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Medical evacuations (MEDEVACs) from offshore installations are both costly and disruptive. Enhancing worker well-being may help reduce evacuations due to illness or injury, thereby maintaining the smooth operation of offshore activities and lowering financial burdens. This scoping review aims to identify whether illness or injury is the predominant cause of MEDEVACs from offshore oil and gas installations and to determine the most common types of illnesses or injuries involved. Additionally, the review outlines a future research agenda focusing on offshore worker health and well-being. A comprehensive structured search was conducted across the Scopus, PubMed, and Web of Science databases, as well as through reference lists and grey literature. Studies were included if they addressedMEDEVACs from offshore oil and gas installations. Eleven articles met the inclusion criteria. Articles indicate that non-occupational illnesses are more frequent causes of MEDEVACs than injuries. Among these, chest pain, cardiovascular issues, and dental problems were disproportionately represented. Contractor personnel were more likely to require evacuation than company employees. Additionally, younger workers were more likely to be evacuated due to injuries. Chronic health conditions were more common reasons for MEDEVACs among older workers. The review highlights the significant role of non-communicable diseases in contributing to MEDEVACs, as opposed to occupational exposures. Investing in preventive health management, targeted research, and workforce education may substantially reduce the prevalence of non-communicable diseases in the offshore environment, lowering MEDEVAC rates, associated costs, and operational disruptions. Further investigation into the underlying causes of ill health among offshore workers is needed to enhance overall workforce well-being.
Atrophic acne scars result from impaired dermal repair following inflammation of the pilosebaceous unit, leading to collagen degradation, dermal atrophy, and tethering by fibrotic strands. Conventional subcision mechanically releases these adhesions but provides limited biologic stimulation for dermal remodeling. Carbon dioxide (CO₂) gas subcision has emerged as a hybrid mechanical-biologic modality that integrates fibrotic release with CO₂ -induced vasodilation, microcirculatory enhancement, and fibroblast activation. To describe the clinical use and short-term outcomes of CO₂ gas subcision for atrophic acne scars and explore its potential as a minimally invasive hybrid treatment. CO₂ device (Trifill Pro, South Korea) and PDLLA (Juvelook, VAIM Inc., South Korea) was used in the study. A temperature-regulated medical-grade CO₂ system delivered controlled intradermal gas through a 30-gauge needle. Short CO₂ bursts were administered into the deep dermal or upper subcutaneous plane to detach fibrotic bands while inducing hypercapnia-associated biologic responses. Five patients with atrophic acne scars underwent a single session. Follow-up at weeks 2 and 4 included standardized photography, clinical assessment of scar depth and contour, and patient-reported satisfaction using a 0-10 Visual Analogue Scale (VAS). Five patients completed follow-up at 4 weeks. All patients demonstrated qualitative improvement in scar depth and contour on clinical assessment. Mean patient satisfaction score (VAS) was high (range 7-9). No serious adverse events were observed. Mild transient erythema and edema resolved spontaneously within hours. Due to the small sample size and short follow-up, results are descriptive rather than statistically powered. CO₂ gas subcision appears to be a feasible and well-tolerated minimally invasive technique combining mechanical fibrotic release with biologic stimulation. This pilot case series suggests short-term improvement in atrophic acne scars; however, larger controlled studies with longer follow-up are required to confirm efficacy and durability. VBlinded manuscript without author contact information.
Small-for-gestational-age (SGA) infants have a higher prevalence and severity of bronchopulmonary dysplasia than appropriate-for-gestational-age (AGA) infants but the evolution of their respiratory pathophysiology characteristics is unknown RESEARCH QUESTION: Do SGA infants with moderate-severe bronchopulmonary dysplasia (msBPD) have different pathophysiological phenotypes (in terms of lung aeration and gas exchange) compared to AGA infants with msBPD? Secondary analysis of the PATH-BPD multicenter cohort. Patients were classified as SGA if their birthweight was <10th percentile or <-2 Z-scores. Lung aeration was assessed with quantitative lung ultrasound. Gas exchange was considered using SpO2/FiO2, PtcO2/FiO2 and PtcCO2. msBPD was defined using NIH-2001, NICHD-2018 and Jensen definitions. Data were analyzed by linear mixed effect regression models RESULTS: Of 347 enrolled neonates, 62 and 32 infants were classified as SGA using the percentile and Z-score threshold, respectively. Regardless of the BPD definition and the growth classification, evolution of lung aeration (β varying between -0.32 and 0.23, p varying between 0.379 and 0.575), SpO2/FiO2 (β varying between 0.78 and 6.1 , p varying between 0.896 and 0.250), PtcO2/FiO2 (β varying between -0.64 and 2.2, p varying between 0.936 and 0.700) and PtcCO2 (β varying between -0.63 and 0.03, p varying between 0.295 and 0.968) was similar in SGA and AGA infants with msBPD INTERPRETATIONS: The evolution of lung aeration and gas exchange in SGA and AGA patients with msBPD is similar, regardless of the BPD definition and growth classification.
Hepatic portal venous gas is an uncommon radiologic finding that has been rarely reported in neurocritical care settings. This article presents two clinically instructive case reports of severe neurological disorders complicated by HPVG. Both patients presented with abdominal distension, absent bowel sounds, and septic shock following neurological surgery, and abdominal imaging confirmed the presence of hepatic portal venous gas. These cases provide valuable clinical references for the abdominal management of patients in neurocritical care.
Human (h)IgG2 monoclonal antibodies (mAbs) are potent agonists due, in part, to their ability to undergo disulfide shuffling within their hinge regions. Herein, we describe a rapid, sensitive, collision-induced unfolding (CIU) assay that possesses a predictive relationship between gas-phase protein unfolding and agonism in hIgG2 variants. Furthermore, our results highlight the significance of hinge engineering in tuning mAb structure-function relationships for the development of future biotherapeutics.
Pressure tuning (PT) of a coupled column ensemble in gas chromatography (GC) changes the retention time of analytes by altering the contribution of each column in the dual column system. This study investigates the effect of PT between the two columns on calculation of compound retention indices (RI), and proposes an approach to align RI data with values reported in a database library. The study first describes a model to predict the relative coupled column contribution to separation (φ) according to the PT process. The first column contribution could be tuned from 0.20 to 0.97 φ1 by altering the mid-point pressure (pj), which implies the property of the two-column ensemble can range from behaving similar to the first column, or to the second column, or some intermediate property depending simply on the junction pressure. The second part establishes a relationship between φ and oven temperature by using multivariate analysis based on isothermal experimental data, showing a significant change of φ in a T programmed GC analysis. The deviation for PT RI from single column RI values is related to two reasons, (1) variable retention on the coupled column ensemble, and (2) contribution of each column arising from PT. RI values can be tuned according to the mid-point pressure setting; for example, γ-terpinene, d-limonene and o-cymene had RI value changes of 3, 8 and 16 I unit, respectively simply by changing pj by 1 psi. A correction factor may be calculated using chi-square fitting to predict single column RI data from experimental PT coupled column RI values at a particular φ, allowing the PT system to match the analyte RI with library database values.
Acute aortic dissection (AAD) complicated by visceral malperfusion represents a catastrophic vascular emergency associated with high mortality. The coexistence of hepatic portal venous gas (HPVG) in this setting is an ominous radiological sign, typically indicating irreversible transmural bowel necrosis and breach of the mucosal barrier. We report a fatal case of STS/SVS Type B3 aortic dissection presenting with extensive visceral ischemia and HPVG to highlight the diagnostic significance of this "deadly triad." A 64-year-old male with a history of hypertension presented to the emergency department with severe, unremitting abdominal pain of 8 h' duration. Physical examination revealed significant four-limb blood pressure asymmetry, with a systolic gradient of nearly 100 mmHg between the right and left upper limbs, alongside diffuse abdominal tenderness. Computed tomography angiography (CTA) demonstrated an STS/SVS Type B3 aortic dissection extending from the aortic arch to the iliac arteries. Critical findings included the celiac trunk and superior mesenteric artery (SMA) straddled the dissection flap, representing a typical combination of static and dynamic obstruction. Critical findings included diffuse HPVG, pneumatosis intestinalis, and multi-organ ischemia. Laboratory results showed admission leukocytosis (WBC 27.1 × 109/L) and a massive cytokine storm (IL-6: 14,001.98 pg./mL) with refractory lactic acidosis. Due to the grave prognosis, the family opted for palliative care, and the patient expired 47 h after the decision. This case underscores the rapid clinical deterioration associated with STS/SVS Type B3 dissection and complex visceral malperfusion. Early CTA recognition of HPVG is vital for identifying irreversible intestinal damage and informing multidisciplinary decision-making in devastating vascular emergencies.
Civil unrest is a critical societal challenge in many parts of the world. Crowd control weapons (including conducted energy devices, chemical irritants, kinetic impact projectiles, acoustic devices, and water cannons) produce agent-specific injuries that do not precisely map onto standard trauma frameworks. This narrative review synthesises the available evidence on the mechanisms, health effects, and emergency department management of casualties inflicted by crowd-control weapons. Emergency department preparedness for civil unrest rests on surge capacity planning across staffing, supplies, space, and systems, with additional demands imposed by chemical decontamination, unpredictable patient volumes, and risks to staff safety. Conducted energy devices cause injury primarily through falls during neuromuscular incapacitation and through probe penetration of sensitive structures; cardiac risk is low but may be amplified by comorbidities and intoxication. Routine cardiac monitoring is not supported for alert, asymptomatic patients after brief exposures. Riot control agents (principally 2-chlorobenzylidene malononitrile [CS], chloroacetophenone [CN], and oleoresin capsicum) activate nociceptive ion channels, producing ocular, respiratory, and dermal injury that is largely self-limiting but can be severe, especially in enclosed spaces or vulnerable populations such as infants, elderly and patients with asthma. Management centres on decontamination and supportive care. Kinetic impact projectiles are responsible for the highest burden of permanent disability, particularly ocular injury; initial presentations may appear deceptively benign, and clinicians must maintain a high index of suspicion for occult internal injury guided by mechanism rather than surface findings. Acoustic devices and water cannons cause auditory barotrauma and blunt trauma, respectively, while improvised incendiary devices produce combined burn and inhalation injury patterns. Each mechanism imposes specific demands on triage, imaging, specialist consultation, and disposition. Emergency clinicians should be familiar with the distinct injury profiles associated with crowd-control weapons and be prepared to manage them within the emergency care setting. Preparedness planning, mechanism-guided clinical assessment, and awareness of agent-specific pathology are essential to optimising outcomes for casualties of civil unrest.
Chronic obstructive pulmonary disease (COPD) having a major cause of morbidity or mortality worldwide. Hematocrit (HCT), a simple or inexpensive marker, provides prognostic information in severe COPD patients receiving long-term oxygen therapy (LTOT), yet Indian data are scarce. To evaluate the prognostic value of HCT in patients with severe COPD on LTOT, assess its trend over time, and correlate HCT with spirometry and arterial blood gas (ABG) parameters. Over 18 months, the Department of Respiratory Medicine at Shri Sathya Sai Medical College and Research Institute in Tamil Nadu carried out this prospective observational study. 100 and 11 patients with severe COPD on LTOT (≥18 h/day) were enrolled after ethical clearance (IEC No: 993/24) and written informed consent. Baseline demographic, clinical, spirometry, HCT, and ABG parameters were recorded and reassessed at 45 days and 3 months. Data were analyzed utilizing SPSS v29. Mean ± standard deviation was employed to express the continuous variables. Pearson correlation and paired t-test was utilized; P < 0.05 has been considered statistically significant. The mean age was 62.8 ± 8.1 years; 58.6% were males. Most participants had severe COPD (64.9%); mean disease duration was 7.4 ± 3.5 years, or mean LTOT duration was 18.6 ± 7.8 months. Baseline HCT was 42.3 ± 3.1%. It declined to 41.7 ± 2.8 at 45 days (P = 0.056) and 41.5 ± 3.0 at 3 months (P = 0.024). Forced vital capacity (FVC) showed a progressive decline from 2.0 ± 0.28 L at baseline to 1.8 ± 0.26 L at 45 days or 1.6 ± 0.29 L at 3 months (P < 0.001). In contrast, forced expiratory volume in 1 s (FEV1) increased from 0.7 ± 0.11 L at baseline to 0.8 ± 0.12 L at 45 days and 0.9 ± 0.14 L at 3 months (P < 0.001). The FEV1/FVC ratio also increased from 0.35 ± 0.19 at baseline to 0.44 ± 0.13 at 45 days or 0.46 ± 0.12 at 3 months (P < 0.001). Significant correlations have been observed among HCT or PaO2 (r = 0.32, P = 0.01) and among HCT and FEV1/FVC ratio (r = 0.29, P = 0.02). Lower baseline HCT was associated with increased hospitalization and mortality (P < 0.05). HCT is an independent prognostic marker in severe COPD patients on LTOT. Declining HCT over time may indicate poor outcomes, while higher values correlate with better oxygenation and lung function. Serial HCT measurement can be a cost-effective tool to risk-stratify and monitor patients in the resource-limited settings. Résumé Introduction:La bronchopneumopathie chronique obstructive (BPCO) constitue l’une des principales causes de morbidité et de mortalité dans le monde. L’hématocrite (HCT), un marqueur simple et peu coûteux, fournit des informations pronostiques chez les patients atteints de BPCO sévère recevant une oxygénothérapie de longue durée (OLD). Cependant, les données indiennes à ce sujet restent limitées. Objectifs: Évaluer la valeur pronostique de l’hématocrite chez les patients atteints de BPCO sévère sous oxygénothérapie de longue durée, analyser son évolution au fil du temps et étudier sa corrélation avec les paramètres spirométriques et les gaz du sang artériel.Méthodologie:Cette étude prospective observationnelle a été menée sur une période de 18 mois au sein du Département de médecine respiratoire du Shri Sathya Sai Medical College and Research Institute, au Tamil Nadu. Après obtention de l’approbation éthique (IEC n° 993/24) et du consentement éclairé écrit, 111 patients atteints de BPCO sévère sous OLD (≥ 18 heures/jour) ont été inclus. Les données démographiques, cliniques, spirométriques, les valeurs d’hématocrite ainsi que les paramètres des gaz du sang artériel ont été recueillis à l’inclusion puis réévalués à 45 jours et à 3 mois. Les données ont été analysées à l’aide du logiciel SPSS version 29. Les variables continues ont été exprimées sous forme de moyenne ± écart-type. Les corrélations de Pearson et le test t apparié ont été utilisés, avec un seuil de significativité fixé à p < 0,05.Résultats:L’âge moyen des participants était de 62,8 ± 8,1 ans et 58,6 % étaient des hommes. La majorité des patients présentaient une BPCO sévère (64,9 %). La durée moyenne de la maladie était de 7,4 ± 3,5 ans et la durée moyenne de l’OLD était de 18,6 ± 7,8 mois. L’hématocrite moyen initial était de 42,3 ± 3,1 %. Il a diminué à 41,7 ± 2,8 % après 45 jours (p = 0,056) puis à 41,5 ± 3,0 % après 3 mois (p = 0,024). La capacité vitale forcée (CVF/FVC) a montré une diminution progressive, passant de 2,0 ± 0,28 L au départ à 1,8 ± 0,26 L à 45 jours puis à 1,6 ± 0,29 L à 3 mois (p < 0,001). À l’inverse, le volume expiratoire maximal par seconde (VEMS/FEV1) a augmenté de 0,7 ± 0,11 L au départ à 0,8 ± 0,12 L à 45 jours puis à 0,9 ± 0,14 L à 3 mois (p < 0,001). Le rapport VEMS/CVF est également passé de 0,35 ± 0,19 à l’inclusion à 0,44 ± 0,13 à 45 jours puis à 0,46 ± 0,12 à 3 mois (p < 0,001). Des corrélations significatives ont été observées entre l’hématocrite et la pression partielle en oxygène artériel (PaO2) (r = 0,32 ; p = 0,01), ainsi qu’entre l’hématocrite et le rapport VEMS/CVF (r = 0,29 ; p = 0,02). Un faible taux d’hématocrite à l’inclusion était associé à une augmentation des hospitalisations et de la mortalité (p < 0,05).Conclusion:L’hématocrite constitue un marqueur pronostique indépendant chez les patients atteints de BPCO sévère sous oxygénothérapie de longue durée. Une diminution progressive de l’hématocrite au cours du suivi peut être le signe d’une évolution défavorable, tandis que des valeurs plus élevées sont associées à une meilleure oxygénation et à une meilleure fonction pulmonaire. La mesure régulière de l’hématocrite représente ainsi un outil simple et économique pour la stratification du risque et le suivi des patients, en particulier dans les contextes à ressources limitées.
The concept of extraesophageal symptoms secondary to GERD is complex and often controversial, leading to diagnostic and therapeutic challenges. Many researchers consider them to be a manifestation of an independent disease - laryngopharyngeal reflux disease (LPRD). The aim of the work is to provide a review of existing literature regarding the mechanisms, diagnostics and treatment of LPRD. A bibliographic research was conducted in the RSCI, PubMed, ScienceDirect databases. Currently, there is no single diagnostic tool to determine unambiguously the relationship between typical symptoms of laryngopharyngeal reflux and gastroesophageal reflux disease (GERD). Determining the contribution of GERD to their development is based on the results of a comprehensive examination of the patient and his response to anti-reflux therapy. The peculiarities of the pathophysiological mechanisms of LPRD (a high percentage of non-acidic, mixed, as well as liquid and/or gas reflux, low resistance of the pharyngeal and upper respiratory tract mucosa to the damaging effect of refluxate) explain the need for treatment approaches that are different from those used for GERD. Lifestyle modification and anti-reflux diet give more predictable results in the treatment of LPRD than drug therapy. Prospects for increasing the effectiveness of drug treatment of diseases caused by regurgitation of gastric contents (LPRD, GERD) involve their phenotyping, as well as the development of interdisciplinary approach. Система взглядов на природу внепищеводных симптомов гастроэзофагеальной рефлюксной болезни (ГЭРБ) сложна и часто противоречива, что приводит к диагностическим и терапевтическим трудностям. Многие исследователи считают их проявлением самостоятельного заболевания — ларингофарингеальной рефлюксной болезни (ЛФРБ). Представить обзор современной литературы о механизмах развития, диагностике и лечении ларингофарингеальной рефлюксной болезни. Проведен библиографический поиск в базах данных РИНЦ, PubMed, ScienceDirect. В настоящее время нет единого диагностического инструмента, позволяющего однозначно определить связь симптомов, характерных для ларингофарингеального рефлюкса, с ГЭРБ. Определение вклада ГЭРБ в их развитие основывается на результатах комплексного обследования больного и его ответе на антирефлюксную терапию. Особенности патофизиологических механизмов ЛФРБ (большая доля некислого, смешанного, а также жидкостного и/или газообразного рефлюкса, низкая резистентность слизистой оболочки глотки и верхних дыхательных путей к повреждающему действию рефлюктата) объясняют необходимость применения лечебных подходов, отличных от тех, которые используются при ГЭРБ. Модификация образа жизни и антирефлюксная диета обеспечивают более предсказуемые результаты при лечении ларингофарингеальной рефлюксной болезни, чем медикаментозная терапия. Перспективы повышения эффективности медикаментозного лечения заболеваний, обусловленных регургитацией желудочного содержимого (гастроэзофагеальной рефлюксной болезни, ларингофарингеальной рефлюксной болезни), предполагают их фенотипирование, а также междисциплинарный подход к ведению пациентов.
Background/Objectives: Rhegmatogenous retinal detachment is a vision-threatening condition often treated with combined cataract surgery and vitrectomy, but accurate postoperative refractive prediction may be difficult when ocular anatomy is altered by preoperative hypotony. This retrospective comparative study evaluated the effect of preoperative ocular hypotony on refractive predictability and visual outcomes after combined phacovitrectomy for rhegmatogenous retinal detachment. Materials and Methods: Electronic medical records from Nagasaki University Hospital from 2010 to 2022 were reviewed. Among 731 eyes that underwent combined phacovitrectomy with sulfur hexafluoride gas tamponade for rhegmatogenous retinal detachment, 17 eyes with preoperative ocular hypotony (intraocular pressure ≤ 7 mmHg) that met the inclusion criteria were identified. Thirty-four eyes with normal intraocular pressure were selected as controls in a 1:2 ratio. Refractive outcomes were assessed through spherical equivalent and mean absolute error, and visual outcomes were evaluated through best-corrected visual acuity at baseline and 6 months postoperatively. Results: Mean absolute error was significantly higher in eyes with hypotony than in normotonic eyes (1.46 ± 0.95 diopters vs. 0.70 ± 0.81 diopters; p = 0.002; mean difference, 0.76 D; 95% CI, 0.21-1.31; Hedges' g = 0.87). Target postoperative refraction within ±0.5 diopters was achieved in 23.5% of hypotonic eyes and 50.0% of normotonic eyes (p = 0.07), the corresponding proportions within ±1.0 D were 35.3% and 76.5%, respectively (p = 0.006). Best-corrected visual acuity improved significantly in both groups, but final visual acuity at 6 months was worse in hypotonic eyes (0.35 ± 0.31 vs. 0.09 ± 0.17 logarithm of the minimum angle of resolution; p < 0.001). Conclusions: Preoperative ocular hypotony in rhegmatogenous retinal detachment was associated with greater refractive prediction error and worse visual outcomes after phacovitrectomy.
Although conservative and liberal oxygenation targets yield similar clinical outcomes in mechanically ventilated critically ill adults, the global environmental and economic implications remain unknown. We conducted an ecological analysis using 2024 country-level aggregate data for 200 countries. Conservative (peripheral O2 saturation, SpO2 88-92%) and liberal (SpO2 ≥96%) oxygenation targets were selected using data from a randomised trial. We quantified total oxygen consumption costs (2024 international dollars [int$]) and associated greenhouse gas emissions (ktCO2eq) by integrating country-specific electricity grids and oxygen sources with parameters from a life-cycle assessment of medical oxygen. Uncertainty intervals were generated through Monte-Carlo simulation, and Bayesian multivariable regression was applied to identify determinants of cost and emissions. Scenario analyses modelled emission reductions under three progressively stringent decarbonisation targets. Adopting conservative rather than liberal SpO2 targets for ventilated ICU patients would reduce global annual expenditures from 180 to 76 million int$ (Δint$104 million) and cut emissions from 884 to 368 ktCO2eq (Δ516 ktCO2eq). Oxygen-related costs were lower in countries with higher Gross Domestic Product per capita but higher in those with greater exposure to fine airborne particles (PM2.5) and higher out-of-pocket health spending. Per-ICU bed greenhouse gas emissions were highest in the Eastern Mediterranean, Central Asia, and upper-middle-income countries. Higher fossil-fuel electricity share and greater hospital-bed density were associated with increased emissions. Cleaner grids would reduce global oxygen-related emissions by 49.4%-91.9%. Conservative oxygenation strategies reduce oxygen-related costs and emissions. Aligning oxygen stewardship with energy-transition policies offers a high-impact pathway to reduce the carbon footprint of critical care while strengthening resilience and equity in oxygen access.
Transoral incisionless fundoplication (TIF) is relatively contraindicated in patients with a body mass index (BMI) > 35 kg/m2. However, the comparative efficacy of TIF in individuals with class I obesity (BMI 30-34.9) to non-obese patients remains unclear. This study aimed to evaluate the safety and efficacy of TIF in adults with class I obesity. We conducted a retrospective cohort study using the TriNetX US Research Network, including data from 69 healthcare organizations through December 2024. Adults (≥ 18 years) with gastroesophageal reflux disease (GERD) who underwent TIF were identified using validated International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients were stratified by BMI (< 30 versus 30-35). Exclusion criteria in this study included the following: individuals with a BMI > 35, major esophageal motility disorders, or concomitant hiatal hernia repair. We performed propensity score matching (1:1) and controlled for age, sex, race, ethnicity, diaphragmatic hernia, and proton pump inhibitor (PPI) use. Primary outcomes included postoperative PPI recidivism (excluding the first 3 months), post-TIF esophagitis, and need for subsequent foregut surgery. Secondary outcomes included post-TIF dysphagia, gas bloat symptoms, and 30-day complications. After propensity matching, 112 non-obese and 112 class I obese patients were included with similar baseline characteristics. Median follow-up exceeded 1,000 days in both groups. Postoperative PPI recidivism, esophagitis, surgical interventions, dysphagia and complications were similar. Notably, bloating was significantly lower in the obese group at 1 year (aOR 0.420; 95% CI 0.18-0.95) and maximum follow-up (aOR 0.446; 95% CI 0.21-0.97). TIF appears safe and effective for GERD in adults with class I obesity with comparable outcomes to non-obese patients.
Due to the continued use of fossil fuels and other chemical pollutants, atmospheric greenhouse gas concentrations and environmental pollution continue to rise. The health sector is both a driver and a victim of these developments, and intensive care medicine (ICM), with its high energy demands, extensive use of disposable products, and large variety of pharmaceuticals, contributes substantially to the climate crisis and environmental degradation. The European Society of Anaesthesiology and Intensive Care (ESAIC) therefore aimed to develop consensus recommendations to reduce the environmental footprint of ICM across Europe. A total of 37 recommendations were initially drafted by four topic groups (1) energy, (2) waste management, (3) medication, and (4) ethics-each composed of three to five experts. To facilitate implementation in both middle- and high-income European countries, the agreement threshold was set at 80%. The recommendations were validated by 37 experts from 20 countries using a two-step Delphi procedure. In the first round, all recommendations reached at least 75% agreement. After amendments to four recommendations based on expert feedback, all achieved over 80% approval in the second round, with 32 receiving more than 90% agreement. The final recommendations address: (1) a complete transition to renewable energy and implementation of energy-saving strategies; (2) optimisation of procurement in clinical processes (10Rs) and waste management solutions for single-use plastics; (3) reduction of greenhouse gas emissions (mainly fluorinated gases) and water toxicity caused by medications, as well as prevention of a further increase in antimicrobial resistance (AMR); and (4) implementation of an environment-related, ethically guided precautionary principle. This ESAIC consensus provides a practical framework for sustainable ICM. Stakeholders at all levels should now introduce these recommendations through institutional policies, procurement criteria, guidelines and quality improvement programmes to align intensive care practice with planetary health goals.
Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive motor neuron degeneration in the brain and spinal cord, with mutant superoxide dismutase 1 (SOD1) induced oxidative stress and neuroinflammation as key pathogenic drivers. Here, we uncover that mutant SOD1 is both a Fenton-like agent able for catalytical generation of ·OH and a hydrogenation catalyst for H2 scavenging reactive oxygen species. To enhance the bioavailability of H2, we develop an orally administered Mg2Si nanosheets based feed for sustained release of high-amount H2. On an ALS model of hSOD1G93A transgenic mice, Mg2Si feed remarkably delays ALS progression, improves the motor performance of ALS mice, and extends their lifespan. Histopathologically, oral Mg2Si treatment ameliorates motor neuron degeneration, misfolded SOD1 aggregation and reactive gliosis in spinal cord, while protecting neuromuscular junctions and ameliorating muscle atrophy during disease progression. Transcriptomic analysis demonstrates the H2-mediated down-regulation of both oxidative stress and neuroinflammatory pathways in response to the suppression of NLRP3 inflammasome activation. The proposed strategy of catalyzed hydrogen therapy offers an inspiration for metalloproteases-related neurodegenerative diseases treatment. STATEMENT OF SIGNIFICANCE: Amyotrophic lateral sclerosis (ALS) is an incurable and devastating neurodegenerative disease lacking effective clinical interventions. Although hydrogen gas (H2) exhibits promising neuroprotective potential, conventional H2 therapy is severely limited by unstable and transient H2 release, failing to sustain long-term treatment requirements for chronic ALS pathogenesis. To overcome this bottleneck, we engineer oral administrable Mg2Si nanosheets that enable sustained H2 release via gastrointestinal retention, achieving stable long-term hydrogen supplementation in vivo. Mechanistically, Mg2Si-derived H2 efficiently eliminates excess free radicals triggered by toxic mutant SOD1, and further disrupts the pathological crosstalk between oxidative stress and neuroinflammation in ALS. In transgenic ALS mice, dietary Mg2Si intervention markedly ameliorates motor dysfunction and effectively delays disease progression. Collectively, this study firstly applies Mg2Si nanomaterial-based sustained hydrogen therapy for ALS treatment, establishes a novel gastrointestinal hydrogen delivery strategy, and provides an innovative and clinically translatable paradigm for the design of hydrogen delivery systems against neurodegenerative disorders.
Accurate assessment of ionized calcium (Ca++) is critical in clinical settings but remains technically and logistically challenging in many healthcare facilities. This study aimed to evaluate the performance of machine learning (ML) models in predicting Ca++ levels measured by blood gas analysis, using routinely available biochemical parameters-total calcium (TotCa), total protein, and albumin-and to compare them with values obtained through direct measurement and established correction formulas. A retrospective analysis was conducted on 84,410 patients aged 20-70 years (43,863 men, 40,547 women). Whole-blood Ca++, serum TotCa, albumin, and total protein levels were retrieved from hospital records. Three ML algorithms-Support Vector Machine (SVM), Random Forest (RF), and Gradient Boosting (GB)-were trained and validated using 5-fold cross-validation. Their performance was benchmarked against three conventional correction formulas: Hanna, Zeisler, and Butler. Among the conventional formulas, the Hanna method showed the highest mean absolute error (MAE = 0.3626), while Zeisler (MAE = 0.0719) and Butler (MAE = 0.0988) performed more closely to measured Ca++. The ML models outperformed all formula-based methods, with GB (R2 = 0.6742), SVM (R2 = 0.6732), and RF (R2 = 0.6730) achieving the highest explained variance. In contrast, Butler and Zeisler yielded R2 values of 0.2684 and 0.4879, respectively. ML models demonstrate superior predictive accuracy for Ca++ compared with conventional correction formulas when using routine biochemical parameters. These findings support the potential integration of ML-based tools into clinical decision support systems. Future research should address model interpretability, pH incorporation, and prospective external validation.
Human exposure to micro- and nanoplastics (MNPs) is increasingly relevant to clinical toxicology, but the field is not yet ready for routine patient-level testing. This narrative review evaluates MNPs as emerging clinical analytes from the perspective of diagnostic laboratory medicine. The central question is how laboratories can measure, interpret and act on toxicological information in human specimens without overstating immature evidence. Current studies have reported MNP-related signals in blood, urine, placenta, breast milk, lung tissue, vascular plaques and other tissues, yet comparisons are constrained by inconsistent definitions, heterogeneous matrices, variable sample preparation, incomplete contamination control, method-dependent reporting units and limited outcome-linked data. Particle-based methods such as micro-Fourier-transform infrared and Raman spectroscopy preserve size and morphology information but have practical detection limits and throughput constraints. Mass-based approaches such as pyrolysis-gas chromatography/mass spectrometry quantify polymer mass but can lose particle-level information and may be vulnerable to matrix interferences. Clinical laboratories should therefore treat MNP measurement as a high-complexity analytical problem requiring matrix-matched validation, procedural and field blanks, uncertainty estimates, orthogonal confirmation for consequential claims, and conservative interpretive comments. At present, MNP testing is best suited to research biomonitoring, occupational and public-health surveillance, exposure-source investigations and translational cohorts linking particle measurements to validated effect biomarkers. The review proposes reporting tiers, readiness levels and a laboratory roadmap to convert uncertain exposure signals into reproducible, interpretable and clinically responsible toxicological information.
The growing prevalence of micro- and nanoplastics (MNPs) in the environment elicits concerns about their possible impact on human neurological health. Although studies on animals have suggested neurotoxic effects, evidence from humans is still scarce. This systematic review gathers existing human data to assess the presence, types, detection techniques, and neurological consequences of MNPs in different biological matrices. A comprehensive review was performed on peer-reviewed research concentrating on human studies that report the detection of MNPs in biological tissues and fluids. Four qualifying studies were identified: one clinical observational study, two cadaveric analyses, and one quasi-experimental trial. The data collected encompassed demographics, detection methods, types and concentrations of polymers, biological matrices examined, and neurological biomarkers. MNPs were observed in cerebrospinal fluid (CSF), faeces, urine, olfactory bulbs (OBs), and in brain, liver, and kidney tissues from postmortem cases. The polymers that were reported most frequently were polyethylene (PE) and polypropylene (PP). The detection methods included micro-Fourier transform infrared spectroscopy (µFTIR), pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS), laser direct infrared imaging (LDIR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Although the available evidence is limited, emerging findings indicate the possible accumulation of MNPs in the human central nervous system (CNS), particularly in individuals with dementia or compromised blood-brain barrier (BBB) integrity. Relationships were noted between MNP exposure and disruptions in the BBB, inflammatory markers, and alterations in the gut-brain axis. This review consolidates the findings and emphasizes the need for further exploration of human exposure to MNPs and their possible accumulation in neural tissues. Although there is variability in methodologies used in the reviewed articles, PE and PP stand out as the primary polymers of concern. While a direct causal relationship cannot yet be confirmed, the results highlight the necessity for improved detection methods, larger sample sizes, and long-term studies to better understand the impact of MNPs on neuroinflammation and neurodegeneration.