Search Results (126)

Introduction: Hepatic infarction is an uncommon but clinically important cause of focal ischemic liver injury. In internal medicine, it usually emerges in acutely ill or complex hospitalized adults with sepsis, shock, malignancy, thrombosis, vasculitis, transplantation, or recent hepatobiliary or interventional procedures who develop a new focal hepatic lesion and abnormal liver tests. Aims: This review aims to provide internists with a practical diagnostic and management pathway for recognizing hepatic infarction, distinguishing it from abscess and malignancy, selecting appropriate imaging, identifying vascular complications, and avoiding unnecessary biopsy or drainage when conservative management is safer. Methods: We performed a structured narrative review of adult hepatic infarction and related ischemic liver entities using targeted searches in PubMed/MEDLINE and Scopus. The search strategy, screening process, and evidence limitations are reported explicitly. Because the available evidence is dominated by case reports, small series, radiology reviews, and guidance on related vascular liver diseases, the synthesis is qualitative and the proposed pathway is conceptual rather than prospectively validated. Results: Hepatic infarction is most often recognized when systemic hypoperfusion, splanchnic vasoconstriction, microvascular dysfunction, or local macrovascular compromise coexist. Multiphasic computed tomography (CT) is usually the first-line acute-care modality, while MRI, contrast-enhanced ultrasound, Doppler ultrasound, CT angiography, or vascular imaging should be selected according to diagnostic uncertainty and suspected arterial or portal venous complications. The main diagnostic pitfalls are misclassification as abscess, malignancy, hematoma, or postoperative collection. Conclusions: In the appropriate clinical context, a wedge-shaped or geographic non-enhancing hepatic lesion should trigger vascular-ischemic reasoning before being labeled as abscess or tumor. The proposed internist-led pathway is intended as a pragmatic conceptual framework for diagnostic reasoning and multidisciplinary communication, not as a validated guideline or evidence-based algorithm. Full article

Addressing the severe risks of floor instability and leakage in underground coal mine reservoirs in Western China under coupled mining and hydraulic pressures, this study developed a fully coupled stress-damage-seepage numerical model. Incorporating rock heterogeneity based on the geological conditions of the Shendong mining area, the model systematically simulates the evolution of floor damage under varying storage pressures, burial depths, mining heights, and lithologies. The simulation results demonstrate that storage pressure is the primary driver for deep damage propagation via a “hydraulic wedging” mechanism, governed by a critical activation threshold of 1.0 MPa. Specifically, before the water storage pressure reaches 1.0 MPa, the floor damage remains dormant and basically unchanged, stagnating at a shallow level. However, once the pressure exceeds this 1.0 MPa threshold, it overcomes the effective confining stress, abruptly shifting the failure mode from shallow discrete fracturing to deep penetrating failure, which is accompanied by an order-of-magnitude surge in permeability. Furthermore, a dimensionless sensitivity analysis reveals that burial depth and lithology strongly govern the failure path and depth. Notably, mudstone possesses a significantly lower intrinsic permeability, and even when subjected to damage, its water barrier performance remains superior to that of sandstone because its localized plastic shear characteristics highly restrict permeability mutations. In contrast, brittle sandstone is highly susceptible to tensile cracking and the formation of deep penetrating seepage channels. Additionally, mining height demonstrates weak sensitivity to the depth of floor damage due to an “equivalent unloading” mechanism, which validates the technical feasibility of constructing underground water reservoirs in ultra-thick coal seams. These findings provide a vital theoretical foundation for the scientific site selection of underground reservoirs and the precise determination of operational water level thresholds to ensure long-term stability. Full article

Clustering is the process in Wireless Sensor Networks (WSNs) used to make the routing process efficient and for selecting the optimized path for sending the data, considering metrics like energy consumption and node distance. Many clustering routing algorithms are addressed for selecting the best path. Among them, Progressive Index Modulation in Intra cluster and Inter cluster routing algorithms uses the index shifting technique for distributing the cluster head role among the sensor nodes. Because of static node deployment, WSN causes the energy hole formation. Hence, this manuscript proposes an Equiangular Wedge Energy Hole Detection (EWED) algorithm for multi-hop WSNs to detect and prevent energy holes. In the hole detection phase, the network region is split into equiangular wedges, where each node serves as a generating point in the geometry to create a Region of Interest (ROI). Finally, the simulation results reveal that the EWED achieves higher network performance compared to the existing clustering routing algorithms. Full article

Background and Objectives: Foot wedges are widely used to modulate ankle alignment in clinical and athletic settings, yet the effects of mediolateral wedge placement on multi-planar lower limb biomechanics during functional unilateral exercises remain poorly characterized. This study aimed to quantify the effects of medial and lateral foot wedge placement on lower limb joint kinematics, muscle activation, and ground reaction forces (GRFs) during the split squat. Materials and Methods: Thirty healthy young adults (12 males, 18 females; 24.5 ± 2.7 years) performed split squats under three randomized conditions using a rigid inclined platform rather than a custom foot orthosis: no wedge (NW), medial wedge (MW), and lateral wedge (LW). Three-dimensional kinematics (Qualisys, 100 Hz), bilateral GRFs (Bertec, 1000 Hz), and surface electromyography (sEMG, 1000 Hz) of the peroneus longus (PL), tibialis anterior (TA), vastus medialis (VM), and vastus lateralis (VL) were recorded synchronously. Repeated-measures ANOVA with Bonferroni post hoc tests and partial eta-squared (η²_p) were used (α = 0.05). Results: LW significantly increased PL and VM activation, sagittal-plane range of motion (ROM) at the ankle, knee, and pelvis, and vertical GRF, compared with MW and NW (p < 0.05). MW significantly increased TA and VL activation and reduced sagittal hip ROM (p < 0.05). No significant differences were observed for mediolateral or anteroposterior GRF. Conclusions: Mediolateral foot wedge placement acutely reorganizes lower limb neuromuscular recruitment, joint kinematics, and vertical ground reaction force during the split squat in healthy young adults. These preliminary findings indicate that wedge orientation, applied via a rigid inclined platform, can acutely and selectively modulate muscle activation patterns; any therapeutic or performance applications, however, were not evaluated here and should not be generalized to conventional clinical orthoses without further investigation. Full article

Ensuring face stability is a pressing concern in slurry shield tunneling under high water pressure. Although slurry infiltration and filter cake formation are known to affect stability, the governing role of seepage forces in the failure mechanisms remains insufficiently understood, and existing models often oversimplify the regulating effect of filter cake permeability. To address this gap, a combined numerical–theoretical approach is developed that explicitly incorporates seepage effects into the failure analysis. A three-dimensional seepage model was developed to simulate transient pore water pressure distribution ahead of the tunnel face, considering filter cake properties, stratum permeability, and applied slurry pressure. Based on the computed seepage field and a wedge-prism composite failure mechanism, an upper-bound limit analysis model was formulated that accounts for the work done by seepage forces. Results reveal a filter cake permeability threshold of 1.0 × 10⁻⁷ m/s, below which further reduction yields negligible stability improvement. Parametric studies quantify the influences of internal friction angle, cohesion, depth-to-diameter ratio, and permeability contrast between soil and filter cake. Validation against field data from the Maliuzhou Tunnel demonstrated that the calculated limit pressures consistently lie below the field-measured slurry pressures, confirming the model’s reliability and its practical utility for guiding slurry pressure selection in complex ground conditions. Full article

Background and Objectives: Conventional supramalleolar osteotomy (SMO) often involves a concomitant fibular osteotomy (FO), which carries risks, such as nonunion and nerve injury. We evaluated the clinical and radiological outcomes of a fibula-preserving SMO (FP-SMO) combined with arthroscopic modified Broström operation (MBO) in patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. Materials and Methods: We retrospectively reviewed 22 patients who underwent medial opening wedge FP-SMO and arthroscopic MBO between 2014 and 2019. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and Foot and Ankle Outcome Score (FAOS). Radiological evaluation included the anterior drawer test (ADT), talar tilt angle, tibiotalar surface (TTS) angle, medial distal tibial angle (MDTA), tibial lateral surface (TLS) angle, Takakura stage, and International Cartilage Regeneration and Joint Preservation Society (ICRS) grade assessed during second-look arthroscopy. Results: At a mean follow-up of 17.22 months, the mean VAS, AOFAS, and FAOS scores improved significantly (p < 0.001). Radiologically, the mean ADT decreased from 5.98 mm to 4.70 mm (p = 0.015), and the mean talar tilt angle decreased from 9.85° to 6.09° (p < 0.001). The mean TTS angle increased from 80.46° to 84.86° (p = 0.021), and the mean MDTA increased from 85.03° to 91.26° (p < 0.001). The TLS angle showed no significant change from 81.17° to 81.54° (p = 0.238). Takakura stage and ICRS grade improved or remained stable in all patients. No major complications, including nonunion, were observed. Conclusions: FP-SMO combined with arthroscopic MBO demonstrated favorable short-term clinical and radiological outcomes in selected patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. This combined approach may be a feasible joint-preserving option that addresses coronal malalignment and lateral ankle instability without requiring FO; however, longer-term comparative studies are needed to confirm its durability and clinical utility. Full article

Biomimetic design has been used to reduce the high operating resistance of agricultural soil-engaging components, thereby lowering energy consumption. However, most existing contour-based structural biomimetic designs rely on a single or a few biological samples, making the resulting designs susceptible to individual variation and randomness in sample selection. To address this issue, this study used the abdomen of antlion larvae as a biological prototype. Abdominal contours of 85 antlion larvae were extracted from the front, top, and side views, and elliptic Fourier descriptors (EFDs) were used for contour normalization, averaging, and reconstruction to obtain population mean contours. Seven biomimetic wedge specimens were designed based on the population mean contours, and vertical penetration and horizontal cutting tests were conducted in two different media. The results showed that in the vertical penetration tests, the B-FT specimen, which integrated contour features from the front and top views, exhibited the best drag-reduction performance. Its average penetration resistance decreased by 44.26% and 32.81% in quartz sand and loam soil, respectively. In the horizontal cutting tests, the B-FTS specimen, which integrated contour features from all three views, showed the lowest average cutting resistance, with reductions of 17.62% and 36.47%, respectively. The FTS contour features were further applied to the biomimetic design of a subsoiler tine and validated by discrete element method (DEM) simulation and soil bin tests. Compared with the standard subsoiler tine, the biomimetic subsoiler tine reduced draft force by 11.57% in the simulation and by 12.61% in the soil bin test. These results demonstrate the drag-reduction effectiveness of population mean contours and provide a statistically grounded geometric reference for the biomimetic low-resistance design of agricultural soil-engaging components. Full article

(1) Background: Left ventricular assist device (LVAD) implantation is a valuable alternative as a bridge to transplant but also as a destination therapy in ineligible patients. Right ventricular failure (RVF) is a major cause of short- and long-term mortality post-LVAD. We aimed to validate echocardiographic and hemodynamic parameters predictive of RVF and adverse outcomes post-LVAD; (2) Methods: We screened a population of patients with end-stage heart failure selected for LVAD implantation according to SIENA protocol and standard international indications, including right heart catheterization (RHC). Individuals were followed up for 1 year with different time points for the development of RVF (primary endpoint) or mortality and hospitalization (secondary endpoint); (3) Results: The population included 29 patients with a mean age of 63 ± 7 years with a mean ejection fraction of 23 ± 4%, mostly due to ischemic etiology. All the patients had a SIENA protocol score of 0–1 before LVAD, and none met the primary endpoint. Regarding the secondary endpoint, among all the tested clinical, laboratory, echo, and RHC indices, only a central venous pressure/wedge pressure (CVP/PCWP) ratio > 0.63 was significantly associated with adverse outcomes (ß = 2.99, p = 0.026); (4) Conclusions: Excluding a pre-implantation RV dysfunction according to SIENA protocol significantly reduces the risk of post-LVAD RVF. The CVP/PCWP ratio may be an additional prognostic marker for mortality and rehospitalization in LVAD patients. Full article

The right ventricle (RV) is a primary determinant of outcomes in cardiac critical care. RV dysfunction independently predicts morbidity and mortality in conditions such as acute coronary syndromes, pulmonary embolism, and cardiogenic shock. This review synthesizes RV evaluation and management by integrating physiologic principles with bedside diagnostic and therapeutic strategies. The RV is exceptionally sensitive to acute afterload increases due to its adaptation to low-pressure pulmonary circulation. Evaluation utilizes a multimodal approach combining echocardiography, invasive hemodynamics, and specifically the pulmonary artery pulsatility index and central venous pressure/pulmonary capillary wedge pressure (CVP/PCWP) ratio and biomarkers. Management focuses on three pillars: individualized preload optimization, afterload reduction via selective pulmonary vasodilators, and contractility augmentation with inotropes. For refractory cases, mechanical circulatory support options like Impella RP, ProtekDuo, and VA-ECMO provide critical bridges to recovery or transplantation. Full article

Background: Noninvasive echocardiographic markers are widely used to estimate left ventricular filling pressure, but their relationship with directly measured left ventricular end-diastolic pressure (LVEDP) is often modest and context-dependent. Whether routinely available noninvasive findings reflect elevated LVEDP through an intermediate invasive pulmonary hemodynamic phenotype remains insufficiently characterized. Objective: To evaluate the relationship of noninvasive echocardiographic and laboratory markers with directly measured LVEDP and to determine whether invasive pulmonary artery diastolic pressure (dPAP) functions as a hemodynamic bridge linking upstream noninvasive findings to elevated left ventricular filling pressure in a routine catheterization cohort. Methods: This retrospective single-center observational study included patients undergoing routine cardiac catheterization with available direct LVEDP measurement and invasive pulmonary artery pressure data. Elevated LVEDP was defined as LVEDP ≥ 15 mmHg, and elevated dPAP as dPAP ≥ 24 mmHg. Noninvasive, bridge, and invasive validation models were evaluated using logistic regression, receiver operating characteristic analysis, calibration assessment, and bootstrap internal validation. Results: A total of 75 patients had direct LVEDP data, 94 had invasive dPAP data, 83 had echocardiographic systolic pulmonary artery pressure (echo-sPAP), and 37 had pulmonary capillary wedge pressure (PCWP) measurements. Patients with elevated LVEDP had significantly higher creatinine (p = 0.026), dPAP (p = 0.043), and PCWP (p = 0.004). Echo-sPAP showed good discrimination for elevated dPAP, with an AUC of 0.791 (95% CI 0.695–0.888), supporting its role as an upstream noninvasive marker of invasive pulmonary hemodynamic burden. A noninvasive model combining echo-sPAP and creatinine showed modest discrimination for elevated LVEDP (AUC 0.664, 95% CI 0.522–0.806; Brier score 0.198), whereas an invasive validation model combining dPAP and creatinine showed better performance (AUC 0.734, 95% CI 0.617–0.850; Brier score 0.176). In bootstrap validation, the optimism-corrected AUCs were approximately 0.624 and 0.711, respectively. Although the invasive model performed numerically better, DeLong comparison did not show a statistically significant difference between the two models (p = 0.459). Conclusions: Routinely available noninvasive echocardiographic and laboratory findings appear to relate to directly measured left ventricular filling pressure through an intermediate invasive pulmonary hemodynamic pattern. Echo-sPAP showed its strongest signal at the level of elevated dPAP, whereas dPAP combined with creatinine provided the most informative model for elevated directly measured LVEDP. These findings support a hypothesis-generating hemodynamic framework linking noninvasive assessment to directly measured filling pressure and may help inform noninvasive hemodynamic triage and physiological risk enrichment in selected clinical settings. Full article

The mechanical properties of stone masonry and its behavior under monotonic and cyclic loading depend significantly on the local properties of the masonry and the wall typology. This paper presents preliminary results from in situ inspection of stone masonry typologies at several locations in the Kvarner Littoral of Croatia, which revealed the use of earth mortar in a building over 200 years old instead of the commonly used lime mortar. This finding prompted the selection of this building as a case study, for which a detailed visual survey was conducted and laboratory testing employed to characterize the masonry components. The visual inspection showed that the walls of the case study building are constructed from non-degraded stones, with wedges between the blocks and larger corner blocks. The earth mortar is degraded on the wall surface, so non-destructive testing was unsuccessful. Laboratory tests on stone specimens confirmed high compressive strength (over 135 MPa), while laboratory tests on earth mortar specimens indicated compressive strength between 2.22 and 2.65 MPa. The stone compressive strength is comparable to that of high-quality Croatian limestones, while the compressive strength of the earth mortar is comparable to that of historic lime mortars. Microscopic analysis and FTIR spectroscopy of the earth mortar revealed that it does not contain sand or gravel, what distinguishes it from commonly used historic earth mortars, where clay minerals serve as a binder for sand and silt particles. This study presents the first comprehensive research on the material properties of an earth mortar in Croatia. Full article

The pile foundations of hydraulic crossing structures are vulnerable to scour, which can significantly reduce bearing capacity and threaten structural safety. In existing studies, simplified assessment approaches have mainly been used, such as pre-defined scour holes or instantaneous scour, which cannot fully capture the progressive development of scour holes. In addition, there are limited systematic comparisons of the lateral responses of piles with different cross-sectional shapes under scour conditions. To address these issues, a series of finite element simulations were carried out in this study and the numerical model was validated against centrifuge test results. The “model change” technique was then used to simulate the progressive development of general scour. Circular and square piles with equal cross-sectional areas were considered under scour conditions, and the effects of instantaneous and progressive scour were compared at the same depth. The load–displacement response, pile–soil deformation and failure mode, bending moment, and pile displacement were analysed, with the results showing that square piles exhibited a higher lateral bearing capacity than circular under both no-scour and two types of general scour conditions. Scour altered the pile–soil failure mode and reduced the extent of the wedge-shaped failure zone around the pile, with that induced by square piles being larger than that induced by circular. At the same scour depth, the difference between the effects of instantaneous and progressive scour on lateral bearing capacity was not significant. The results indicate that the pile cross-sectional shape is a key factor affecting scour resistance and that square piles show a relative advantage. The findings provide useful guidance for the cross-sectional selection and lateral bearing capacity assessment of pile foundations in scour-prone areas. Full article

Background: Segmentectomy is increasingly used and is emerging as a key treatment option for early-stage non-small cell lung cancer (NSCLC). However, questions remain regarding the adequacy of lymph node evaluation, particularly differences in N1 versus N2 dissection, and the implications for staging accuracy and adjuvant therapy. Methods: This narrative review synthesizes evidence from studies published between 2019 and 2025 comparing nodal upstaging, survival outcomes, and the role of completion lobectomy following segmentectomy versus lobectomy. Results: Twelve studies, including more than 175,000 patients, were analyzed. Lobectomy was associated with a significantly higher overall nodal upstaging rate (14.5% vs. 6.6%, p < 0.001), driven primarily by increased detection of N1 disease (13.3% vs. 3.7%, p < 0.001), while N2 upstaging rates were similar between procedures (5.5% vs. 3.2%, p = 0.07). Despite lower N1 detection, adjusted analyses reported comparable survival outcomes among patients with occult pathologic N1 (pN1) or N2 (pN2) disease who received adjuvant therapy. Segmentectomy provided outcomes comparable to lobectomy, whereas wedge resection was associated with inferior survival (HR 1.23, p = 0.042). Completion lobectomy has not demonstrated a consistent survival benefit and was associated with substantial morbidity in limited retrospective series, including high rates of thoracotomy conversion and major complications. Conclusions: When performed with systematic nodal dissection, adequate surgical margins, and appropriate adjuvant therapy, segmentectomy appears to provide survival outcomes comparable to lobectomy in selected patients with early-stage NSCLC. Completion lobectomy may not be routinely required and should be considered on a case-by-case basis within a multidisciplinary context. These findings support the use of segmentectomy in carefully selected patients when high-quality surgical staging and integrated oncologic care are ensured, while highlighting the need for prospective studies addressing occult nodal disease in the modern treatment era. Full article

Background/Objectives: This study aimed to assess the safety and efficacy of lung surgery for the treatment of early-stage non-small cell lung cancer (NSCLC) in octogenarians, with a specific focus on the Uniportal-VATS approach, evaluating surgical outcomes and short-term oncological results within a precision medicine perspective. Methods: This retrospective, single-center study included octogenarian patients who underwent surgical treatment for early-stage NSCLC between January 2018 and March 2024. Among 1329 patients treated during the study period, 136 octogenarians were carefully evaluated by a multidisciplinary board and selected for surgical management. Results: The mean age was 82.41 ± 2.72 years, with a prevalence of men (63.2%). In 107 (78.7%) cases, lung resection was performed using the Uniportal-video-assisted thoracic surgery (U-VATS) approach. Overall, 71 lobectomies (52.2%) and 65 segmentectomies or wedge resections (47.8%) were performed, balancing oncological radicality with comorbidities. Only minor complications occurred, such as atelectasis (2.9%), atrial fibrillation (4.4%), pneumonia (1.5%), or air-leakage (2.2%). Factors significantly associated with postoperative complications included open approach (p = 0.014), lobectomy as the extent of resection (p = 0.008), and chronic obstructive pulmonary disease (COPD) (p = 0.010). On multivariable analysis, lobectomy remained the only independent predictor for postoperative complications (OR: 5.95, 95% CI [1.24–28.62], p = 0.026). In-hospital and 90-day mortality were null. The median length of hospital stay in octogenarians was 6 days and was significantly shorter in the Uniportal-VATS group compared with the open surgery one (p < 0.001). All patients were discharged home independently. One- and three-year overall survival rates were 88% and 71%, respectively. No risk factor was associated with mortality in our series. Conclusions: Lung surgery, particularly the Uniportal-VATS approach, appears to be a safe and effective treatment option for octogenarian patients with early-stage NSCLC, provided that patient selection is carefully based on individual clinical characteristics within a multidisciplinary framework based on individualized risk stratification. When feasible, sublobar resection should be preferred in order to minimize postoperative complications. Full article

Selenium (Se) is a vital element for human health and seafood represents one of its major dietary sources. Nevertheless, information regarding the bioaccessibility of Se from seafood commonly consumed in Thailand remains scarce. To address this limitation, the present study evaluated in vitro Se bioaccessibility using the equilibrium dialyzability approach. Ten seafood species frequently selected by Thai consumers were investigated to determine total Se concentrations following different culinary treatments, namely fresh, boiling, frying, and grilling. For thermally processed samples, gastrointestinal digestion was simulated in vitro through enzymatic digestion prior to bioaccessibility assessment using the equilibrium dialyzability method. Inductively coupled plasma triple quadrupole mass spectrometry (ICP-QQQ-MS) was used to precisely quantify the total and dialyzable Se fractions. The effects of seafood species and cooking methods were evaluated statistically using two-way analysis of variance and the Tukey’s honestly significant difference (HSD) test for post hoc comparisons. The findings showed that, across the majority of cooking techniques, Indo-Pacific horseshoe crab eggs consistently showed considerably greater Se contents than other seafood (p < 0.05). Moreover, Se bioaccessibility in Indo-Pacific horseshoe crab eggs (81.1–88.3%) was markedly greater than that observed in other seafood items, including musk crab, blue crab, oysters, and wedge shell, regardless of cooking method (p < 0.05). No statistically significant differences in Se bioaccessibility were observed among boiling, frying, and grilling (p > 0.05), indicating that thermal processing did not adversely affect Se availability. Overall, the seafood species examined in this study, irrespective of preparation method, contained substantial Se levels with high bioaccessibility, underscoring their nutritional value and supporting dietary recommendations that promote balanced consumption of marine foods. Full article