable, as only one unvaccinated neonate with RSV infection required invasive ventilation. Conclusions: In this real-world analysis, we demonstrated a good short-term safety profile of nirsevimab, as well as a potentially high efficacy in the general neonatal population with lower RSV infection incidence. However, future studies are needed to better assess its long-term safety and season-wide efficacy. Full article

Under normal conditions, the novel zinc blende beryllium oxide (zb BeO) exhibits in a metastable crystalline phase, which is less stable than its wurtzite counterpart. Ultrathin zb BeO epifilms have recently gained significant interest to create a wide range of advanced high-resolution, high-frequency, flexible, transparent, nano-electronic and nanophotonic modules. BeO-based ultraviolet photodetectors and biosensors are playing important roles in providing safety and efficiency to nuclear reactors for their optimum operations. In thermal management, BeO epifilms have also been used for many high-tech devices including medical equipment. Phonon characteristics of zb BeO at ambient and high-pressure P ≠ 0 GPa are required in the development of electronics that demand enhanced heat dissipation for improving heat sink performance to lower the operating temperature. Here, we have reported methodical simulations to comprehend P-dependent structural, phonon and thermodynamical properties by using a realistic rigid-ion model (RIM). Unlike zb ZnO, the study of the Grüneisen parameter γ(T) and thermal expansion coefficient α(T) in zb BeO has revealed atypical behavior. Possible reasons for such peculiar trends are attributed to the combined effect of the short bond length and strong localization of electron charge close to the small core size Be atom in BeO. Results of RIM calculations are compared/contrasted against the limited experimental and first-principle data. Full article

In this pilot study, the crossing behavior of elementary school students commuting on bicycles was investigated with the objective of enhancing safety around pedestrian crossings within school zones. With a noticeable increase in crashes involving young cyclists near schools, this research assessed the effectiveness of visual nudges in the form of red strips displaying “CYCLISTS DISMOUNT” instructions. Initial observations indicated a lack of compliance with dismounting regulations. After the initial observations, a specific elementary school was selected for the implementation of the nudging intervention and additional pre- (N = 91) and post-intervention (N = 71) observations. The pre-intervention observations again revealed poor adherence to the regulations requiring cyclists to dismount at specific points. Following our targeted intervention, the post-intervention observations marked an improvement in compliance. Indeed, the visual nudge effectively communicated the necessity of dismounting at a critical location, leading to a higher rate of adherence among cyclists (52.74% pre-intervention, 97.18% post-intervention). Although it also indirectly affected the behavior of the accompanying adult, who more often held hands with their children while crossing, this effect was weaker than the direct effect on dismounting behavior (20.88% pre-intervention, 39.44% post-intervention). The findings of the current pilot study underscore the possible impact of nudging on behavior and advocate for a combined approach utilizing physical nudges to bolster safety within school zones. Follow-up research, including, for instance, multiple sites, long-term effects, or children traveling alone, is called for. Full article

In South Korea, securing ground space for installing hydrogen refueling stations in urban areas is challenging due to limited ground space and high-density development. Safety concerns for hydrogen systems in enclosed urban environments also require careful consideration. To address this issue, this study explored a method of undergrounding hydrogen infrastructure as a solution for urban hydrogen charging stations. This study examined the characteristics of hydrogen diffusion and concentration reduction under leakage conditions within a confined hydrogen infrastructure, focusing on key safety systems, including emergency shut-off valves (ESVs) and ventilation fans. We discovered that the ESV reduced hydrogen concentration by over 80%. Installing two or more ventilation fans arranged horizontally improves airflow and enhances ventilation efficiency. Moreover, increasing the number of fans reduces stagnant zones within the space, effectively lowering the average hydrogen concentration. Full article

Adverse drug events (ADEs) significantly impact patient safety and health outcomes. Manual ADE detection from clinical narratives is time-consuming, labor-intensive, and costly. Recent advancements in large language models (LLMs), including transformer-based architectures such as Bidirectional Encoder Representations from Transformers (BERT) and Generative Pretrained Transformer (GPT) series, offer promising methods for automating ADE extraction from clinical data. These models have been applied to various aspects of pharmacovigilance and clinical decision support, demonstrating potential in extracting ADE-related information from real-world clinical data. Additionally, chatbot-assisted systems have been explored as tools in clinical management, aiding in medication adherence, patient engagement, and symptom monitoring. This narrative review synthesizes the current state of LLMs in ADE detection from a clinical perspective, organizing studies into categories such as human-facing decision support tools, immune-related ADE detection, cancer-related and non-cancer-related ADE surveillance, and personalized decision support systems. In total, 39 articles were included in this review. Across domains, LLM-driven methods have demonstrated promising performances, often outperforming traditional approaches. However, critical limitations persist, such as domain-specific variability in model performance, interpretability challenges, data quality and privacy concerns, and infrastructure requirements. By addressing these challenges, LLM-based ADE detection could enhance pharmacovigilance practices, improve patient safety outcomes, and optimize clinical workflows. Full article

Vehicle-to-everything (V2X) communication is a fundamental technology in the development of intelligent transportation systems, encompassing vehicle-to-vehicle (V2V), infrastructure (V2I), and pedestrian (V2P) communications. This technology enables connected and autonomous vehicles (CAVs) to interact with their surroundings, significantly enhancing road safety, traffic efficiency, and driving comfort. However, as V2X communication becomes more widespread, it becomes a prime target for adversarial and persistent cyberattacks, posing significant threats to the security and privacy of CAVs. These challenges are compounded by the dynamic nature of vehicular networks and the stringent requirements for real-time data processing and decision-making. Much research is on using novel technologies such as machine learning, blockchain, and cryptography to secure V2X communications. Our survey highlights the security challenges faced by V2X communications and assesses current ML and blockchain-based solutions, revealing significant gaps and opportunities for improvement. Specifically, our survey focuses on studies integrating ML, blockchain, and multi-access edge computing (MEC) for low latency, robust, and dynamic security in V2X networks. Based on our findings, we outline a conceptual framework that synergizes ML, blockchain, and MEC to address some of the identified security challenges. This integrated framework demonstrates the potential for real-time anomaly detection, decentralized data sharing, and enhanced system scalability. The survey concludes by identifying future research directions and outlining the remaining challenges for securing V2X communications in the face of evolving threats. Full article

Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article

Objective: This retrospective observational study evaluated the efficacy and safety of an ovarian stimulation protocol for embryo banking that involves continuous administration of clomiphene citrate (CC) in combination with gonadotropins, without the use of GnRH antagonists. Methods: Conducted at the Serum IVF Clinic in Athens, Greece, the study included 250 women aged 25–45 who underwent IVF for embryo banking. The protocol involved administering 150 mg of CC daily from day 2 of the menstrual cycle until the day before hCG trigger, alongside 150 IU/day of Meriofert. Outcomes assessed included oocyte yield, fertilization rates, incidence of ovarian hyperstimulation syndrome (OHSS), and hormonal correlations. Comparative and regression analyses explored differences between age groups and predictors of success. Results: The protocol demonstrated a favorable safety profile with no cases of OHSS and yielded a mean of 10.25 oocytes per patient. Group analysis showed significantly more oocytes retrieved in women under 40 (mean: 12.5) versus those over 40 (mean: 8.43), while fertilization rates were paradoxically higher in the older cohort (59.16% vs. 30.68%, p < 0.0001). Regression models revealed basal FSH to be a significant inverse predictor of oocyte yield, but it was positively associated with fertilization rate. Continuous CC use effectively suppressed premature LH surges without compromising oocyte or embryo quality, allowing flexible and cost-effective stimulation with minimal monitoring. Conclusions: Continuous administration of clomiphene citrate in combination with gonadotropins presents a promising, antagonist-free ovarian stimulation protocol for embryo banking. The approach is economically efficient, reduces monitoring requirements, and maintains safety and effectiveness and is particularly notable in women over 40. Further studies are warranted to validate these findings and refine protocol mechanisms. Full article

The continuous advancement of fire protection technologies has necessitated the development of comprehensive safety standards, leading to an increasingly diversified and specialized regulatory landscape. This has made it difficult for fire protection professionals to quickly and accurately locate the required fire safety standard information. In addition, the lack of effective integration and knowledge organization concerning fire safety standard entities has led to the severe fragmentation of fire safety standard information and the absence of a comprehensive “one map”. To address this challenge, we introduce FT-FLAT, an innovative CNN–Transformer fusion architecture designed specifically for fire safety standard entity extraction. Unlike traditional methods that rely on rules or single-modality deep learning, our approach integrates TextCNN for local feature extraction and combines it with the Flat-Lattice Transformer for global dependency modeling. The key innovations include the following. (1) Relative Position Embedding (RPE) dynamically encodes the positional relationships between spans in fire safety texts, addressing the limitations of absolute positional encoding in hierarchical structures. (2) The Multi-Branch Prediction Head (MBPH) aggregates the outputs of TextCNN and the Transformer using Einstein summation, enhancing the feature learning capabilities and improving the robustness for domain-specific terminology. (3) Experiments conducted on the newly annotated Fire Safety Standard Entity Recognition Dataset (FSSERD) demonstrate state-of-the-art performance (94.24% accuracy, 83.20% precision). This work provides a scalable solution for constructing fire safety knowledge graphs and supports intelligent information retrieval in emergency situations. Full article

A wide range of strategies have been developed to modulate dysfunctional brain activities. This narrative review provides a comparative analysis of biophysical, genetic, and biological neuromodulation approaches with an emphasis on their known or unknown molecular targets and translational potential. The review incorporates data from both preclinical and clinical studies covering deep brain stimulation, transcranial electrical and magnetic stimulation, focused ultrasound, chemogenetics, optogenetics, magnetogenetics, and toxin-based neuromodulation. Each method was assessed based on specificity, safety, reversibility, and mechanistic clarity. Biophysical methods are widely used in clinical practice but often rely on empirical outcomes due to undefined molecular targets. Genetic tools offer cell-type precision in experimental systems but face translational barriers related to delivery and safety. Biological agents, such as botulinum neurotoxins, provide long-lasting yet reversible inhibition via well-characterized molecular pathways. However, they require stereotaxic injections and remain invasive. To overcome individual limitations and improve targeting, delivery, and efficacy, there is a growing interest in the synthesis of multiple approaches. This review highlights a critical gap in the mechanistic understanding of commonly used methods. Addressing this gap by identifying molecular targets may help to improve therapeutic precision. This concise review could be valuable for researchers looking to enter the evolving field of the neuromodulation of brain function. Full article