Search Results (161)

This paper introduces a unified and systematic design methodology for robotic systems that is generalizable across a wide range of applications. It integrates rigorous mathematical formalisms such as kinematics, dynamics, control theory, and optimization with advanced simulation tools, ensuring that each design decision is grounded in provable theory. The approach defines clear phases, including mathematical modeling, virtual prototyping, parameter optimization, and theoretical validation. Each phase builds on the previous one to reduce unforeseen integration issues. Spanning from conceptualization to deployment, it offers a blueprint for developing mathematically valid and robust robotic solutions while streamlining the transition from design intent to functional prototype. By standardizing the design workflow, this framework reduces development time and cost, improves reproducibility across projects, and enhances collaboration among multidisciplinary teams. Such a generalized approach is essential in today’s fast-evolving robotics landscape where rapid innovation and cross-domain applicability demand flexible yet reliable methodologies. Moreover, it provides a common language and set of benchmarks that both novice and experienced engineers can use to evaluate performance, facilitate knowledge transfer, and future-proof systems against emerging application requirements. Full article

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Background and Objectives: While α1-blockers like silodosin are the mainstay for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), combination therapy with phytotherapeutics may provide enhanced symptom control. Xipag^® is a novel formulation containing Graminex^® G96 (pollen extract) and Teupol^® 25P (teupolioside), offering anti-inflammatory and antiandrogenic effects. This study aimed to evaluate the efficacy of Xipag^® versus hexanic extract of Serenoa repens (HESr), both in combination with silodosin, in patients with LUTS/BPH. Materials and Methods: We conducted a single-center, prospective, observational, comparative study involving male patients with moderate-to-severe LUTSs undergoing treatment with silodosin. Patients were allocated to receive either Xipag^® or HESr in addition to silodosin, with follow-up every 3 months for 12 months. Primary outcomes included changes in symptom scores such as IPSS, QoL, and functional improvements such as peak urinary flow rate (Qmax). Multivariable regression analyses were used to assess predictors of the response. Results: Patients receiving Xipag^® showed significantly greater improvements in Qmax at all follow-up points (p < 0.05), with earlier and more sustained benefits compared to the HESr group. QoL index scores and PSA levels were also significantly better in the Xipag^® group starting from month six onward. IPSS scores improved in both groups but were significantly lower in the Xipag^® group only at 12 months (p = 0.04). No differences in erectile function (IIEF-5) or adverse events were observed. Conclusions: Xipag^® in combination with silodosin provides superior improvement in urinary flow, symptom-related QoL, and PSA reduction compared to HESr plus silodosin, with a favorable safety profile. These findings support the use of multi-target nutraceuticals like Xipag^® as a valuable adjunct in the management of LUTS/BPH. Larger randomized trials are warranted to confirm these results and explore underlying mechanisms. Full article

Here, we describe a case of an asymptomatic 73-year-old female patient who suffered from type A acute aortic dissection with epiaortic arteries involvement and underwent surgical operation 9 years ago. A follow-up color Doppler ultrasound revealed a right vertebral artery intermittent flow reversal due to innominate artery dissection. To our knowledge, no previous studies have reported this intermittent flow reversal; therefore, supra-aortic trunks should be considered among the possible causes of vertebral artery flow reversal. Full article

Interleukin-23 (IL-23) is a key cytokine involved in the pathogenesis of various immuno-mediated inflammatory diseases. In recent years, several drugs selectively targeting IL-23 have been developed and three of them (mirikizumab, risankizumab and guselkumab) were successfully investigated in clinical trials for ulcerative colitis (UC). All of them showed a good profile for efficacy, alleviating symptoms, and inducing endoscopic and histologic improvement, with very low incidence of adverse events. Bowel urgency also emerged as a crucial outcome from patients’ perspective in the mirikizumab trials. The correct positioning of IL-23 inhibitors in the therapeutic algorithm for UC represents a new challenge for physicians, especially because it is not guided by biomarkers or predictors of effectiveness. Moreover, no comparative clinical data exist among the available IL-23 inhibitors, although molecular differences might potentially impact their effectiveness. A role for IL-23-inhibitors may also lie in combination with drugs with different mechanisms of action for complex, multi-refractory patients. This review, focusing on UC, summarizes all the clinical data available on IL-23 inhibitors and provides a perspective on the best clinical scenarios to maximize their effectiveness. Full article

Most of the developed and studied service robots for vertical locomotion, as visual inspection, are made up by a rigid body with legs, wheels, or both. Thus, the robot can only displace over regular and/or flat surfaces since it is not able to adapt to the irregularities and projections of the wall. Therefore, this paper presents the design and analysis of an adaptable robot for vertical locomotion service tasks, which has a body made up of four wheeled legs that can easily adapt to the different irregularities and projections of building facades. The robot uses an Electric Ducted Fan (EDF) as the vortex adhesion system. Each leg has a rubber cover, which allows a higher mechanical adaptability of the robot over different irregularities of the wall. Theoretical backgrounds and open issues are addressed by considering some challenging problems such as mechanical adaptability modeling as well as kinematic and static analysis. Laser sensors are mounted over the robot to measure the adaptability of the robot, between the legs and body, at each time of the experimental tests for vertical locomotion. Full article

Background: Cold dissection (CD) during nerve-sparing robot-assisted radical prostatectomy (nsRARP) in patients with prostate cancer has been proposed to improve functional outcomes by reducing the thermal damage to neurovascular bundles (NVBs). This study compares the impact of CD versus thermal dissection (TD) on postoperative early continence and erectile function recovery. Methods: A prospective comparative analysis was conducted on patients undergoing nsRARP, comparing CD and TD techniques. Continence was assessed at 15, 30, and 90 days, while erectile function was evaluated at 30, 90, and 180 days using IIEF-5 scores. Logistic and linear regression analyses were performed to identify predictors of functional recovery. Results: CD significantly improved early continence at 15 and 30 days (p < 0.05), although the difference diminished by 90 days. Erectile function recovery was consistently higher in the CD group at all time points (p < 0.01). Age negatively impacted continence and erectile function recovery, while preoperative IIEF-5 scores were strong predictors of erectile function. Prostate volume, BMI, and metabolic syndrome showed no significant influence on outcomes. Conclusions: CD enhances early continence and erectile function recovery following nsRARP by preserving NVBs and minimizing thermal damage. This technique offers a valuable approach to improving patient functional outcomes. Further studies are required to validate its long-term benefits. Full article

Background: Minimally invasive surgery has improved patient outcomes but raises environmental concerns due to carbon emissions from disposable instruments, energy consumption, and hospital resource use. This study evaluates the carbon footprint of robot-assisted and laparoscopic nephrectomies. Methods: A multicenter prospective study analyzed 162 patients undergoing robot-assisted or laparoscopic partial (RAPN, LPN) and radical nephrectomy (RARN, LRN). Life cycle assessment (LCA) quantified CO₂ emissions from instrument use, sterilization, and energy consumption. Results: Robot-assisted procedures had lower CO₂ emissions than laparoscopic approaches. Emissions from instrument disposal were 9.04 kg in RAPN vs. 12.14 kg in LPN (p = 0.02) and 8.74 kg in RARN vs. 11.45 kg in LRN (p = 0.03). Despite higher intraoperative energy use, robot-assisted surgery produced 3–4 kg less CO₂ per procedure due to reusable instruments and shorter hospitalization. Conclusions: Robot-assisted nephrectomy reduces environmental impact by minimizing waste and hospital stays. Efforts should focus on reusable instruments, energy efficiency, and sustainability initiatives to mitigate surgical carbon footprints while ensuring high-quality care. Full article

Background: The purpose of this study is to assess how the socio–family demographic status of patients is related to the onset of delirium in a large cohort of older adults aged ≥65 years evaluated in the emergency department (ED) using a comprehensive geriatric assessment (CGA). Methods: This is a cross-sectional, observational, retrospective study conducted in the ED of a teaching hospital. We enrolled 2770 geriatric patients admitted to the ED from January 2019 to December 2023 and evaluated them using CGA. Clinical variables assessed in the ED were evaluated for associations with delirium onset and in-hospital mortality. Results: Delirium was statistically related to frailty statuses as measured via the Clinical Frailty Scale (CFS) (OR 1.47 [1.39–1.56]; p < 0.001). The occurrence of delirium was also associated with living arrangements: “living with other relatives” condition (OR 1.43 [1.12–1.83]; p = 0.004) and residence in a nursing home (OR 1.72 [1.30–2.31]; p < 0.001). In addition, compared to patients in emergency conditions (NEWS > 5), it emerges that patients with better clinical stability have a lower risk of developing delirium (NEWS 3–5 OR 0.604 [0.48–0.75]; p < 0.001—NEWS < 3 OR 0.42 [0.34–0.53]; p < 0.001). In-hospital mortality was associated with age, male sex, frailty status, clinical instability, and the onset of delirium in the ED. Conclusions: Delirium is a multifactorial and acute syndrome representing a negative prognostic factor of in-hospital mortality, especially in elderly patients. Independent of the clinical condition, the patient’s living arrangement could be of relevance to the onset of delirium in the ED. Early comprehensive geriatric assessments in the ED could allow the early detection of all predisposing risk factors, resulting in the timely implementation of supportive strategies to prevent the onset of delirium in EDs. Full article

Here, we describe the case of an asymptomatic 70-year-old male patient who performed a contrast-enhanced computed tomography examination for prostate cancer staging, and an exceptional finding was reported. Specifically, a probable and never before reported minimal V aortic arch remnant with a thin intima–media band that joins together the anterior and posterior aortic walls. Full article

Dynamical processes during the different stages of evolution of tropical cyclones play crucial roles in their development and intensification, making them one of the most powerful natural forces on Earth. Given their classification as extreme atmospheric events resulting from multiple interacting factors, it is significant to study their dynamical behavior and the nonlinear effects generated by emerging structures during scales and intensity transitions, correlating them with the surrounding environment. This study investigates the extraordinary and record-breaking case of Tropical Cyclone Freddy (2023 Indian Ocean tropical season) from a purely dynamical perspective, examining the superposition of energetic structures at different spatio-temporal scales, by mainly considering thermal fluctuations over 12 days of its evolution. The tool used for this investigation is the Proper Orthogonal Decomposition (POD), in which a set of empirical basis functions is built up, retaining the maximum energetic content of the turbulent flow. The method is applied on a satellite imagery dataset acquired from the SEVIRI radiometer onboard the Meteosat Second Generation-8 (MSG-8) geostationary platform, from which the cloud-top temperature scalar field is remote sensed looking at the cloud’s associated system. For this application, considering Freddy’s very long life period and exceptionally wide path of evolution, reanalysis and tracking data archives are taken into account in order to create an appropriately dynamic spatial grid. Freddy’s eye is followed after its first shape formation with very high temporal resolution snapshots of the temperature field. The energy content in three different characteristic scale ranges is analyzed through the associated spatial and temporal component spectra, focusing both on the total period and on the transitions between different categories. The results of the analysis outline several interesting aspects of the dynamics of Freddy related to both its transitions stages and total period. The reconstructions of the temperature field point out that the most consistent vortexes are found in the outermost cyclonic regions and in proximity of the eyewall. Additionally, we find a significant consistency of the results of the investigation of the maximum intensity phase of Freddy’s life cycle, in the spatio-temporal characteristics of its dynamics, and in comparison with one analogous case study of the Faraji tropical cyclone. Full article

Background/Objectives: Various factors influence intrauterine growth and birth weight. We investigated the possible association between first-trimester pregnancy thyroid functions and birth weight. Methods: A retrospective observational study was conducted from 31 March 2021 to 30 September 2022. Ninety-eight low-risk pregnant women were evaluated. To obtain a homogeneous population, we included only patients with no maternal or fetal comorbidities. TSH, FT3, and FT4 levels in the first trimester and birth weight were recorded and analyzed. Results: The average maternal age was 33.37 years (IQR = 8.67), with a median BMI of 24.98 kg/m² (IQR = 5.66). The average gestational week of pregnancy was 39.40 weeks (IQR = 2.10). Linear regression for birth weight according to TSH effects adjusted by sociodemographic and clinical factors did not show any associations between birth weight and TSH, age, ethnicity, BMI, smoking, or weight gain. Pregnancy duration was associated with birth weight: β = 172.027, p-value < 0.001. A negative significant correlation between FT3 and birth weight was found (beta = −118.901 95% CI: −222.942 to −14.859, p = 0.026). Age, ethnicity, BMI, smoking, and weight showed non-significant associations with birth weight. The FT3 scatterplot showed a negative correlation of FT3 levels with birth weight. Higher values of FT3 were associated with a low birth weight (R = −0.22, p = 0.029). Conclusions: Our study, focused on the first trimester, found a negative correlation between FT3 variations and birth weight. Full article