Search Results (2,005)

Building-integrated photovoltaic (BIPV) systems play a pivotal role in advancing low-carbon urban transformation. However, replacing conventional building envelope materials with photovoltaic (PV) panels modifies heat transfer processes and airflow patterns, potentially influencing urban environmental quality. This study examines the impacts of BIPV on building energy efficiency, PV system performance, and street canyon micro-climates, including airflow, temperature distribution, and pollutant dispersion, under perpendicular wind speeds ranging from 0.5 to 4 m/s, across three installation configurations and three installation positions. Results indicate that rooftop PV panels outperform facade-mounted systems in power generation. Ventilated PV configurations achieve optimal energy production and thermal insulation, thereby reducing building cooling loads and associated electricity consumption. Moreover, BIPV installations enhance street canyon ventilation, improving pollutant removal rates: ventilation rates increased by 1.43 times (rooftop), 3.02 times (leeward facade), and 2.09 times (windward facade) at 0.5 m/s. Correspondingly, canyon-averaged pollutant concentrations decreased by 30.1%, 87.7%, and 85.9%, respectively. However, the introduction of facade PV panels locally reduces pedestrian thermal comfort, particularly under low wind conditions, but this negative effect is significantly alleviated with increasing wind speed. To quantitatively evaluate BIPV-induced micro-climatic impacts, this study introduces the Pollutant-Weighted Air Exchange Rate (PACH)—a metric that weights the air exchange rate by pollutant concentration—providing a more precise indicator for evaluating micro-environmental changes. These findings offer quantitative evidence to guide urban-scale BIPV deployment, supporting the integration of renewable energy systems into sustainable urban design. Full article

Background and Aims: Severe acute respiratory distress syndrome (ARDS) in patients with long COVID remains associated with extremely high mortality and significant long-term sequelae. Non-invasive ventilatory strategies such as continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) are widely used before endotracheal intubation (ETI). Still, their comparative effectiveness in this population is not well established. Understanding survival outcomes and sequelae can help refine treatment strategies for this high-risk group. This study aimed to evaluate outcomes, sequelae, and treatment strategies in long COVID patients with severe ARDS, focusing on non-invasive ventilatory support before ETI. Materials and Methods: A retrospective cohort analysis was performed using a study comparing severe ARDS patients with and without COVID-19. The inclusion criterion was a Horovitz quotient (PaO₂/FiO₂) < 50 mmHg. Results: The study included a total of 59 patients diagnosed with long COVID-19 ARDS, with a mortality rate of 85%. A significant proportion of the patient population was male, accounting for 75%. The highest survival rate was observed among patients who initially received CPAP support, with a survival rate of 23.08%, in contrast to those treated solely with HFNC or those who alternated between HFNC and CPAP. Among patients who required endotracheal intubation and subsequent mechanical ventilation, survival rates were 40% for those who had previously received CPAP, 10% for those treated with alternating HFNC and CPAP, and 0% for those managed exclusively with HFNC before ETI. Survivors often exhibited sequelae, such as impaired pulmonary function, persistent dyspnea, and diminished physical performance. Conclusions: Patients with long COVID who develop severe ARDS (PaO₂/FiO₂ < 50 mmHg) face exceptionally high ICU mortality, with outcomes determined mainly by age, comorbidities, and profound hypoxemia. Although CPAP showed a trend toward improved survival, the data do not establish superiority and should be regarded as hypothesis-generating. Rather, they highlight the complexity of managing this underrepresented subgroup and underscore the need for larger, multicenter studies with broader inclusion criteria to confirm or refute these preliminary observations. Full article

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population. Full article

Severe acute respiratory syndrome (SARS), caused by the COVID-19 virus, continues to pose a significant public health challenge in Brazil, particularly in 2024, with high mortality rates among vulnerable groups. This study aimed to describe the sociodemographic, clinical and vaccination profiles of SARS cases due to COVID-19 in Brazil in 2024, as well as analysing factors associated with clinical outcomes such as death, admission to the intensive care unit (ICU) and the need for ventilatory support. A total of 30,529 reported cases were analysed. On average, the interval between the last vaccine dose and symptom onset was 30.31 months (SD = 6.77), while the interval between symptom onset and clinical outcome was 13.26 days (SD = 16.55), revealing significant variability. The results showed higher mortality rates among men (23.7%) than women (19.1%) (p < 0.0001). Mortality increased progressively with age, reaching 24.4% in individuals aged 60 years or older, whereas rates were below 2% in children under 10 years of age. The highest proportions of deaths were observed regionally in the Northeast (26.8%) and North (22.6%), in contrast to the Midwest (17.7%) (p < 0.0001). Men were also more likely to require ICU admission (38.1% vs. 33.6%) and ventilation (62.9% vs. 60.5%). A time interval of over 24 months since the last vaccine dose was associated with higher mortality (21.9% vs. 20.6%; p = 0.0005). These results highlight the importance of ongoing surveillance and updating the vaccination schedule, particularly for more vulnerable populations. Full article

Introduction: Radon is a radioactive noble gas formed from uranium decay in the Earth’s crust. The most significant isotope, 222Rn, emits alpha particles capable of damaging lung tissue and inducing cancer. Radon exposure is affected by geophysical and building characteristics and is recognized as a Group 1 carcinogen by the IARC. Despite regulatory thresholds (e.g., EURATOM standards), health risks remain. Various mitigation methods aim to reduce indoor radon exposure and its impact. Materials and Methods: This systematic review followed PRISMA guidelines. PubMed, Scopus, and Web of Science were searched up to 28 February 2025, using a defined string. Studies with original data on radon exposure and lung cancer risk or mitigation efficacy were included. Independent screening and quality assessment (Newcastle–Ottawa Scale) were conducted by multiple reviewers. Results: Of the 457 studies identified, 14 met the inclusion criteria. Eleven of these investigated the link between indoor radon and lung cancer risk, and three evaluated mitigation strategies. Radon levels were commonly measured using passive alpha track detectors. Levels varied depending on geographical location, season, building design and ventilation, these were higher in rural homes and during the colder months. Case–control studies consistently found an increased lung cancer risk with elevated radon exposure, especially among smokers. Effective mitigation methods included sub-slab depressurisation and balanced ventilation systems, which significantly reduced indoor radon concentrations. Adenocarcinoma was the most common lung cancer subtype in non-smokers, whereas squamous and small cell carcinomas were more prevalent in smokers exposed to radon. Discussion and Conclusions: This review confirms the robust association between indoor radon exposure and lung cancer. Risks persist even below regulatory limits and are amplified by smoking. While mitigation techniques are effective, their application remains uneven across regions. Stronger public education, building codes, and targeted interventions are needed, particularly in high-risk areas. To inform future prevention and policy, further research should seek to clarify radon’s molecular role in lung carcinogenesis, especially among non-smokers. Full article

Background: The Geriatric Nutritional Risk Index (GNRI) is a simple tool for nutritional assessment, but its long-term prognostic value in patients undergoing pancreaticoduodenectomy (PD) remains unclear. Methods: This retrospective study included adult patients who underwent PD between January 2014 and December 2023 at Chang Gung Memorial Hospital. Patients were grouped by GNRI: inferior (<82), moderate (82–98), and superior (≥98). Propensity score matching was performed based on age, sex, cancer type, surgical approach, and ASA status. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results: Among 371 patients, inferior GNRI was associated with worse median survival time (18.64 vs. 34.62 months, HR = 2.953, p < 0.001). This association was observed in both pancreatic cancer and other periampullary malignancies. Inferior GNRI also correlated with higher short-term mortality and adverse perioperative outcomes, including longer ICU stay, and greater need for ventilator support, reintubation, reoperation and total parenteral nutrition (TPN). Conclusions: Preoperative GNRI is a strong predictor of survival and short-term outcomes in PD patients. Early nutritional assessment may aid risk stratification and intervention. Full article

Background: Optimal energy and protein delivery during the early phase of severe trauma remains unclear. Observational studies frequently contradict the findings of randomized controlled trials, raising concerns about confounding factors. The aim of this study is to assess nutritional adequacy and daily variability in the energy gaps and its impact on outcomes using innovative statistical methods. Methods: Prospective observational study enrolled severely injured patients in the ICU at the Level 1 trauma center between October 2023 to April 2025. To describe the evolution of calorie and protein deficits during the first 10-day ICU stay, we utilized a linear mixed-effects model to estimate each patient’s individual energy gap trajectory. Results: 286 patients were analyzed. Median APACHE II and ISS score was 16.0 (12.0–20.0) and 22.0 (18.0–27.0), respectively. Mortality rate was 35.3%. Patients received 68.3% of prescribed calories and 76.8% of proteins. Admission energy deficit, rate of caloric intake, and their interaction are associated with ICU mortality. Increased day-to-day energy variability was associated with longer duration of mechanical ventilation (HR = 0.55, 95% CI: 0.31–0.99; p = 0.047). Patients who achieved better caloric (HR = 0.68, 95% CI: 0.48–0.98, p = 0.036) and protein (HR = 0.29, 95% CI: 0.09–0.96, p = 0.043) nutrition had a lower hazard of developing nosocomial infection. Conclusions: This study supports the 2023 ESPEN guidelines, showing that achieving the recommended energy and protein intake during the early phase of severe trauma is linked to lower mortality rates, shorter mechanical ventilation time, and reduced risk of nosocomial infections. Full article

Background: Sepsis is a common and serious complication in pediatric hematology oncology (PHO) patients. The Endothelial Activation and Stress Index (EASIX) score offers a potentially accessible tool for risk stratification in septic patients. Our objective was to evaluate the association of the EASIX score with adverse clinical outcomes among septic PHO patients. Methods: A retrospective review was conducted for all PHO patients admitted to the intensive care unit (ICU) with sepsis from July 2022 to December 2024. Results: A total of 53 patients with 65 sepsis events were included in this analysis. The median age was 14.9 [IQR 9.9] y and the most common disease was hematologic malignancy. In our cohort, 60% needed vasopressors, 36% required invasive mechanical ventilation, and 22% underwent renal replacement therapy (RRT). Log2-EASIX > 2.5 was associated with higher vasopressor requirements (87% versus 45% in the low log2-EASIX group, p = 0.001) and an increased need for RRT (39% versus 12%, p = 0.024). Septic PHO patients with log2-EASIX > 2.5 were 6.9 times more likely to require vasopressor support [(95% CI 1.7–27.8) p = 0.007]. In addition, PHO patients with log2-EASIX > 2.5 had a longer ICU stay (7 d versus 2 d in the low log2-EASIX group, p = 0.024) and an extended overall hospitalization (33 d versus 25 d, p = 0.029). Conclusions: A higher EASIX score was associated with adverse outcomes in critically ill septic PHO patients. Our findings suggest that the EASIX score can be used as a tool for identifying septic patients at an increased risk of clinical deterioration and poor outcomes. Prospective studies in larger cohorts are warranted to validate and expand upon these findings. Full article

Background: Bloodstream infections (BSIs) complicate COVID-19 inpatients, increasing morbidity, mortality, and healthcare burden. This systematic review and meta-analysis evaluated prevalence, antimicrobial resistance (AMR), risk factors, and outcomes of BSIs in RT-PCR-confirmed COVID-19 cases. Methods: We searched PubMed, Google Scholar, ScienceDirect, and MDPI journals (January 2020–August 2025) following PRISMA 2020 guidelines. Twenty-two observational studies (~123,500 patients, ~602,000 blood cultures) were included: 10 prospective and 12 retrospective. Random-effects models estimated pooled prevalence, odds ratios (ORs), and mean differences, with subgroup analyses (ICU, non-ICU, pediatric) and meta-regression.Results: Pooled BSI prevalence was 8.2% (95% CI: 5.7–11.0; I² = 50%). Subgroup prevalence was higher in ICU (12.5%) than non-ICU (5.2%) populations. Pediatric cohorts (n = 3) showed a prevalence of 10.8%. Gram-negative pathogens predominated (61%), particularly Klebsiella pneumoniae (26%) and Acinetobacter baumannii (21%). AMR rates were 36% for MRSA and 31% for ESBL-producing Enterobacterales. Risk factors included mechanical ventilation (OR: 2.6), immunosuppression (OR: 2.3), and corticosteroid use (OR: 2.4). BSIs were associated with increased mortality (OR: 2.6), prolonged hospitalization (+6.8 days), and higher ICU admission (OR: 3.1).Conclusions: BSIs, largely driven by multidrug-resistant pathogens, substantially worsen COVID-19 outcomes. Variability in diagnostic criteria (CDC vs. ECDC) and reliance on retrospective designs are limitations, though moderate heterogeneity (I² = 50%) enhances generalizability across diverse populations. Strengthened infection prevention and antimicrobial stewardship are urgently required. Full article

Background: Rowing is a highly demanding endurance sport, requiring simultaneous work of approximately 70% of the body’s muscle mass and the combined contribution of aerobic and anaerobic energy systems. Objective: This study aimed to analyze the cardiorespiratory responses and performance characteristics of elite junior male and female rowers during maximal effort over 2000 m on a rowing ergometer. Methods: Fifteen junior rowers (six males aged 15–17 and nine females aged 15–18) participated in the study. Anthropometric data (body height, weight, and body surface area) were recorded. All participants performed a maximal 2000 m test on a Concept2 D-model ergometer. Throughout the test, oxygen uptake (VO₂), carbon dioxide production (VCO₂), heart rate, and ventilation parameters were continuously measured. Performance and physiological data were analyzed in three intensity zones, defined by ventilatory thresholds (VT1–VT3), as well as at peak exercise. Results: Significant anthropometric differences were observed between genders. In terms of performance, males completed the 2000 m test significantly faster than females (208.83 ± 87.66 s vs. 333.78 ± 97.51 s, p = 0.0253). Relative VO₂ at peak exercise was higher in males (58.73 ± 5.25 mL·kg⁻¹·min⁻¹) than females (48.32 ± 6.09 mL·kg⁻¹·min⁻¹, p = 0.0046). In most cardiorespiratory parameters, males outperformed females significantly, except for heart rate and ventilatory equivalents. Ranking analysis revealed that higher VO₂max values were generally associated with a better placement in both genders, though this relationship was not perfectly linear. Performance time was negatively correlated with VO₂Peak (r = −0.8286; p < 0.001), rVO₂Peak (r = −0.6781; p < 0.01), and O₂P_Peak (r = −0.7729; p < 0.01). Conclusions: The findings confirm significant gender differences in anthropometric and cardiorespiratory characteristics of elite junior rowers and reinforce VO₂max as a key determinant of performance. Yet, deviations from a direct VO₂max–rank correlation highlight the influence of tactical, psychological, and biomechanical factors. Future research should provide practical recommendations for monitoring performance and tailoring training to optimize adaptation and long-term athlete development. Full article

Background: Intensive Care Unit (ICU) readmission and in-hospital mortality are critical indicators of patient outcomes following ICU discharge. Patients readmitted to the ICU often face worse prognosis, higher healthcare costs, and prolonged hospital stays. Identifying high-risk patients is essential for optimizing post-ICU care and resource allocation. Methods: This two-phase study included the following: (1) a retrospective analysis of ICU survivors in a mixed medical–surgical ICU to identify risk factors associated with ICU readmission and in-hospital mortality, and (2) a prospective validation of a newly developed predictive model: the Worse Outcome Score (WOScore). Data collected included demographics, ICU admission characteristics, severity scores (SAPS II, SAPS III, APACHE II, SOFA), interventions, complications and discharge parameters. Results: Among 1.190 ICU survivors, 126 (10.6%) were readmitted to the ICU, and 192 (16.1%) died in hospital after ICU discharge. Key risk factors for ICU readmission included Diabetes Mellitus, SAPS III on admission, and ICU-acquired infections (Ventilator-Associated Pneumonia (VAP) and Catheter-Related Bloodstream Infection, (CRBSI)). Predictors of in-hospital mortality were identified: medical admission, high SAPS III score, high lactate level on ICU admission, tracheostomy, reduced GCS at discharge, blood transfusion, CRBSI, and Acute Kidney Injury (AKI) during ICU stay. The WOScore, developed based on the results above, demonstrated strong predictive ability (AUC: 0.845 derivation, 0.886 validation). A cut-off of 20 distinguished high-risk patients (sensitivity: 88.1%, specificity: 73.0%). Conclusions: ICU readmission and in-hospital mortality are influenced by patient severity, underlying comorbidities, and ICU-related complications. The WOScore provides an effective, easy-to-use risk stratification tool that can guide clinicians in identifying high-risk patients at ICU discharge and guide post-ICU interventions, potentially improving patients’ outcomes and optimizing resource allocation. Further multi-center studies are necessary to validate the model in diverse healthcare settings. Full article

Vilobelimab, a first-in-class, human–mouse chimeric immunoglobulin G4 (IgG4) kappa monoclonal antibody, targets human complement component 5a (C5a) in plasma. Unlike upstream complement inhibitors, vilobelimab does not inhibit the generation of the membrane attack complex (C5b-9), necessary to mitigate certain infections. C5a is a strong anaphylatoxin and chemotactic agent that plays an essential role in both innate and adaptive immunity. Elevated levels of C5a have been associated with pathologic processes, including sepsis and inflammatory respiratory disorders such as acute respiratory distress syndrome (ARDS). Blocking C5a with vilobelimab has shown therapeutic promise. A randomized, multicenter placebo-controlled Phase III study of vilobelimab in patients with severe COVID-19 (PANAMO) found that patients treated with vilobelimab had a significantly lower risk of death by day 28 and 60. Based on this study, the United States Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Gohibic^® (vilobelimab) injection for the treatment of COVID-19 in hospitalized adults when initiated within 48 h of receiving invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO). In January 2025, the European Commission (EC) granted marketing authorization for Gohibic^® (vilobelimab) for the treatment of adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who are receiving systemic corticosteroids as part of standard of care and receiving IMV with or without ECMO. Herein, we review the mechanism of action of vilobelimab in selectively inhibiting C5a-induced inflammation, outlining its bench-to-bedside development from the fundamental biology of the complement system and preclinical evidence through to the clinical data demonstrating its life-saving potential in the management of COVID-19–induced ARDS. Full article

Background: Liberation from mechanical ventilation is a major objective in critically ill patients. Various criteria for extubation are used with different success rates. We developed a novel, simple bedside maneuver and index that involves measuring breath-hold duration and forced vital capacity (FVC). We named it the Respiratory Breath Hold Index (RBHI). Methods: We enrolled 225 mechanically ventilated intensive care unit (ICU) patients who were candidates for extubation. At the end of a spontan eous breathing trial (SBT), and just prior to extubation, patients were asked to hold their breath and perform a stalked FVC maneuver. The ability to perform a breath-hold maneuver and its duration were recorded and compared with a standard SBT. Results: 171 patients (76%) were successfully extubated, while 54 patients (24%) failed extubation. A successful SBT alone did not predict extubation, as 80.1% of passed SBT and 81.5% of failed SBT patients were extubated successfully (p = 1.00). However, a higher RBHI, together with the ability to hold breath and breath-hold duration, was highly associated with a successful extubation (p < 0.0001). Logistic regression analysis showed that RBHI over 3 was correlated with higher rates of successful extubation (OR 4.252, p < 0.001). Overall, 89% of patients who passed SBT and were able to hold breath were successfully extubated. (p < 0.0001). Whereas, among patients who passed SBT but failed to hold breath, only 24% were successfully extubated (p < 0.0001). Conclusion: Higher RBHI, together with the ability to hold a breath just prior to extubation in mechanically ventilated patients, is more sensitive and specific, and may be superior to standard SBT in predicting a successful extubation. Full article

Cave systems serve as key interfaces connecting surface and underground carbon cycles, and research on their carbon dynamics provides a unique perspective for revealing the mechanisms of carbon transport and transformation in karst critical zones. In this study, we established a multi-factor monitoring framework spanning the atmosphere–soil–cave continuum and associated meteorological conditions, continuously recorded cave microclimate parameters (temperature, relative humidity, atmospheric pressure, and cave winds) and CO₂ concentrations across atmospheric–soil–cave interfaces, and employed stable carbon isotope (δ¹³C) tracing in Mahuang Cave, a typical karst cave in southwestern China, from 2019 to 2023. The results show that the seasonal amplitude of atmospheric CO₂ and its δ¹³C is small, while soil–cave CO₂ and δ¹³C fluctuate synchronously, exhibiting “high concentration-light isotope” signatures during the rainy season and the opposite pattern during the dry season. Cave CO₂ concentrations drop by about 29.8% every November. Soil CO₂ production rates are jointly controlled by soil temperature and volumetric water content, showing a threshold effect. The δ¹³C response exhibits nonlinear behavior due to the combined effects of land-use type, vegetation cover, and soil texture. Quantitative analysis establishes atmospheric CO₂ as the dominant source in cave systems (66%), significantly exceeding soil-derived contributions (34%). At diurnal, seasonal, and annual scales, carbon-source composition, temperature and precipitation patterns, ventilation effects, and cave structure interact to control the rhythmic dynamics and spatial gradients of cave microclimate, CO₂ levels, and δ¹³C signals. Our findings enhance the understanding of carbon transfer processes across the karst critical zone. Full article

In swine production, it is broadly recognized that ventilation rates and indoor environmental conditions influence pig productivity. However, sparse scientific data are available on the combined effects and potential interactions of these factors in commercial production systems. This study investigated indoor environmental and management factors influencing wean-to-finish pig mortality in a commercial system. Temperature, relative humidity (RH), and carbon dioxide (CO₂) were recorded every 10 min in the front and back of 16 barns across five grow-finish sites in eastern North Carolina for two turns (four barns) or three turns (12 barns) for a total of 44 pig groups. Proportional weekly mortality was modeled using a generalized linear mixed model. Results showed that pigs in environments warmer than the desired room temperature had lower mortality (p < 0.001), suggesting cold stress was more detrimental than heat stress. Elevated RH and CO₂ at the back of the barn were linked to increased mortality (p < 0.001), highlighting air exchange rates as a key indicator. Mortality was greatest in pig groups placed during Spring and lowest in Summer (p < 0.05), and mortality declined as pigs aged (p = 0.0134). Surprisingly, greater barn occupancy correlated with lower mortality (p = 0.0012), potentially related to piglet quality at placement. The predictive power of the model varied with the turn of pigs, with R² averaging 0.24 (ranging from 0.001 to 0.61) and an average RMSE of 0.36% (ranging from 0.17% to 0.77%). Ammonia (NH₃) was recorded at the back of six barns, and concentrations were modeled. Greater NH₃ concentrations were associated with increased pig age, RH, and CO₂, as well as lower deviation from desired room temperature and lower barn occupancy. Collectively, these findings highlight the importance of proper ventilation and management on swine productivity. Full article