Search Results (7,933)

Slovakia’s biomethane production potential represents up to 10% of Slovakia’s natural gas consumption, which is largely unexploited. The aim of this paper is to develop a model of each available technology (continuous, dry batch, and wet batch) as well as that of a biogas treatment unit and evaluate the energetic, economic, and environmental potential of building a new anaerobic digestion plant in Slovakia, considering four plant locations with feedstock abundance within a 30 km perimeter. Feedstock composition and availability, energy integration, and product usability are evaluated. The applied multi-criteria decision analysis (MCDA) considers four evaluation criteria: return on investment (ROI), CO₂ emissions production, potential industrial biowaste revenue, and municipal density within the operational region. Biogas plant deployment analysis yielded the Levice facility as top-ranked, primarily due to its minimal environmental impact and superior logistical performance, closely followed by the Žilina, Michalovce, and Prešov facilities. When comparing biomethane production facilities, the Levice plant was excluded due to economic infeasibility, and the Žilina facility emerged as the optimal choice, particularly due to its superior ROI performance and the largest biomethane production potential of over 1 million m³ biomethane per year. Thus, biomethane station deployment in Slovakia has proved feasible and can enhance the energy self-sustainability of the country and contribute to meeting the decarbonization goals. Full article

Sustainable urban water system (UWS) management is vital for climate-resilient, resource-efficient cities. This study presents the first comprehensive life cycle assessment (LCA) of Seoul Metropolitan City (SMC)’s UWS, encompassing water abstraction, treatment, distribution, wastewater collection and treatment, and sludge management. Nine midpoint impact categories from ReCiPe 2016 (H) were analyzed to identify environmental hotspots and mitigation pathways. Results show that wastewater treatment dominates impacts, contributing 57.3% of global warming potential (GWP; 0.947 kg CO₂-eq per functional unit of 1 m³ of potable water supplied) and 71.1% of freshwater eutrophication (FE; 0.00066 kg P-eq/m³), driven by electricity use, sludge disposal, and direct CH₄/N₂O emissions. Electricity consumption is the leading driver across GWP, terrestrial acidification (TA), and fossil resource scarcity (FRS). Infrastructure construction notably influenced terrestrial ecotoxicity (TET) and human toxicity. Sensitivity analysis showed that SMC’s projected 2030 electricity mix could reduce GWP and FRS by up to 18%. Scenario evaluations revealed that sludge ash utilization in concrete and expanded wastewater reuse improve resource circularity, whereas biogas upgrading, solar generation, and heat recovery significantly lower GWP and FRS. The findings underscore the importance of energy decarbonization, resource recovery, and infrastructure longevity in achieving low-carbon and resource-efficient UWSs. This study offers a transferable framework for guiding sustainability transitions in rapidly urbanizing, energy-transitioning regions. Full article

Continuous growth in prices for primary energy sources and environmental restrictions on pollutant emissions justify investments in industrial facilities to minimize specific energy consumption. In addition, oil-producing and refining enterprises were built in previous decades, when energy efficiency problems were not so urgent, so little attention was paid to the development and application of tools for improvement. In this regard, at present, the application and development of methods for increasing energy efficiency is certainly relevant, especially for oil processing and stabilization units (OPSUs) at fields, through which all oil produced in a country passes. Our goal is to achieve heat integration of OPSUs with a capacity of 4 million tons of processed raw materials per year. In this study, for the heat integration of the OPSU, pinch-analysis methods with the construction of grid diagrams are used for a retrofitting project for increasing the energy efficiency of the heat exchange network (HEN) of an OPSU. The heat and economic analysis of the synthesized HEN were performed using Pinch 2.02 software. This paper presents a retrofitting-based energy-efficiency project for the OPSU HEN. A method for evolving the synthesized HEN by breaking heat load paths is applied to increase the economic efficiency of the retrofit project. The stability of the OPSU operation in the optimal mode is shown with the observed change in the bank interest rate. The implementation of the synthesized HEN will reduce specific energy consumption by 77%, decreasing CO₂ emissions released into the atmosphere by 30 thousand tons per year. Full article

Background: This scoping review screens modern literature in search of effective treatment approaches that target both upper and lower airway diseases. Methods: After the establishment of a research protocol, 227 potential articles were obtained through a logged search method. These were screened and narrowed down to 26 included articles. Data were extracted using a standardized data extraction form and were analyzed thematically and analytically. Results: The main integrated treatment approaches are biological (dupilumab was the most mentioned molecule) and non-biological (allergen immunotherapy, nasal saline irrigation, and endoscopic polypectomy). Data suggest that these approaches are effective in improving upper and lower airway outcomes and showcase a good safety profile. Conclusions: Patients with upper and lower airway diseases should benefit from integrated treatment approaches when possible. Full article

Accurate documentation of burn wounds is essential for evaluating treatment outcomes and monitoring healing progression. Traditional two-dimensional (2D) photography remains the clinical standard but lacks depth and volumetric accuracy. Three-dimensional (3D) scanning offers enhanced visualization of wound morphology and tissue vitality, potentially improving objectivity in burn assessment. This study compares two handheld 3D scanning systems—Artec Eva and Revopoint Miraco—in documenting acute and healing burn wounds, using standard clinical photography as the reference. Fifteen patients with second-degree and third-degree burns were prospectively examined at the Burn Unit of AGEL Hospital Košice-Šaca, with five representative cases selected for detailed analysis. For each patient, clinical photographs and paired 3D scans were obtained under standardized conditions and evaluated for color fidelity, wound margin clarity, representation of epithelialisation islands, necrotic tissue, and correlation with clinical findings. Across all cases, Artec Eva demonstrated superior color accuracy, clearer wound delineation, and more realistic visualization of tissue vitality and re-epithelialisation. Revopoint Miraco reliably captured wound shape but produced darker tones and exaggerated surface relief, occasionally distorting depth perception. Overall, both systems successfully identified key healing features; however, Artec Eva provided more clinically accurate and visually consistent results. Three-dimensional scanning represents a valuable adjunct to conventional burn documentation. Full article

Recently, deep learning methods have seen major advancements and are preferred for medical image analysis. Clinically, deep learning techniques for cancer image analysis are among the main applications for early diagnosis, detection, and treatment. Consequently, segmentation of breast histology images is a key step towards diagnosing breast cancer. However, the use of deep learning methods for image analysis is constrained by challenging features in the histology images. These challenges include poor image quality, complex microscopic tissue structures, topological intricacies, and boundary/edge inhomogeneity. Furthermore, this leads to a limited number of images required for analysis. The U-Net model was introduced and gained significant traction for its ability to produce high-accuracy results with very few input images. Many modifications of the U-Net architecture exist. Therefore, this study proposes the watershed encoder–decoder neural network (WEDN) to segment cancerous lesions in supervised breast histology images. Pre-processing of supervised breast histology images via augmentation is introduced to increase the dataset size. The augmented dataset is further enhanced and segmented into the region of interest. Data enhancement methods such as thresholding, opening, dilation, and distance transform are used to highlight foreground and background pixels while removing unwanted parts from the image. Consequently, further segmentation via the connected component analysis method is used to combine image pixel components with similar intensity values and assign them their respective labeled binary masks. The watershed filling method is then applied to these labeled binary mask components to separate and identify the edges/boundaries of the regions of interest (cancerous lesions). This resultant image information is sent to the WEDN model network for feature extraction and learning via training and testing. Residual convolutional block layers of the WEDN model are the learnable layers that extract the region of interest (ROI), which is the cancerous lesion. The method was evaluated on 3000 images–watershed masks, an augmented dataset. The model was trained on 2400 training set images and tested on 600 testing set images. This proposed method produced significant results of $98.53\%$ validation accuracy, $96.98\%$ validation dice coefficient, and $97.84\%$ validation intersection over unit (IoU) metric scores. Full article

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA treatment, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) remains unclear. This study evaluates the efficacy and safety of baricitinib in patients with severe AA and coexisting psoriasis and/or PsA. Materials and Methods: A retrospective case series of five patients (mean age 53.2 years) with severe AA (SALT > 80) or alopecia universalis (AU) and concomitant psoriasis (n = 2) and/or PsA (n = 3) was conducted in the Dermatology Unit of Policlinico of Tor Vergata, Catholic University of the Sacred Heart and La Sapienza University of Rome, Italy. Patients received baricitinib 4 mg/day and were assessed at weeks 4, 24, and 52 using SALT, PASI, and pVAS scores. Results: At week 52, one patient achieved complete AA remission, while two improved to SALT < 20 (mean SALT 83 to 8.75). Psoriasis remained stable (mean PASI 1.4 to 0.5). However, one PsA patient worsened (pVAS 9) and discontinued the treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but it may not be optimal for PsA. Further studies are needed to define its role in multiple immune diseases. Full article

Therapeutic plasma exchange is a procedure in which plasma is removed and replaced with another fluid to correct blood abnormalities. There is growing evidence of its benefit in certain clinical conditions, including thrombotic thrombocytopenic purpura, hematological diseases, and immune-mediated neurological disorders. Therapeutic plasma exchange prescription includes the choice of technique (centrifugation or membrane filtration) and the choice of vascular access, as well as the total plasma volume to be exchanged, the type of replacement fluid, the number and frequency of sessions, and the method of anticoagulation. These patients may be critically ill and undergo this technique in an intensive care unit, where the intensivist manages the procedure independently or in collaboration with other specialists. We aim to make an easy-to-follow general prescription of this procedure, by offering a practical revision that empowers physicians, such as non-autonomous intensivists, to autonomously prescribe and manage this procedure, reducing delays in initiating treatment and addressing complications. Full article

Chronic Pseudomonas aeruginosa lung infections in cystic fibrosis (CF) represent one of the most treatment-refractory bacterial diseases, sustained by biofilm formation, metabolic dormancy, and adaptive antibiotic resistance evolution. While bacteriophage (phage) therapy has emerged as a promising alternative for multidrug-resistant (MDR) pathogens, clinical studies in CF have demonstrated transient reductions in bacterial burden without achieving complete eradication. This review integrates molecular, evolutionary, and immunological findings to explain the multifactorial barriers that limit phage therapeutic efficacy in chronic CF infections. We highlight three major obstacles: (i) bacterial dormancy and persistence within biofilms that restrict phage adsorption and replication; (ii) hypermutability and extensive genotypic diversification of CF-adapted P. aeruginosa, which accelerate phage resistance evolution and necessitate broad host-range coverage; and (iii) CF-specific immune constraints—including a dysfunctional innate immune system and phage-neutralizing humoral immunity—that reduce phage bioavailability and undermine sustained bacterial clearance. Emerging strategies to overcome these challenges include the discovery of dormant-targeting phages capable of replicating in metabolically quiescent cells, evolution-informed phage training to delay resistance evolution, and synthetic phage engineering approaches designed to disrupt biofilms and expand host-range coverage. In parallel, computational or artificial intelligence (AI)-guided frameworks for phage cocktail design and cystic fibrosis transmembrane conductance regulator (CFTR) modulator-mediated restoration of host immune function together offer a more integrated therapeutic paradigm that unites phage biology and host immune context. By unifying clinical outcomes with mechanistic, evolutionary, and immunological perspectives, this review outlines a next-generation framework for phage therapy in CF aimed at achieving more durable therapeutic outcomes. Full article

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Hemadsorption therapies remove inflammatory mediators and are used as adjunctive treatment in selected patients. Although increased immature granulocyte (IG) levels correlate with inflammatory severity, changes in IG levels after hemadsorption therapy have not been previously evaluated. Methods: This retrospective observational study included patients with sepsis who received hemadsorption therapy in intensive care units between January 2021 and July 2025. Sepsis was diagnosed according to the Surviving Sepsis Campaign 2021 guidelines, and hemadsorption was initiated for persistent hemodynamic instability despite standard therapy. Treatment was performed using a Jafron HA330 cartridge for at least three 6 h sessions. IG count and percentage, inflammatory parameters, lactate levels, and organ dysfunction scores were recorded before and after therapy. ICU mortality was the primary outcome. Statistical analyses included paired comparisons, multivariable logistic regression, and ROC curve analysis. Results: Among 887 patients with sepsis, 196 met the inclusion criteria. The ICU mortality rate was 43.9%, and the median time between pre- and post-treatment measurements was 4 days (IQR: 3–5). After hemadsorption therapy, IG count, IG%, inflammatory parameters, lactate levels, SOFA scores, and vasopressor requirements decreased (all p-values < 0.001). IG parameters were higher in non-survivors. Post-treatment IG# (AUC 0.880) and IG% (AUC 0.812) showed good discriminative performance. Conclusions: Hemadsorption therapy was associated with reductions in IG parameters and inflammatory indicators in sepsis. These findings support IG parameters as complementary measures of immune and inflammatory dynamics during hemadsorption therapy. Accordingly, this study should be regarded as a hypothesis-generating investigation describing associations of IG dynamics in septic patients undergoing hemadsorption, rather than demonstrating treatment efficacy or causal effects. Full article

Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs. Full article

Background/Objectives: Reduced-ejection-fraction heart failure (HFrEF) constitutes a challenge due to its high morbidity and mortality. The use of sacubitril/valsartan (angiotensin receptor–neprilysin inhibitors [ARNI]) and SGLT2 inhibitors (SGLT2i) represents a change in management approach with a demonstrated association with positive ventricular remodeling and a reduction in cardiovascular events. We describe the clinical and therapeutic course of patients with HFrEF in a specialized unit, comparing two consecutive periods (2011–2016 vs. 2017–2021), with emphasis on the impact of ARNI and SGLT2i upon clinical parameters and the use of devices. Methods: A retrospective, longitudinal observational study was carried out in 1363 outpatients with HFrEF, with at least two years of follow-up. Clinical characteristics, treatments, the evolution of left ventricular ejection fraction (LVEF), mortality, and the use of devices (implantable cardioverter–defibrillator [ICD], cardiac resynchronization therapy [CRT]) were evaluated. Results: A total of 1363 patients were analyzed, showing a significant therapeutic change in the 2017–2021 group with the incorporation of ARNI (40%) and SGLT2i (25%). This cohort achieved better ventricular recovery, with a significantly higher mean LVEF at one year compared to the 2011–2016 group (44.3% vs. 42.1%; p = 0.004). Regarding devices, ICD implantation rate decreased in the recent period (7.2% vs. 11.1%; p = 0.016), while CRT indication increased. Most importantly, all-cause mortality after two years fell from 9.4% to 5.9% (p = 0.023). Multivariate analysis confirmed that this survival improvement was independently associated with the study period (HR 1.57 for the earlier group) and was linked to the protective effect of contemporary pharmacological treatments. Conclusions: The systematic introduction of ARNI and SGLT2i in the treatment of HFrEF was associated with improved ventricular function, reduced need for device implantation, and lower mortality over the middle term in a real-life clinical setting. Full article

The rising incidence of invasive fungal infections (IFIs) and the associated antifungal resistance underscore the need for antifungal stewardship (AFS) programs. Evaluating physicians’ knowledge and practices is crucial for identifying gaps and planning effective AFS interventions. A self-administered questionnaire was distributed to staff and resident physicians at a referral university-affiliated hospital in Greece in November 2025. The survey examined participants’ knowledge on fungal diagnosis and treatment, their prescribing attitudes and practices, and their AFS-related education, knowledge and preferences. In total, 70 physicians (46 residents and 24 staff consultants) participated in the survey from medical departments (63%), surgical departments (30%), and intensive care units (7%). Physicians surveyed demonstrated a low average knowledge score of 36.6% correct answers (SD, 22.7%; range 0% to 90%) regarding IFIs and antifungal agents, and significant variation was observed across different hospital departments. Awareness of risk factors for IFI varied widely, with recognition rates of different factors ranging from 10% to 100% across departments. Many physicians (71%) reported a lack of confidence in prescribing antifungal therapy and reliance on infectious disease experts was common (84%). Most preferred training methods were case-based discussions and printed guidelines. The substantial knowledge gaps and low confidence in prescribing antifungals among physicians highlight the urgent need for education and implementation of local guidelines to optimize antifungal use that might improve patient outcomes. Full article

Objectives: Central airway obstruction (CAO) caused by malignant tumors may necessitate combined and prompt treatment. The aim is to recanalize and stabilize the airways as palliation. We present our multicentric experience managing malignant CAO through the placement of Y-shaped self-expanding covered metallic or silicone trachea-bronchial stents. Methods: This retrospective study includes patients who underwent placement of Y-shaped stents from 2002 to 2024 across six different centers in Italy and Great Britain. We evaluated outcomes related to the feasibility and safety of the procedure, as well as the palliation of dyspnoea on the Modified Borg Scale of Dyspnoea. Results: Eighty patients (56.2% female) with a mean age of 64.8 ± 9.6 years were included in the study. Successful placement was achieved in 76 (95%) cases, with no cases of intraoperative mortality. The mean procedure time was 36.64 ± 15.7 min. The complications noted included: 7 (8.7%) cases of periprocedural clinical complications and 7 (8.7%) patients requiring intensive care unit admittance after the procedure. Fifty patients (78.1%) received cancer treatment following the procedure. The mean dyspnoea score on the Borg scale decreased from 7.78 ± 0.98 to 4.02 ± 2.2 (p < 0.05). Conclusions: The placement of metal or silicone Y-shaped stents is a feasible and safe procedure for the palliative treatment of dyspnoea in patients with malignant stenosis of the trachea and main bronchi. Stabilizing the airway also enables these patients to access cancer treatments. Full article

Acid mine drainage (AMD) and acid-generating mine wastes exhibit low pH, high sulfate levels, and complex multi-metal loads that strain conventional treatment. Thermoacidophilic red algae of the order Cyanidiales, particularly Galdieria sulphuraria (G. sulphuraria), have attracted interest as a biological option because they tolerate extreme acidity and elevated temperatures, grow under low light in mixotrophic or heterotrophic modes, and display rapid metal binding at the cell surface. This review synthesizes about two decades of peer-reviewed work to clarify how G. sulphuraria can be deployed as a practical module within mine water treatment trains. We examine the mechanisms of biosorption and bioaccumulation and show how they map onto two distinct configurations. Processed freeze-dried biomass functions as a regenerable sorbent for rare earth elements (REEs) and selected transition metals in packed beds with acid elution for recovery. Living cultures serve as polishing units for divalent metals and, when present, nutrients or dissolved organics under low light. We define realistic operating windows centered on pH 2–5 and temperatures of approximately 25–45 °C, and we identify matrix effects that govern success, including competition from ferric iron and aluminum, turbidity and fouling risks, ionic strength from sulfate, and suppression of REE uptake by phosphate in living systems. Building on laboratory studies, industrial leachate tests, and ecosystem observations, we propose placing G. sulphuraria upstream of bulk neutralization and outline reporting practices that enable cross-site comparison. The goal is an actionable framework that reduces reagent use and sludge generation while enabling metal capture and potential recovery of valuable metals from mine-influenced waters. Full article