Search Results (12,414)

Background and Objectives: The erector spinae plane block (ESPB) is an emerging regional anesthesia technique that has demonstrated effectiveness in reducing postoperative pain and opioid consumption following laparoscopic cholecystectomy (LC). However, the optimal timing of ESPB whether administered preoperatively or postoperatively remains uncertain, particularly regarding its influence on intraoperative hemodynamic stability and procedural feasibility. This study aimed to compare the analgesic efficacy, intraoperative hemodynamic profiles, and procedural advantages of preoperative versus postoperative ESPB in patients undergoing elective LC. Materials and Methods: In this prospective, randomized, and single-blind clinical trial, 80 ASA I–II adult patients scheduled for elective LC were randomly assigned to receive bilateral ESPB either before anesthesia induction (Group 1) or immediately after surgery but prior to extubation (Group 2). All patients received standardized general anesthesia. The primary outcome was postoperative pain measured by the numeric rating scale (NRS) at 2 h postoperatively. Secondary outcomes included NRS scores at other time points (0, 4, 6, 12, and 24 h), intraoperative and postoperative hemodynamic parameters, cumulative 24 h rescue analgesic consumption, patient satisfaction scores, and adverse events. Results: Both groups experienced significant reductions in postoperative NRS scores, with no statistically significant differences between groups in pain intensity or tramadol consumption. However, the preoperative ESPB group exhibited significantly more stable intraoperative blood pressure readings, particularly at 30 and 60 min after incision and at extubation. No ESPB-related complications occurred in either group. Patient satisfaction levels were comparable across groups. Conclusions: Preoperative and postoperative ESPBs offer comparable analgesic efficacy and opioid sparing effects in LC. However, preoperative ESPB provides enhanced intraoperative hemodynamic stability and avoids the logistical challenges of performing blocks under anesthesia, including repositioning related risks. These findings suggest that preoperative ESPB may be considered for integration into enhanced recovery after surgery (ERAS) protocols for minimally invasive biliary surgery, pending further large-scale multicenter trials. Full article

The Nile, Indus, and Yellow River deltas are historically significant and have experienced extensive shoreline changes over the past 50 years, yet the roles of human interventions and natural events remain unclear. In this study, the Net Shoreline Movement and End Point Rate (EPR) were calculated to quantify the erosion and accretion of the shoreline, respectively. Subsequently, linear trend analysis was employed to identify potential directional shifts in shoreline behavior. These measures are combined with segment-scale cumulative area and the EPR trend to reveal where erosion or accretion intensifies, weakens, or reverses through time. Results show distinct, system-specific trajectories, the Nile lost ~27 km² from 1972 to1997 as a result of the dam construction and sediment reduction, and lost only ~3 km² more from 1997 to 2022, with local stabilization. The Indus switched from intermittent gains before 1990s to sustained loss after that, totaling ~300 km² of cumulative land loss mainly due to upstream dam constructions and storm events. The Yellow River gained ~500 km² from 1973 to 1996 then lost ~200 km² after main-channel relocation and reduced sediment supply despite active-mouth management. These outcomes indicate that deltas are very vulnerable to system wide human activities and natural events. Combined, satellite-derived metrics can help prioritize locations, guide feasible interventions, establish annual monitoring and trigger action. A major caveat of this study is that yearly shoreline rates and 5–10-yearaverages can mask short-lived or very local shifts. Targeted field surveys and finer-scale modeling (hydrodynamics, subsidence monitoring, bathymetry) are therefore needed to refine the design and inform better policy choices. Full article

Offshore reservoirs in the high water-cut stage present significant development challenges, including declining production, complex remaining oil distribution, and the inadequacy of conventional evaluation methods to capture intricate flow dynamics. To overcome these limitations, this study introduces a novel approach based on flow diagnostics for performance evaluation and potential adjustment. The method integrates key metrics such as time-of-flight (TOF) and the dynamic Lorenz coefficient, supported by reservoir engineering principles and numerical simulation, to construct a multi-parameter evaluation system. This system, which also incorporates injection–production communication volume and inter-well fluid allocation factors, precisely quantifies and visualizes waterflood displacement processes and sweep efficiency. Applied to the QHD32 oilfield, this framework was used to establish specific thresholds for operational adjustments. These include criteria for infill drilling (waterflooded ratio < 45%, remaining oil thickness > 6 m, TOF > 200 days), conformance control (TOF < 50 days, dynamic Lorenz coefficient > 0.5), and artificial lift optimization (remaining oil thickness ratio > 2/3, TOF > 200 days). Field validation confirmed the efficacy of this approach: an additional cumulative oil production of 165,600 m³ was achieved from infill drilling in the C29 well group, while displacement adjustments in the B03 well group increased oil production by 2.2–3.8 tons/day, demonstrating a significant enhancement in waterflooding performance. This research provides a theoretical foundation and a technical pathway for the refined development of offshore heavy oil reservoirs at the ultra-high water-cut stage, offering a robust framework for the sustainable management of analogous reservoirs worldwide. Full article

Environmental, Social, and Governance (ESG) communications have proliferated across Fortune 500 companies, yet no validated frameworks exist for systematically distinguishing authentic from superficial positioning. This study develops and validates the Dynamic Authenticity Evaluation Model (DAEM), measuring three interactive dimensions of ESG communication authenticity: operational alignment, temporal consistency, and communication specificity. Through dual-evaluator protocols applied to eight mega-cap companies, DAEM achieves excellent inter-rater reliability (ICC = 0.85; Krippendorff’s α = 0.83). An event study analysis across sixteen major ESG announcements reveals no significant correlation between communication authenticity and abnormal stock returns (r = 0.289; p = 0.491), with effects being bounded below ±0.30% cumulative abnormal returns through equivalence testing. Preliminary stakeholder analysis suggests differential authenticity sensitivity, with employee engagement showing a stronger association with DAEM scores (r = 0.423) than market reactions (r = 0.289). Results indicate that authentic ESG communications influence non-market stakeholders more than short-term stock prices, suggesting that market value creation requires operational rather than symbolic approaches, while authentic communication remains important for stakeholder relationship management. Full article

Background: Prostate cancer is the second most common malignant cancer among men, and according to the predictions, the estimated number of new cases will substantially grow in the coming years. Therefore, the costs of the disease will increase as well. Methods: We conducted a literature review of the state of knowledge about the costs of treatment and the economic burden of prostate cancer. The vast majority of studies were focused on direct costs only, which clearly shows the literature gap. Results: We focused on the estimates of direct costs, i.e., treatment of prostate cancer, adjuvant and neoadjuvant treatment, and supportive and palliative care, and indirect costs. Cost-effectiveness analyses indicated that docetaxel combined with androgen deprivation therapy (ADT) was the most cost-effective strategy for metastatic hormone-sensitive prostate cancer (incremental cost-effectiveness ratio (ICER): USD 13,647). In contrast, novel therapies such as PARP inhibitors and whole-genome-sequencing-guided treatments were not cost-effective unless drug prices were reduced by 47–70%. In the United States, 5-year cumulative treatment costs ranged from USD 48,000 for conservative management to over USD 91,000 for radiotherapy, while out-of-pocket expenses averaged AUD 1172 in Australia. Indirect costs were also considerable, with Slovakia reporting an increase in sick leave costs from EUR 1.2 million in 2014 to EUR 2.1 million in 2022. Conclusions: Metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer were the most frequent categories for various treatment cost evaluations. A few specific combinations of drugs were cost-effective only under the condition of dropping the unit prices of a medication. Further summarizing, reviewing, and developing a methodology for standardized comparisons are needed. Full article

Background: Despite technological advancements in cataract surgery, including Femtosecond Laser-Assisted Cataract Surgery (FLACS), postoperative dry eye disease (DED) remains a challenge, impacting patients’ quality of life. Identifying preoperative predictors of ocular discomfort could improve patient management. Methods: This exploratory prospective study compared the onset of DED symptoms and ocular surface changes after FLACS and standard cataract surgery (SCS). Twenty eyes were evaluated preoperatively and postoperatively, using Ocular Surface Disease Index (OSDI), Non-Invasive Break-Up Time (NI-BUT), Schirmer I Test, and Oxford Score. One-week OSDI was analyzed as the dependent variable using multivariable quantile regression (τ = 0.5), with baseline parameters (OSDI, Oxford score, Schirmer test, NI-BUT), age, BCVA, surgical technique, and cumulative dissipated energy (CDE) as predictors. Results: FLACS was associated with a transient worsening of OSDI at one week, which resolved by three months, whereas SCS showed a milder but more gradual increase. In multivariable analysis, baseline OSDI (β = 0.61, p < 0.001) and Oxford score (β = 5.42, p = 0.045) were independent predictors, while surgical technique and perioperative parameters were not significant. In a reduced model, both predictors confirmed their association. Subgroup analyses showed baseline OSDI as predictive only in FLACS. Conclusions: Preoperative ocular surface status emerges as the main determinant of early postoperative DED symptoms. Routine assessment of OSDI and Oxford scores may help identify at-risk patients and guide preventive strategies. Full article

Water is a critical resource for both environmental integrity and human health. This study assessed the concentrations of potentially toxic elements (PTEs)—Pb, Cd and Hg—in surface waters adjacent to six urban settlements within the Barranca de Metztitlán Biosphere Reserve (MBR), Mexico. Ecological and health risks were evaluated for vulnerable groups, including children, adolescents, and the elderly. Cd and Hg water concentrations surpassed the national and international water quality criteria at three locations. Ecological and health risk analysis of Pb was not conducted as Pb concentrations were below LOD (0.02 ppm). Ecological risk analysis revealed a low potential risk for Cd exposure but a high risk for Hg at its highest concentration in the reserve. Health risk assessment revealed that Cd and Hg pose a non-carcinogenic risk, particularly to children under three years old. Hazard quotients (HQ) and cumulative risk indices (HI) exceeded safe thresholds at multiple sites. Infants (0–11 months) were the most susceptible, even at contaminant levels near detection limits. These findings emphasize the importance of routine monitoring and early intervention strategies to mitigate exposure risks, especially in vulnerable populations within the MBR. Full article

Background/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies. Full article

Background and Objectives: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard care for acute coronary syndrome (ACS). Although ticagrelor showed superiority over clopidogrel in pivotal trials, patients with advanced chronic kidney disease (CKD) or on dialysis were underrepresented and results in Asian populations have been inconsistent. Materials and Methods: We conducted a retrospective cohort study using the Taiwan Society of Cardiology Acute Coronary Syndrome-Diabetes Mellitus (TSOC ACS-DM) registry between 1 October 2013, and 30 September 2016. Eligible patients had type 2 diabetes mellitus and ACS with stage III–V CKD or were on dialysis at index hospitalization and were discharged on aspirin plus either ticagrelor or clopidogrel. The primary endpoint was a composite of cardiovascular (CV) death, CV-related readmission, and repeated revascularization. Cumulative incidence functions were compared using expectation maximization (EM) weighting and propensity score adjustment. Results: After exclusions, 451 patients were analyzed (ticagrelor n = 116; clopidogrel n = 335). Ticagrelor associated with higher myocardial infarction (HR 1.59, 95% CI 1.12–2.28, p = 0.010), CV-related readmission (HR 1.72, 95% CI 1.12–2.65, p = 0.014), repeated revascularization (HR 2.24, 95% CI 1.36–3.68, p = 0.002), and the composite endpoint (HR 1.63, 95% CI 1.06–2.48, p = 0.024) at 2 years. Conclusions: Among real-world Taiwanese patients with type 2 diabetes mellitus, ACS, and CKD, ticagrelor use was linked to increased risks of cardiovascular events compared to clopidogrel. However, these relationships might be affected by potential confounding factors. Randomized controlled trials are necessary to establish the best antiplatelet strategy for this high-risk group. Full article

A multi-target robust observation method for satellite constellations based on hypergraph algebraic connectivity and observation precision theory is proposed to address the challenges posed by the surge in space targets and system failures. First, a precision metric framework is constructed based on nonlinear batch least squares estimation theory, deriving the theoretical precision covariance through cumulative observation matrices to provide a theoretical foundation for tracking accuracy evaluation. Second, multi-satellite collaborative observation is modeled as an edge-dependent vertex-weighted hypergraph, enhancing system robustness by maximizing algebraic connectivity. A constrained simulated annealing (CSA) algorithm is designed, employing a precision-guided perturbation strategy to efficiently solve the optimization problem. Simulation experiments are conducted using 24 Walker constellation satellites tracking 50 targets, comparing the proposed method with greedy algorithm, CBBA, and CSA-bipartite Graph methods across three scenarios: baseline, maneuvering, and failure. Results demonstrate that the CSA-hypergraph method achieves 0.089 km steady-state precision in the baseline scenario, representing a 41.4% improvement over traditional methods; in maneuvering scenarios, detection delay is reduced by 34.3% and re-achievement time is decreased by 47.4%; with a 30% satellite failure rate, performance degradation is only 9.8%, significantly outperforming other methods. Full article

The present investigation provides a comparative six-month analysis of atmospheric pollution by polycyclic aromatic hydrocarbons (PAHs) in the urban region of Opole, Poland. The study employs dual monitoring methods: traditional quartz filter-based active air sampling and active moss biomonitoring using Pleurozium schreberi, Sphagnum fallax, and Dicranum polysetum mosses. The experimental campaign took place from August 2021 to February 2022, spanning the autumn and winter seasons. PAH concentrations were measured using gas chromatography–mass spectrometry (GC-MS) following methodical sample extraction protocols. Filters documented transient air changes in PAHs, particularly high-molecular-weight (HMW) components such as benzo[a]pyrene (BaP), which exhibited considerable increases during the colder months due to heightened heating activities and less dispersion. The size of particles deposited on the filters varied from 0.16 to 73.6 μm, with an average size of 0.71 μm. Mosses exhibited cumulative uptake trends, with D. polysetum showing the greatest bioaccumulation efficiency, particularly for low- and medium-molecular-weight PAHs, followed by P. schreberi and S. fallax. Meteorological indices, including sun radiation and air temperature, demonstrated significant negative relationships with PAH buildup in mosses. Diagnostic ratio analysis verified primarily pyrogenic sources (e.g., fossil fuel burning), although petrogenic contributions were detected in D. polysetum, indicating its increased sensitivity to evaporative emissions. The study shows that the integration of moss biomonitoring with traditional filter samples provides a strong, complementary framework for assessing air quality, particularly in fluctuating meteorological settings. The results advocate for the integration of moss-based methodologies into environmental monitoring initiatives and provide significant insights into contaminant dynamics influenced by seasonal and meteorological factors. Full article

We present a quantitative theory of contraction and expansion cycles within the Quantum Memory Matrix (QMM) cosmology. In this framework, spacetime consists of finite-capacity Hilbert cells that store quantum information. Each non-singular bounce adds a fixed increment of imprint entropy, defined as the cumulative quantum information written irreversibly into the matrix and distinct from coarse-grained thermodynamic entropy, thereby providing an intrinsic, monotonic cycle counter. By calibrating the geometry–information duality, inferring today’s cumulative imprint from CMB, BAO, chronometer, and large-scale-structure constraints, and integrating the modified Friedmann equations with imprint back-reaction, we find that the Universe has already completed $N_{\mathrm{past}}=3.6\pm 0.4$ cycles. The finite Hilbert capacity enforces an absolute ceiling: propagating the holographic write rate and accounting for instability channels implies only $N_{\mathrm{future}}=7.8\pm 1.6$ additional cycles before saturation halts further bounces. Integrating Kodama-vector proper time across all completed cycles yields a total cumulative age $t_{\mathrm{QMM}}=62.0\pm 2.5\mathrm{Gyr}$, compared to the $13.8\pm 0.2\mathrm{Gyr}$ of the current expansion usually described by $\mathrm{\Lambda }$CDM. The framework makes concrete, testable predictions: an enhanced faint-end UV luminosity function at $z\gtrsim 12$ observable with JWST, a stochastic gravitational-wave background with $f^{2/3}$ scaling in the LISA band from primordial black-hole mergers, and a nanohertz background with slope $\alpha \simeq 2/3$ accessible to pulsar-timing arrays. These signatures provide near-term opportunities to confirm, refine, or falsify the cyclical QMM chronology. Full article

This study proposes a behavioral monitoring framework for newborn piglets based on SPMF-YOLO object detection and ByteTrack multi-object tracking, which enables precise quantification of early postnatal activity levels and health assessment. The method enhances small-object detection performance by incorporating the SPDConv module, the MFM module, and the NWD loss function into YOLOv11. When combined with the ByteTrack algorithm, it achieves stable tracking and maintains trajectory continuity for multiple targets. An annotated dataset containing both detection and tracking labels was constructed using video data from 10 piglet pens for evaluation. Experimental results indicate that SPMF-YOLO achieved a recognition accuracy rate of 95.3% for newborn piglets. When integrated with ByteTrack, it achieves 79.1% HOTA, 92.2% MOTA, and 84.7% IDF1 in multi-object tracking tasks, thereby outperforming existing methods. Building upon this foundation, this study further quantified the cumulative movement distance of each newborn piglet within 30 min after birth and proposed a health-assessment method based on statistical thresholds. The results demonstrated an overall consistency rate of 98.2% across pens and an accuracy rate of 92.9% for identifying abnormal individuals. The results validated the effectiveness of this method for quantifying individual behavior and assessing health status in newborn piglets within complex farming environments, providing a feasible technical pathway and scientific basis for health management and early intervention in precision animal husbandry. Full article

Background: Distal pancreatectomy (DP) is a potentially curative procedure for tumors of the pancreatic body and tail. Minimally invasive DP (MIDP), including laparoscopic and robotic techniques, is increasingly being adopted. This study aimed to evaluate the perioperative outcomes of robotic DP (RDP) in comparison with laparoscopic and open approaches using a network meta-analysis and meta-regression. Methods: We systematically searched MEDLINE, EMBASE, Web of Science, and Scopus for studies comparing at least two surgical approaches. Both Bayesian and frequentist network meta-analyses were performed. Results: Sixty-seven studies involving 18,113 patients met the inclusion criteria. Surface under the cumulative ranking (SUCRA) analysis showed that RDP ranked first in 84.6% of measured parameters. Laparoscopic DP (LDP) demonstrated intermediate performance, whereas open DP (ODP) consistently ranked lowest. Operative time was significantly longer for RDP compared with ODP (MD = +25.93 min, 95% CI 7.68–44.18), while LDP and ODP were comparable. RDP significantly reduced 30-day mortality (OR = 0.37, 95% CI 0.16–0.84) and conversion rates compared with LDP (OR = 0.30, 95% CrI 0.22–0.40). Both minimally invasive approaches (RDP and LDP), compared with open surgery, were associated with reduced blood loss (−304 mL and −273 mL), fewer transfusions (OR 0.25 and 0.30), smaller transfused volumes (−1.98 and −1.86 units), shorter ICU stays (−4.0 and −2.3 days), fewer reinterventions (OR 0.45 and 0.56), and shorter hospital stays (−8.8 and −6.9 days), respectively. Conclusions: Although associated with longer operative time, RDP appears safe and may confer significant advantages over both laparoscopic and open surgery, including reduced 30-day mortality, lower conversion rates, and improved perioperative outcomes, particularly when performed in high-volume, well-equipped centers. Full article

Northern Thailand experiences annual haze events with fine particulate matter (PM2.5) exceeding standards, posing risks to schoolchildren. This cross-sectional study (Chiang Mai, 2024) evaluated respiratory impacts among primary school children aged 8–12 years. Daily mean PM2.5 concentrations were obtained from a single fixed-site monitoring station (36T) located within 2 km of the spirometry site. Among 93 children with acceptable spirometry, 52% exhibited restrictive, 18% obstructive, and 30% had normal function. After adjustment for BMI, males had significantly lower odds of any pulmonary abnormality than females (AOR = 0.084; 95% CI 0.017–0.417; p = 0.002). The mean FEV₁/FVC ratio was normal (86.30 ± 13.07%), whereas mean FVC, FEV₁, and PEF were significantly below predicted values, indicating a predominantly restrictive pattern. This predominance likely reflects cumulative exposure to biomass-burning related PM2.5 during the haze season, infiltration of outdoor PM2.5 into indoor environments alongside indoor sources, and the vulnerability of developing lungs in children’s factors that reduce lung volumes while largely preserving the FEV₁/FVC ratio. The exposure assessment provides pragmatic, proximity-based estimates but is limited by reliance on one station and one season, which may not capture spatial or temporal variability. These findings highlight sex-based susceptibility and support stronger air quality protections for children. Full article