Search Results (6,807)

Shield construction of deep tunnels for urban drainage involves many risk factors, and potential safety hazards are difficult to monitor and identify directly. In order to improve the risk management level of shield construction in urban drainage deep tunnel, this study proposes a method for identifying risk factors by combining text mining technology and the entropy weight method. By using this method, 34 safety risk factors were successfully extracted from the safety accident reports of urban drainage deep tunnel shield construction and the related text data. The results of this study show that the text mining method could play an important role in the risk management of urban drainage deep tunnel shield construction; the introduction of the entropy weight method further improved the accuracy of risk factor identification. The results of this study not only enrich the research content of risk management in urban drainage deep tunnel shield construction but also provide theoretical guidance for managers to formulate risk management measures and optimize risk management procedures. Full article

Recently, there has been increased interest in NASICON-type electrodes for sodium-ion batteries due to their unique combination of intercalation properties, low cost, and safety. However, their commercialization is hindered by the low electrical conductivity. One strategy to overcome this issue is to integrate NASICON materials with carbon additives. This study shows that carbon additives improve the sodium storage performance of a NASICON-type electrode in various ways, depending on the additives’ functional groups, texture, and conductivity properties. The proof-of-concept is based on a multi-electron phospho-sulphate electrode, NaFeVPO₄(SO₄)₂ (NFVPS) mixed with carbon black (C) and reduced graphene oxide (rGO). Carbon-coated samples are obtained via a simple ball milling procedure followed by thermal treatment in an argon flow. Sodium storage in the composites occurs through capacitive and Faradaic reactions. The Faradaic reaction is facilitated at the carbon black composite, while the capacitive reaction dominates for the rGO composite. NFVPS operates through two-electron reactions at 20 °C, while the increased temperatures favor the three-electron reaction. The rGO composite outperforms the carbon black composite in terms of cycling stability and rate capability at 20 and 40 °C. The role of the rGO and carbon black in electrochemical performance is discussed based on the different reactivity of hydroxyl/epoxide and carbonyl functional groups with the electrolyte salt, NaPF₆, and the solvent, polypropylene carbonate. Full article

Objectives: To clarify the need for a kidney exchange program (KEP) in Japan by conducting a questionnaire survey on KEPs and simulated KEPs by virtual cross-matching based on past cases of transplantation avoidance. Methods: In addition to the content regarding KEPs, an electronic survey was conducted to investigate the number of cases of kidney transplant abandonment due to “immunological” reasons over the past 10 years (2012–2021). Virtual cross-matching was conducted to simulate the feasibility of avoiding immunological risks and enabling kidney transplantation in patients who were previously unable to undergo the procedure. Results: The survey received responses from 107 facilities (response rate: 81.7%). In response to the question about the necessity of a KEP in Japan, 71 facilities (66.4%) indicated that KEPs are necessary. In addition, 251 living-donor kidney transplants were abandoned for “immunological” reasons over the past decade (2012–2021). Among the 80 pairs for which detailed information was available, virtual cross-matching simulations showed that 37/80 pairs (46.3%) were donor-specific antibody (DSA)-negative for blood type-matched combinations, and 41/80 pairs (51.3%) were DSA-negative for blood type-incompatible transplants. Conclusions: The need for a KEP in Japan and its potential usefulness were demonstrated. Full article

The assessment of physical quantity values, especially in case of sports-related activities, is critical to evaluate the performance and fitness level of athletes. In real-world applications, motion analysis tools are often employed to assess motor performance in subjects. In case the methods used to calculate a specific quantity of interest differ from each other, different values may be provided as output. Therefore, there is the need to get a coherent final measurement, giving the possibility to compare results homogeneously, combining the different methodologies used by the instruments. These tools vary in measurement capabilities and the physical principles underlying the measurement procedures. Emerging differences in results could lead to non-uniform evaluation metrics, thus making a fair comparison unpracticable. A possible solution to this problem is provided in this paper by implementing an iterative approach, working on two measurement time series acquired by two different instruments, specifically focused on jump height estimation. In the analyzed case study, two instruments estimate the jump height exploiting two different technologies: the inertial and the vision-based ones. In the first case, the measurement value depends on the movement of the center of gravity during jump activity, while, in the second case, the jump height is derived by estimating the maximum distance ground–foot during the jump action. These approaches clearly could lead to different values, also considering the same jump test, due to their observation point. The developed methodology can provide three different ways out: (i) mapping the inertial values towards the vision-based reference system; (ii) mapping the vision-based values towards the inertial reference system; (iii) determining a comprehensive measurement, incorporating both contributions, thus making measurements comparable in time (performance progression) and space (comparison among subjects), eventually adopting only one of the analyzed instruments and applying the transformation algorithm to get the final measurement value. Full article

This is a single-center study about upward facing in branched endovascular aortic repair. Background: The evolution of branched endovascular aortic repair (BEVAR) has introduced upward-facing branches as a novel approach to facilitate exclusive transfemoral access in complex aortic aneurysm repair. This study evaluates the feasibility, safety, and early outcomes of custom-made BEVAR devices incorporating upward-facing branches in patients with cranially oriented renal arteries. The investigation further aims to analyze the technical success and mid-term outcomes related to these novel devices, as well as to identify any challenges or complications specific to the use of upward-facing branches in clinical practice. Methods: We retrospectively analyzed 17 patients treated at a single center between January 2020 and December 2024 using custom-made Cook Medical branched stent grafts with at least one upward-facing branch. Demographics, comorbidities, target vessel details, bridging stent graft (BSG) configurations, and procedure-related complications were collected. The primary endpoints were technical success and branch patency. Secondary endpoints included short- and mid-term branch-related complications. Results: The cohort had a mean age of 70 years, with hypertension (88%) and coronary artery disease (47%) being common comorbidities. Technical success was achieved in 100% of cases. The left renal artery was the most frequently targeted vessel (63.2%). Most upward-facing branches were bridged using a combination of balloon-expandable and self-expandable stents. One patient (5.9%) experienced a renal bleeding complication requiring embolization. There were no cases of primary stent occlusion or dislocation. At a mean follow-up of 14 months, one asymptomatic occlusion of an upward-facing branch was detected in computed tomography angiography. No further upward-facing branch-related complications occurred, and 1-year follow-up was available in 41.2% of patients. Conclusions: In our single-center study including 17 patients, upward-facing branches in BEVAR demonstrate high technical success and a low complication rate, offering a promising alternative to traditional access strategies. These findings support broader adoption in select anatomical scenarios, pending larger comparative studies and longer-term data collection. Full article

This paper provides an in-depth analysis of the microstructural characteristics and the chemical content of Polybutylene Terephthalate (PBT) composites that have different contents of Glass Fiber (GF). Blending of VALOX 420 (30 wt% GF/PBT) with unreinforced VALOX 310 allowed the composites to be prepared, with control of the concentration and distribution of the GF. The GF reinforcement and PBT matrix were characterized by an advanced microstructural spectrum and spatial analysis to show the influence of fiber density, dispersion, and chemical composition on performance. Findings indicate that GF content has a profound effect on microstructural properties and damage processes, especially traction effects in various regions of the specimen. These results highlight the significance of accurate control of GF during fabrication to maximize durability and performance, which can be used to inform the design of superior PBT/GF composites in challenging engineering applications. The implications of these results are relevant to a number of high-performance sectors, especially in automotive, electrical, and consumer electronic industries, where PBT/GF composites are found in extensive use because of their outstanding mechanical strength, dimensional stability, and thermal resistance. The main novelty of the current research is both the microstructural and chemical assessment of PBT/GF composites in different fiber contents, and this aspect is rather insufficiently studied in the literature. Although the mechanical performance or macro-level aging effects have been previously assessed, the Literature usually did not combine elemental spectroscopy or spatial microstructural mapping to correlate the fiber distribution with the damage mechanisms. Further, despite the importance of GF reinforcement in achieving the right balance between mechanical, thermal, and electrical performance, not much has been conducted in detail to describe the correlation between the microstructure and the evolution of damage in short-fiber composites. Conversely, this paper will use the superior spatial elemental analysis to bring out the effects of GF content and dispersion on micro-mechanisms like interfacial traction, cracking of the matrix, and fiber fracture. We, to the best of our knowledge, are the first to systematically combine chemical spectrum analysis with spatial mapping of PBT/GF systems with varied fiber contents—this allows us to give actionable information on material design and optimized manufacturing procedures. Full article

T-bar penetrometers have been widely used to measure strength parameters of marine clay in laboratory and in situ tests. However, using the deep resistance factor derived from full-flow conditions to evaluate the undrained shear strength of shallow clay layers may lead to significant underestimation. Furthermore, the deep resistance factor is inherently influenced by the strain-softening behavior of clay rather than maintaining the constant value (typically 10.5) as conventionally assumed in practice. To address this issue, large-deformation finite element (LDFE) simulations incorporating an advanced exponential strain-softening constitutive model were performed to replicate the full T-bar penetration process—from shallow embedment to deeper depths below the mudline. A series of parametric studies were conducted to examine the influence of key parameters on the resistance factor and the associated failure mechanisms during penetration. Based on numerical results, empirical formulas were derived to predict critical penetration depths for both trapped cavity formation and full-flow mechanism initiation. For penetration depths shallower than the full-flow depth, an expression for the softening correction factor was developed to calibrate the shallow resistance factor. Finally, combined with global optimization algorithms, a computer-aided back-analysis procedure was established to estimate strain-softening parameters using resistance-penetration curves from initial penetration tests in marine clay. The reliability of the back-analysis procedure was validated through extensive comparisons with a series of numerical simulation results. This procedure can be applied to the interpretation of T-bar in situ test results in soft marine clay, enabling the evaluation of its strain-softening behavior. Full article

One of the most significant public health issues of the twenty-first century is antimicrobial resistance (AMR), which is responsible for thousands of deaths each year and undermines the efficacy of commonly used antibiotics. In dentistry, the frequent and sometimes inappropriate use of antibiotics, combined with the complexity of the oral microbiome, creates a high-risk environment for the development and spread of antimicrobial-resistant microorganisms. Although clinical infections have received most of the attention, dental unit waterlines, dentures, and orthodontic appliances are three reservoirs that play an important but underestimated role in this global crisis. These environments provide perfect conditions for biofilm formation and, further, the survival and growth of resistant microorganisms. This review aims to discuss the origins and mechanisms of AMR, the unrecognized role of these three reservoirs in dental settings, and their contribution to the AMR issue. It also highlights the necessity of strict infection control procedures and targeted antimicrobial stewardship strategies to overcome this growing threat. Full article

Background: Outpatient operative hysteroscopy is a minimally invasive procedure widely used for the diagnosis and treatment of intrauterine pathologies, including intrauterine adhesions (IUAs), which significantly affect fertility. Despite its therapeutic potential, the procedure itself may predispose patients to de novo adhesion formation. This review evaluates the effectiveness of anti-adhesion gels, particularly hyaluronic-acid-based formulations, in preventing IUAs and improving reproductive outcomes after outpatient operative hysteroscopy. Materials and Methods: A systematic search was performed in PubMed, CINAHL, Embase, and Web of Science for studies published between January 2020 and May 2025. Inclusion and exclusion criteria were defined using PICO guidelines. Relevant studies were screened and selected by two independent reviewers. Results: Anti-adhesion gels, especially hyaluronic acid and its derivatives, were associated with a lower recurrence of IUAs and improved reproductive outcomes. Combination therapies, such as hyaluronic acid gel with intrauterine devices (IUDs), showed better efficacy than monotherapy. Several studies also reported increased endometrial thickness, higher implantation rates, and improved pregnancy outcomes, although live birth rates remained inconsistent. Conclusions: Hyaluronic-acid-based anti-adhesion gels appear effective in reducing postoperative adhesion formation and enhancing reproductive outcomes in outpatient hysteroscopy. The best results are seen with multimodal preventive strategies. However, heterogeneity across studies highlights the need for standardized, prospective, randomized controlled trials to establish optimal clinical use. Full article

Patient-tailored, 3D-printed surgical guides offer significant potential to improve precision and therapeutic efficacy in cardiac ablation surgery. However, reliable post-sterilization material performance presents a critical yet underexplored barrier to clinical adoption. This study investigates how disinfection and sterilization impact the mechanical and thermal properties of photopolymer resins. Specimens from two 3D-printing resins (Bioflex A80 MB™, 3Dresyns; MED625FLX™, Stratasys) were treated with four combinations of disinfection techniques (low-temperature manual cleaning; high-temperature machine washing) and sterilization techniques (H₂O₂ vs. autoclaving). We assessed post-sterilization properties by mechanical (material integrity, bending tests), thermal (differential scanning calorimetry, thermogravimetric analysis), and viscoelastic (dynamic mechanical analysis) studies. Statistical analysis was performed using one-way ANOVA with Bonferroni post hoc tests (α = 0.05). From this preliminary study, we conclude that MED625FLX maintains integrity and flexibility across all tested disinfection and sterilization methods. Bioflex A80 MB is only suitable for low-temperature disinfection–sterilization, as high-temperature treatments cause surface cracking. Neither resin is appropriate for cryogenic conditions due to the risk of brittleness. Further research into post-sterilization properties is essential to ensure the safety and clinical reliability of these materials in cardiac procedures. Full article

Background/Objectives: Pain, anxiety, and distress are common yet frequently insufficiently managed issues for patients undergoing radiology and radiotherapy procedures. Immersive technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), are emerging as innovative non-pharmacological approaches to alleviate such burdens through engaging interventions. This review, combining scoping and narrative methodologies, seeks to examine the current application, efficacy, and integration of these technologies to enhance patient care and wellbeing within diagnostic and oncological environments. Methods: Employing a mixed scoping and narrative review approach, this study conducted a systematic search of PubMed, EMBASE, Scopus, and Web of Science databases (no date restrictions—search included studies up to May 2025) to identify relevant studies utilizing VR, AR, MR, or XR for mitigating pain, anxiety, or distress in patients undergoing radiology or radiotherapy. Two independent reviewers selected eligible papers, with data extracted systematically. The narrative analysis supplemented the scoping review by providing contextual insights into clinical relevance and technological challenges. Results: The screening process identified 76 articles, of which 27 were assessed for eligibility and 14 met the inclusion criteria. Most studies focused on oncology and primarily employed VR as the immersive technology. VR has shown promising effects in reducing anxiety and pain—particularly during radiotherapy sessions and invasive procedures—and in supporting patient education through engaging, immersive experiences, making it a valuable approach meriting further investigation. Patient acceptance was notably high, especially among those with elevated distress levels. However, findings in radiology were less consistent, likely due to shorter procedure durations limiting the effectiveness of VR. The variability in outcomes highlights the importance of tailoring immersive interventions to specific procedures and patient needs. The narrative component identified key barriers, such as regulatory hurdles, standardization issues, and implementation challenges, that need addressing for broader clinical adoption. Conclusions: Immersive digital therapeutics are evolving from preliminary research tools toward more structured incorporation into clinical practice. Their future success relies on harmonizing technological advancements with patient-focused design and robust clinical evidence. Achieving this will require collaborative efforts among researchers, industry stakeholders, and healthcare providers. The integration of scoping and narrative review methods in this study offers a comprehensive perspective on the current landscape and informs strategic directions for advancing immersive technologies in radiology and radiotherapy. Full article

Corrosion failure of oil well tubing in the ocean can lead to significant economic losses. Surface treatment is often used to enhance the corrosion resistance of tubing, while corrosion acceleration will occur in a certain environment. This work combined onset failure analysis and corrosion simulation measurements to understand the failure procedure and corrosion mechanism of nickel plating materials in calcium chloride water-type weak corrosion environment. The microscopic analysis results of the failed part show CO₂ corrosion products co-deposit with SRB bacterial sulfide products and Ca compounds. The damage of nickel plating is accompanied by S-containing products, which was confirmed by simulated immersion experiments at 50 °C, 0.28 MPa CO₂ partial pressure, and a speed of 3 m/s. The aggressive solution penetrates through the micro-damage pores, followed by the degradation of the Ni plating layer into NiS, leading to the localized loss of protection and triggering under-deposit corrosion. Concurrently, the SRB’s anaerobic environment generates CO₂ corrosion byproducts and SRB-derived FeS. Full article

Background: The emergency medical services (EMS) sector, as a complex system, presents substantial hurdles in providing excellent treatment while operating within limited resources, prompting greater adoption of artificial intelligence (AI) as a tool for improving operational efficiency. While AI models have proved beneficial in healthcare operations, there is limited explainability and interpretability, as well as a lack of data used in their application and technological advancement. Methods: The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, using PubMed, IEEE Xplore, and Web of Science, with a procedure of double screening and extraction. The search included articles published from 2018 to the beginning of 2025. Studies were excluded if they did not explicitly identify an artificial intelligence (AI) component, lacked relevance to emergency department (ED) or prehospital contexts, failed to report measurable outcomes or evaluations, or did not exploit real-world data. We analyzed the data source used, clinical subclasses, AI domains, ML algorithms, their performance, as well as potential roles for large language models (LLMs) in future applications. Results: A comprehensive PRISMA-guided methodology was used to search academic databases, finding 1181 papers on prehospital emergency treatment from 2018 to 2025, with 65 articles identified after an extensive screening procedure. The results reveal a significant increase in AI publications. A notable technological advancement in the application of AI in EMS using different types of data was explored. Conclusions: These findings highlighted that AI and ML have emerged as revolutionary innovations with huge potential in the fields of healthcare and medicine. There are several promising AI interventions that can improve prehospital emergency care, particularly for out-of-hospital cardiac arrest and triage prioritization scenarios. Implications for EMS Practice: Integrating AI methods into prehospital care can optimize the use of available resources, as well as triage and dispatch efficiency. LLMs may have the potential to improve understanding and assist in decision-making under pressure in emergency situations by combining various forms of recorded data. However, there is a need to emphasize continued research and strong collaboration between AI experts and EMS physicians to ensure the safe, ethical, and effective integration of AI into EMS practice. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Timely and accurate diagnosis and staging are crucial for treatment decisions. Objective: To assess the feasibility, safety, and diagnostic/staging yield of a bronchoscopy-based pathway supported by EBUS-TBNA in a regional Romanian center. Bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may reduce the need for surgical confirmation, yet its implementation in regional centers is inconsistent. Materials and Methods: This retrospective study included 67 patients with suspected lung cancer evaluated at a regional oncology center between December 2023 and February 2024. All patients underwent bronchoscopy, and EBUS-TBNA was performed in those with mediastinal lymphadenopathy on imaging, with endoscopic tissue biopsies (endobronchial/EBUS-TBNA). Demographic, clinical, histological, and molecular data were collected and analyzed using descriptive statistics and chi-square/Fisher’s exact tests. Results: Among the 67 patients, 42 (62.7%) underwent EBUS-TBNA. The majority were diagnosed in advanced stages (stage III–IV: 83.6%), with adenocarcinoma being the most frequent histological subtype. PD-L1 expression was positive in 52.2% of cases, and p63 in 67.2%. No significant procedural complications occurred, and adequate tissue sampling for histopathological and molecular analyses was achieved in all cases. Associations were found between PD-L1 and advanced TNM stage (p = 0.026), as well as between p63 status and TNM stage (p = 0.002). Conclusions: This study supports the feasibility and safety of a bronchoscopy-based diagnostic and staging algorithm supported by EBUS-TBNA, achieving reliable sampling and avoiding surgical confirmation in a regional oncology setting. Further prospective studies are warranted to validate these findings. Full article

Objectives: Esophagogastroduodenoscopy (EGD) performed with topical pharyngeal anesthesia presents less adverse events and post-procedural impairment associated with sedation. The aim of this study was to evaluate if by combining Flurbiprofen and Lidocaine sprays for topical pharyngeal anesthesia there is an improvement in patient tolerance and endoscopist satisfaction in comparison to using Lidocaine spray alone. Methods: We conducted a single center, double blind, randomized controlled trial designed to compare unsedated EGD using topical Flurbiprofen spray (Strepsils Intensive^®) plus Lidocaine spray versus Lidocaine spray alone. We assessed patients’ tolerance and endoscopist satisfaction through a 0 to 10 points visual numerical rating scale. Results: A total of 36 patients were included and randomized in two equal groups: Lidocaine and Flurbiprofen spray group (FL) and Lidocaine spray group (L). No significant differences were found amongst groups for patient discomfort score (FL 5.33 ± 2.42, L 5.56 ± 2.12, p = 0.708), pain score (FL 1.77 ± 2.17, L 1.89 ± 0.74, p = 0.119), gag reflex intensity score (FL 1.61 ± 0.82, L 1.83 ± 0.68, p = 0.418), patient satisfaction score (FL 7.78 ± 2.46, L 7.22 ± 1.78, p = 0.428), and endoscopist satisfaction score (FL 7.5 ± 2.87, L 7.58 ± 1.45, p = 0.312). Conclusions: During unsedated EGD, both Lidocaine plus Strepsils spray and Lidocaine spray alone were safe and well tolerated. The combination of Flurbiprofen and Lidocaine did not significantly improve patients’ level of discomfort, pain, gag reflex, and satisfaction and endoscopist satisfaction. Full article