While fundamental radiological protection standards remain consistent for operating and decommissioning nuclear power plants (NPPs), the unique challenges of decommissioning require a specialized program. This study analyzes the radiological characteristics of decommissioned NPPs and proposes a tailored protection program. Key findings indicate that although total radioactive inventory decreases, radiation dose rates in work areas can fluctuate significantly during the removal and movement of structures and components. The risk of internal exposure and alpha contamination increases due to fine aerosols generated during cutting. The proposed program includes five key elements: ALARA (As Low As Reasonably Achievable), effective access control and monitoring, high-frequency radiological surveys, contamination control, and prevention of internal exposure. This approach aims to optimize radiation exposure, prioritize the removal of high-radiation sources, expand real-time monitoring, and enhance worker training. The study's results aim to bolster safety and establish a robust radiological protection system for future Korean NPP decommissioning efforts.
Multicenter electronic health records (EHRs) can support quality improvement and comparative effectiveness research in critical care. However, limitations of EHR-based research include challenges in abstracting key clinical variables, including a patient's level of consciousness. This study aimed to develop a natural language processing model to predict Glasgow Coma Scale (GCS) scores from daily EHR notes. The study included adult patients (aged ≥18 years) admitted to Mass General Brigham (MGB) hospitals (2017-2024) and patients from the Medical Information Mart for Intensive Care-III (MIMIC-III version 1.4; 2001-2012) database. A dataset of all patients from both institutions was split into training (70%) or hold-out test (30%) sets. Variables consisted of daily notes, age, sex, and admission type. A pooled ordinal regression model (ordinalNet) with an elastic net penalty was trained to predict the lowest daily level of consciousness across 3 classes of impairment: severe (GCS score 3-8), moderate (GCS score 9-12), and mild (GCS score 13-15), and a pooled linear model was trained to predict continuous GCS scores (3-15). Gold standard GCS was obtained from structured flowsheet data. External generalizability was assessed using a single-institution ordinal model trained on MGB and tested on MIMIC. Following post hoc calibration, the performance of the ordinal and linear models was evaluated on the hold-out test sets using the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) for the ordinal models and root mean square error and Pearson correlation coefficient for the linear models. The modeling cohort included 145,897 patients (MGB: n=123,257, MIMIC: n=22,640), with 1,446,965 days of hospitalization between training and testing sets; the average age was 62 (SD 18) years, and the sex distribution was balanced. The pooled ordinalNet achieved an AUROC of 0.96 (95% CI 0.96-0.96) and an AUPRC of 0.77 (95% CI 0.76-0.77). The single-institution ordinal model achieved an AUROC of 0.90 (95% CI 0.89-0.90) and an AUPRC of 0.80 (95% CI 0.79-0.80). The pooled linear model achieved a root mean square error of 2.30 (95% CI 2.30-2.30) and a correlation of 0.76 (95% CI 0.76-0.76). Predictions for severe GCS were driven by terms indicating unresponsiveness and critical interventions, moderate GCS by intermediate alertness descriptors, and mild GCS by mentions of normal or awake behavior. Pooled ordinal and linear models can accurately predict GCS from unstructured data and can support large-scale phenotyping of neurological assessments for future critical care research.
We demonstrate a 4.5 Tesla high-temperature superconductor magnet (HTS) operating in liquid nitrogen (LN2) at 77 K as a proof-of-concept platform for compact high-field generation. While cryocooler-based HTS magnets and liquid helium cooled magnets are already established, LN2 cooled magnets offer simpler and potentially lower infrastructure cooling approach compared to cryofree or liquid helium. Additionally, liquid helium (LHe) remains scarce, expensive and challenging to handle. With HTS technology that allows for high magnetic fields even with LN₂ cooling, we developed a double-pancake coil magnet to assess its performance. The magnet was constructed with 2 × 200 m, 10 mm wide HTS tape, not exceeding the width of a pencil length. Each single pancake (1 × 200 m) coil was powered individually, generating a magnetic field strength of 3 Tesla. Stacking the pancake coils yields a double-pancake magnet that reaches a maximum field of 4.5 Tesla when operated in parallel. These results were obtained with pancake coils that had previously been quenched in LHe, indicating the robustness of our manufacturing and operation approach. The present work demonstrates the feasibility of LN2-cooled HTS magnets for NMR-relevant high-field applications and provides a basis for future optimization of geometry, field homogeneity, and operating temperature. Ultimately reaching sufficiently high magnetic fields and homogenity for nuclear magnetic resonance spectroscopy (NMR) operated solely in LN2.
Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide, with atherosclerosis playing a central role in their pathogenesis. A fluorescent probe activatable by leucine aminopeptidase was synthesized and designated as LAP probe. This probe was constructed using a hemicyanine scaffold conjugated with an LAP-recognizing peptide via a condensation reaction. Upon LAP activation, a bathochromic shift in absorption and a marked turn-on fluorescence response in the near-infrared region were observed, with a strong linear correlation established between fluorescence intensity and LAP concentration. The probe successfully distinguished foam cells from normal macrophages and enabled in vivo imaging of atherosclerotic plaques in high-fat diet-fed ApoE-/- mice. Serum LAP activity was found to be significantly elevated in atherosclerotic mice and in patients with arterial stenosis, particularly in those with severe stenosis exceeding 60%, as confirmed by receiver operating characteristic curve analysis. The probe exhibited low toxicity with no observable organ damage. These findings demonstrated that LAP probe holds promise for the auxiliary diagnosis and risk stratification of atherosclerosis.
Small airway mucus impaction in chest computed tomography (CT) is a clinically significant finding in chronic obstructive pulmonary disease (COPD), associated with accelerated pulmonary function decline, increased frequency of acute exacerbations, and higher susceptibility to respiratory infections. However, a validated predictive tool for identifying patients at risk of CT-detected mucus plugs is currently lacking. This study aimed to develop and validate a nomogram to predict small airway mucus obstruction in patients with COPD. We retrospectively enrolled 212 COPD patients from Shenzhen Second People's Hospital (January 2021 to June 2022), of whom 47 had CT-confirmed mucus plugs (mucus plug group, MP) and 165 did not (non-mucus plug group, NMP). Univariate and receiver operating characteristic (ROC) analyses were used to identify candidate predictors. Multivariate logistic regression was conducted to construct the final predictive model, which was then transformed into a nomogram. Internal validation was performed using bootstrap sampling (1000 iterations). Bronchiectasis, chronic rhinosinusitis (CRS), body mass index (BMI), forced expiratory flow at 25-75% of predicted (FEF25-75%pred), residual volume-to-total lung capacity ratio (RV/TLC), and serum 25-hydroxyvitamin D [25(OH)D] were identified as independent risk factors for CT mucus plugs. The nomogram demonstrated excellent predictive value with an AUC of 0.9611. Calibration curves and decision curve analyses demonstrated good clinical utility. Bootstrap internal validation further supported the model's predictive stability. This nomogram provides a practical, individualized tool to facilitate early identification and personalized management of COPD patients at risk of small-airway mucus obstruction.
Low-iridium cobalt spinel oxides are promising anode catalysts for proton-exchange membrane water electrolyzers (PEMWEs), but their practical application remains limited by the structural instability of Ir-O-Co motifs at high current densities. Here, we show that the simultaneous incorporation of Mn and Ir into the octahedral (Oh) sites of Co3O4 to form Ir0.1Co1.93Mn0.97O4 markedly enhances both acidic oxygen evolution activity and durability. In contrast to the single-doped analogues, in which Mn is predominantly stabilized as Jahn-Teller-active Mn3+ in Co2MnO4 and Ir exists as less oxidized Ir>4+ in Ir0.1Co2.9O4, Ir0.1Co1.93Mn0.97O4 exhibits an optimized local coordination environment with Jahn-Teller-suppressed Mn4+ and high-valence Ir>4+ species at the Oh sites. This distinctive local coordination chemistry enhances structural robustness while promoting catalytic activity under operating conditions. In a practical PEMWE, Ir0.1Co1.93Mn0.97O4 sustains stable operation for 2800 h at 0.5-1.0 A cm-2, outperforming most reported low-Ir-loading catalysts. This work highlights the importance of coordination asymmetry in the design of durable electrocatalysts for clean energy conversion.
To identify latent profiles of resilience and fear of progression in patients undergoing lung resection and evaluate their relationships with discharge symptoms and postoperative frailty. This two-wave longitudinal observational study enrolled 387 patients undergoing video-assisted thoracic surgery. Preoperative psychological constructs (resilience and fear of progression) were assessed at admission (T1), while postoperative symptoms and frailty status were evaluated at the time of discharge (T2). Latent profile analysis and the robust three-step approach were used to identify unobserved patient subgroups. Multivariable linear and logistic regression analyses were then applied to evaluate the independent associations between these psychological profiles and discharge symptom burden as well as postoperative frailty status, after adjusting for perioperative clinical covariates. Three distinct profiles were identified: "Low Resilience-High Fear Group" (Profile 1, 24.3%), "Balanced Group" (Profile 2, 39.0%), and "High Resilience-Low Fear Group" (Profile 3, 36.7%). Living alone was a significant covariate associated with profile membership (P < 0.05). For discharge symptoms, using Profile 1 as the reference, membership in Profile 2 (b = -4.89) and Profile 3 (b = -16.95) was significantly associated with lower symptom scores (both P < 0.05). Regarding postoperative frailty at discharge, patients in Profile 3 had a 77% lower likelihood of worsening frailty status than those in Profile 1 (OR = 0.23, 95% CI: 0.13-0.40, P < 0.001). Additionally, primary caregiver type, preoperative frailty, and surgical procedures were independently related to discharge frailty status (all P < 0.05). Preoperative psychological stratification serves as an independent indicator of discharge symptoms and frailty status. These findings confirm that classification based on psychological variables provides critical clinical information not captured by standard surgical indices. Prioritizing psychological risk stratification in thoracic surgical workflows is necessary to guide targeted perioperative interventions and improve recovery outcomes.
Water-soluble esophagram and endoscopy are commonly used to detect anastomotic leak after esophagectomy. However, the comparative performance of these two modalities in detecting leaks has not been well established. We retrospectively reviewed all patients who underwent esophagectomy for cancer between January 2021 and December 2022 from a prospectively maintained database. Occurrence, management and consequences of leaks were examined. The primary outcome was to compare the diagnostic performance of esophagram and endoscopy in detecting anastomotic leak. Therefore, a total of 846 patients were identified. The overall incidence of anastomotic leak was 10.4%. Patients with leaks had older age and more retrosternal routes for reconstruction. Of them, 466 patients underwent endoscopy and 217 underwent esophagram. After matching, 434 patients, 217 per group were analyzed. The sensitivity and negative predictive value of endoscopy were 79.2% and 97.5%, whereas those of esophagram were only 37.9% and 91.3%, respectively (P = 0.003; P = 0.007). In the subset of patients with cervical anastomosis, endoscopy also demonstrated superior sensitivity (78.3% vs 36.0%, P = 0.004) and negative predictive value (97.4% vs 90.8%, P = 0.007). Esophagram showed false-negative results in 18 patients, while only 5 leaks were missed by initial endoscopy. Regarding the management of false negatives, esophagram group showed non-significant trends toward longer hospital stay and more interventions, including stenting (11.1% vs 0%) and clipping (5.6% vs 0%) (both P > 0.05). In conclusion, endoscopy showed higher sensitivity and negative predictive value than esophagram in detecting anastomotic leak after esophagectomy in this study. However, a large-scale, randomized study is warranted to validate these results.
The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.
Hypochlorous acid (HClO) is a key reactive oxygen species (ROS) involved in both normal physiology and disease pathogenesis. Imbalances in its intracellular levels are strongly associated with inflammatory disorders and cancer. In this work, we introduce TPE-ML, a novel aggregation-induced emission (AIE) probe built on a thiomorpholine scaffold. This probe features a distinctive "off-on-off" fluorescence switching behavior. It exhibits a Stokes shift of approximately 170 nm and enables sensitive detection of HClO with a limit of detection as low as 1.37 μM. Solvent-dependent assays confirm its AIE characteristics: the fluorescence intensity increases 15-fold in solvent mixtures with 99% water fraction. Upon selective oxidation by HClO, TPE-ML converts from an AIE-active aggregated state to a dispersed state, accompanied by marked fluorescence quenching. Theoretical calculations further reveal an increased dipole moment and hydrophobicity (log P) further altered electronic properties after oxidation. Using the standard addition method, TPE-ML achieved quantitative analysis of HClO in strawberries, apples, baby cabbage, and lettuce, with spiked recoveries ranging from 98.3% to 107.8%. It also permitted on site visual monitoring, as the fluorescence turned from yellow to dark under 365 nm UV illumination. Furthermore, this probe allowed real time imaging of both externally added and endogenously produced HClO in living 4 T1 cells, underscoring its biomedical promise. Collectively, this work introduces a fresh AIE based sensing mechanism for HClO, thereby enriching the methodological toolbox for ROS detection in biological specimens.
Safety studies of the COVID-19 vaccine have identified some adverse events. Yet newer variant-updated formulations, along with increased hybrid immunity, may change these risks. Early-era safety data may not reflect experience with updated formulations in more immune-experienced populations. To evaluate 90-day risks for adverse events after coadministration of COVID-19 and influenza vaccines compared with influenza vaccination alone, across bivalent, XBB-adapted, and KP-adapted COVID-19 vaccine periods. Target trial emulation using electronic health care data. U.S. Department of Veterans Affairs. Participants receiving both COVID-19 and seasonal influenza vaccines (n = 705 124) and those receiving only an influenza vaccine (n = 1 813 205) between 1 September 2022 and 26 August 2025. Receipt of both COVID-19 and seasonal influenza vaccines versus receipt of only an influenza vaccine. 90-day risks for 46 prespecified individual adverse events grouped into 3 composite outcomes (tier 1, serious or life-threatening; tier 2, clinically significant; tier 3, less severe or self-limiting), using weighted discrete-time survival models. For all 3 composite outcomes, risks were similar between groups: tier 1 (risk ratio [RR], 1.03 [95% CI, 0.99 to 1.09]), tier 2 (RR, 0.99 [CI, 0.96 to 1.03]), and tier 3 (RR, 0.99 [CI, 0.96 to 1.02]). Of the 46 individual adverse events, 2 tier-3 risks had nominal statistical significance: syncope (RR, 1.09 [CI, 1.02 to 1.17]) and tinnitus (RR, 0.95 [CI, 0.92 to 0.99]); no risks were statistically significant after correcting for multiple comparisons. For all risks in tier 1 or tier 2, confidence bounds included 1.0 (no effect). In period-stratified analyses, neither composite (tier) nor individual event estimates supported differences in risks between groups. Generalizability and potential unmeasured confounding. Same-day coadministration of COVID-19 and influenza vaccines was not associated with an increased risk for adverse events in 3 updated-formulation periods. These findings support the short-term safety of coadministration. U.S. Department of Veterans Affairs.
A significant knowledge gap persists in understanding the mechanisms driving peripheral nerve regeneration and improving postoperative recovery. Rat models serve as essential tools for investigating peripheral nerve injury or repair due to their affordability, resilience, and functional similarity to humans. This study provides a comprehensive overview of surgical dissection details and the application of rat peripheral nerve models. Under approval from the Vanderbilt University Medical Center Institutional Animal Care and Use Committee, dissections of upper and lower extremity peripheral nerves were performed in 2 Sprague-Dawley rats. Standardized techniques were documented for median, ulnar, radial, musculocutaneous, intercostal, femoral, obturator, sciatic, tibial, common peroneal, sural, and pudendal nerves. All peripheral nerves were successfully identified and exposed. Functional correlations and applications were summarized for each model, including regeneration, neuropathic pain, motor recovery, and nerve grafting. The sciatic nerve remains the most established model, while the median and ulnar nerves offer reliable forelimb motor assessments with a lower risk of self-mutilation. This comprehensive review defines dissection techniques, applications, and comparative advantages of rat peripheral nerve models. These standardized methods aim to guide model selection and strengthen translational research in peripheral nerve regeneration and repair.
The incidence of esophageal adenocarcinoma (EAC) has continued to increase, with a poor 5-year survival rate of ~20%. Barrett's esophagus is the only recognized precursor to EAC, so public health strategies focus on identifying and screening high-risk populations. Currently, the standard screening method is sedated esophagogastroduodenoscopy. However, this approach has challenges, including its invasive nature, need for sedation, higher cost, procedure-related risks, sampling error, and poor suitability for population-wide screening. As a result, alternative screening techniques such as transnasal endoscopy and less invasive options including non-endoscopic cell collection devices with biomarker assays have been explored. In this review, we summarize current approaches for identifying at-risk populations and screening methods and provide insights into technologies that could complement screening strategies in the future.
Pressure sores, or decubitus ulcers, are a common and debilitating complication of immobility, particularly affecting individuals with spinal cord injuries, advanced age, or prolonged hospitalization. These wounds result from sustained pressure exceeding capillary perfusion pressure, leading to tissue ischemia and necrosis, often beginning at the muscle-bone interface. Despite preventive efforts, pressure sores remain highly prevalent and frequently recur, posing significant challenges to patient care and health care systems. This review outlines the underlying pathophysiology and risk factors for ulcer development, with a focus on high-risk populations. Prevention strategies, including specialized support surfaces, frequent repositioning, and nutritional optimization, are essential for reducing incidence and severity. Established ulcers can require surgical debridement for wound control and complex reconstructive procedures for closure. Perioperative planning, including strict offloading protocols and infection control, is key to long-term flap durability. Emerging regenerative approaches, such as stem cell-enriched matrices and growth factor therapies, show promise as adjuncts or alternatives to traditional reconstruction. By integrating prevention, precise surgical technique, and biological innovation, robust outcomes in pressure sore management are increasingly within reach. Ongoing research should prioritize long-term outcomes and the reduction of recurrence in high-risk populations.
Dural arteriovenous fistula (DAVF) in the sphenoid region is a rare condition. It develops following aberrant vascular connections between arterial branches of the external and internal carotid arteries with sphenoidal venous drainage. The treatment can be endovascular embolization or open surgery to obliterate the fistula. A 62-year-old man was incidentally diagnosed with a DAVF located at the left lesser sphenoid wing during a routine checkup. Preoperative angiographic imaging revealed a high-grade fistula with arterial feeders originating from both the internal and external carotid arteries and venous drainage into the superficial middle cerebral vein (SMCV). Based on the angioarchitecture of the DAVF, surgery was performed, successfully obliterating the arterial feeders and disconnecting the fistula. The authors present an asymptomatic case of a left lesser sphenoid wing DAVF with an atypical venous drainage pattern involving the SMCV, sparing the cavernous sinus. Recognition of the vascular architecture and the high-grade nature of this vascular malformation is crucial for ensuring proper treatment and preventing serious complications. https://thejns.org/doi/10.3171/CASE2628.
Peste des petits ruminants virus (PPRV) is a highly contagious morbillivirus causing severe disease in small ruminants, with major implications for global food security and ongoing eradication efforts. Despite the availability of effective vaccines, the absence of antiviral therapeutics represents a critical gap in outbreak control. Here, we describe the design and in vitro characterization of a synthetic peptide derived from the heptad repeat C (HRC) region of the PPRV fusion (F) protein as a novel viral entry inhibitor. The HRC peptide potently inhibited PPRV F/H-mediated membrane fusion in a dose-dependent manner, with IC₅₀ values of 11.80 μM and 18.11 μM for SLAM/CD150- and nectin-4-dependent entry, respectively. Consistently, the peptide blocked viral entry in a vesicular stomatitis virus (VSV)-based pseudovirus system (IC₅₀ = 14.5 μM). Antiviral activity was further confirmed using a replicative morbillivirus model (canine distemper virus), where significant inhibition of infection was observed in both co-treatment and virus pre-treatment conditions. Notably, the combination with a fusion inhibitory compound (FIP) resulted in synergistic antiviral activity (FICI = 0.44), highlighting the potential of dual-targeting strategies. Biophysical analyses revealed a strong α-helical propensity in membrane-mimetic environments and high stability in human serum. Molecular docking and dynamics simulations indicated that the HRC peptide stabilizes the F protein by bridging critical domains through a persistent hydrogen-bond network, thereby preventing the conformational rearrangements required for membrane fusion. Collectively, these findings provide the first evidence that HRC-derived peptides can effectively inhibit PPRV entry and support their development as antiviral agents to complement current eradication strategies.
This study aims to develop a spatio-temporal predictive model for the luminous intensity distribution of the laser welding molten pool-a key visual indicator of process stability and quality-to overcome the limitations of conventional analytical models in handling complex multi-physical interactions. A data-driven framework based on a nonparametric artificial neural network architecture is proposed. Gaussian functions are employed as radial basis functions to capture localized spatio-temporal variations in the light field. The root mean square error is adopted as the evaluation metric and integrated into a systematic hyperparameter optimization procedure to enhance model fidelity and robustness. The optimized model successfully predicts two distinct molten pool luminous patterns under different welding conditions. Predictions show strong agreement with synchronized high-speed experimental images, confirming the model's accuracy and generalization capability. This method effectively reconstructs the molten pool's luminous signature, demonstrating significant potential for real-time process monitoring, online anomaly detection, and non-destructive quality assessment in advanced laser welding operations.