Search Results (139)

An EF1 tornado struck Nansha District, Guangzhou, Guangdong, on 28 July 2024. To explore the dynamic and thermodynamic changes during the tornado’s life cycle, high-resolution spatiotemporal data from Foshan’s X-band phased-array radar and the direct wind field synthesis algorithm were used to reconstruct the 3D wind field. The dynamics and 3D structure of the tornado were analysed, with a new parameter, vorticity volume (VV), introduced to study its variation. The observation results indicate that the tornado moved roughly from south to north. During the tornado’s early stage (00:10–00:20 UTC), arc-shaped and annular echoes emerged and positive vorticity increased (peaking at 0.042 s⁻¹). Based on the tornado’s movement direction, the right side of the vortex centre was divergent, while the left side was convergent, whereas the vorticity area and volume continued to grow centrally. During the mature stage (00:23–00:25 UTC), the echo intensity weakened and, at 00:24, the vorticity reached its peak and touched the ground, with the vorticity area and volume also reaching their peaks at the same time. During the dissipation stage (00:25–00:30 UTC), the vorticity and echo features faded and the vorticity area and volume also declined rapidly. The analysis showed that the vorticity volume effectively reflects the tornado’s life cycle, enhancing the understanding of the dynamic and thermodynamic processes during the tornado’s development. Full article

Cellulite, characterised by cutaneous dimpling, surface irregularities, and dermal atrophy skin texture, affects up to 90% of post-pubertal females. It is a multifactorial condition involving anatomical, hormonal, and metabolic components, primarily affecting the thighs and buttocks. Despite numerous available therapies, there remains a high demand for effective, non-invasive, and well-tolerated treatment options. This single-centre, in vivo, prospective study evaluated the efficacy of a non-pharmacological, thermogenic topical cream-gel combined with manual massage in women with symmetrical grade II or III cellulite (Nürnberger–Müller scale). A total of 56 female participants (aged 18–55 years) were enrolled and instructed to apply the product twice daily for eight weeks to the thighs and buttocks. Efficacy was assessed using instrumental skin profilometry (ANTERA^® 3D CS imaging system), dermatological clinical grading, and patient self-assessment questionnaires. Quantitative analysis showed a mean reduction of 23.5% in skin indentation volume (p < 0.01) and a mean decrease of 1.1 points on the cellulite severity scale by week 8. Patient-reported outcomes revealed 85.7% satisfaction with visible results and 91% satisfaction with product texture and ease of application. Dermatological evaluation confirmed no clinically significant adverse reactions, and only 3.5% of participants reported mild and transient skin sensitivity. These findings suggest that this topical cream-gel formulation, when used in conjunction with manual massage, represents a well-tolerated and non-invasive option for the cosmetic improvement of moderate to severe cellulite. Full article

For patients with retroperitoneal sarcomas (RPSs), en-bloc resection with macroscopically negative margins remains the only potentially curative treatment. Textbook outcomes (TOs) are composite measures developed to compare ideal surgical outcomes for complex oncologic resections. The aims of this study were as follows: to define TO for RPS resections; to investigate the impact of treating service and other variables on TO; and to investigate the impact of treating service on achieving a TO. Population-based data from the Queensland Oncology Repository (QOR) was used to perform a retrospective review of all adult patients who underwent resection for primary RPS in Queensland between 2012 and 2022. TO was defined as follows: en-bloc resection; macroscopically negative margins; no unplanned ICU admission, no Clavien–Dindo III or greater complications; hospital length of stay of 14 days or less; no readmission within 30 days; and no 90-day mortality. A TO was achieved in 82 (56.94%) of the 144 patients included in the study. A high-grade histological subtype, the resection of three or more contiguous organs, major vascular resection and treatment outside of a high-volume sarcoma centre (HVSC) were significant negative predictors of achieving TOs (p < 0.05). On multivariate analysis, treatment at a high-volume sarcoma centre was independently associated with a 2.6-fold increase in TO (1.18–5.88, p = 0.02). Achieving a TO was associated with higher five-year DFS (61.5% vs. 41.3%, p = 0.03) and OS (76% vs. 59.4%, p = 0.02). In our state, TOs provide a measure of the quality of RPS resection across multiple health services, with patients treated at high-volume sarcoma centres more likely to achieve a TO. TO rates are associated with improved five-year DFS and OS. Full article

Background: Colorectal liver metastases (CRLM) occur in up to 50% of colorectal cancer with a significant impact on patient survival, of whom only 20–30% will be considered suitable for surgical treatment. Despite the progress in systemic therapies, palliative chemotherapy alone results in a 5-year overall survival (OS) < 10%. Recently, liver transplantation (LT) has been reconsidered as an option and demonstrates improved survival in highly selected patients. This study assessed the impact of implementing a standardised patient selection protocol (LITORALE) on post-transplant outcomes for unresectable CRLM (uCRLM) at a high-volume single centre. Methods: This is a prospective observational study including all consecutive patients transplanted for uCRLM at our institution between July 2015 and September 2024. This prospective observational study evaluated the impact of the LITORALE protocol on post-transplant outcomes in uCRLM patients at a single centre. Patients who underwent LT between July 2015 and September 2024 were grouped into pre-LITORALE (2015–2021) and LITORALE (post-2021) cohorts. Recipient profiles, transplant variables, and post-transplant outcomes were compared. Results: Twenty-one patients were included (eight pre-LITORALE, thirteen LITORALE). The LITORALE group had a lower median number of lesions (4 vs. 17.5, p = 0.004), a smaller major lesion size (3 cm vs. 5.5 cm, p = 0.082), and a significantly lower tumour burden score (6.32 vs. 18.02, p = 0.002). Similar to recent major clinical trials, one- and three-years OS were 100% and 83%, respectively, after protocol introduction; recurrence patterns were significantly different, with reduced multi-site recurrences (7.7% vs. 50%, p = 0.048) and a higher incidence of lung-only recurrences in the LITORALE group (50% vs. 0%, p = 0.033). Conclusions: The introduction of the LITORALE protocol significantly influenced patient selection and recurrence patterns in LT for uCRLM. Although the limited number of patients and the short study timespan highlight the need for future validation, these preliminary results support the adoption of structured, multidisciplinary criteria to optimise oncologic outcomes. Full article

Background: Robot-assisted total mesorectal excision has been proposed as an alternative to laparoscopic TME for rectal cancer. However, its short-term outcomes and long-term oncological efficacy remain debated, especially in Western populations. This study evaluates the short-term clinical and long-term oncological outcomes of robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres. Methods: This multicentre, international, retrospective cohort study included 1390 patients from the EUREKA collaborative dataset who underwent robot-assisted total mesorectal excision for rectal cancer between January 2013 and January 2022. All surgeries were performed by expert surgeons beyond the learning curve. Data were analysed for patient demographics, perioperative outcomes, pathological findings, and three-year survival metrics. Kaplan–Meier analysis was used to evaluate overall and disease-free survival. Results: Of 1390 patients, 60.6% underwent restorative low anterior resection. Conversion to open surgery occurred in 3.7%, and postoperative complications were reported in 28.7%. Anastomotic leakage occurred in 14.7% of patients who underwent restorative low anterior resection. The median operative time was 223 min. R0 resection was achieved in 94.7%, and circumferential resection margin positivity was 5.5%. Three-year overall survival was 90.1%, disease-free survival was 88.6%, and local recurrence was 2.9%. Conclusions: Robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres is safe, with low conversion rates, acceptable complication rates, and favourable oncological outcomes. These findings underscore the potential of robot-assisted total mesorectal excision as a standard approach for rectal cancer in specialised settings. Full article

Background/Objectives: Rectal cancer is a major global health issue with high morbidity and mortality rates. Local recurrence (LR) significantly impacts patient outcomes, decreasing survival rates and often necessitating extensive secondary treatments. While robot-assisted total mesorectal excision (R-TME) is becoming a preferred method for rectal cancer surgery due to its improved precision and visualisation, long-term data on LR and predictors of recurrence remain limited. This study aims to determine the 3-year LR rate following R-TME and to identify predictors of recurrence to enhance patient selection and the personalisation of treatment. Methods: This retrospective international multicentre cohort study included 1039 consecutive rectal cancer patients who underwent R-TME between 2013 and 2020, with a minimum of 3 years of follow-up. Data from tertiary colorectal centres in the United Kingdom, the Netherlands, Spain, France, Italy, and Belgium were analysed. Potential predictors of LR were identified using backward elimination, and four machine learning models were evaluated for predicting LR. Results: The 3-year LR rate was 3.8%. Significant predictors of LR included advanced clinical M-staging, length of the hospital stay, postoperative ileus, postoperative complications, pathological N-staging, the completeness of resection, and the resection margin distance. The eXtreme Gradient Boosting model performed best for LR prediction, with a final accuracy of 77.1% and an AUC of 0.76. Conclusions: R-TME in high-volume centres achieves low 3-year LR rates, suggesting that robot-assisted surgery offers oncological safety and advantages in rectal cancer management. This study underscores the importance of surgical precision, patient selection, and standardised perioperative care, supporting further investment in robotic training to improve long-term patient outcomes. Full article

The Italian Aerospace Research Centre (CIRA) is developing an unmanned stratospheric platform for Earth observation and telecommunications, known as a High-Altitude Pseudo-Satellite (HAPS). This paper presents an aerodynamic and stability analysis of a new closed-wing HAPS configuration. The design uses a hybrid approach, combining aerodynamic and aerostatic forces to achieve weight balance, with the stability analysis accounting for the buoyancy force applied at the center of volume of the structure. Following the initial design phase, which aims for an altitude of 20 km, a speed of 16 m/s, and a payload capacity of 20 kg, a suitable configuration using a NACA 0018 airfoil is selected. The aircraft lift–drag curve is evaluated using a stationary, incompressible Reynolds-Averaged Navier–Stokes (RANS) analysis with a k-$\omega$ SST turbulence model in OpenFoam. A detailed longitudinal and lateral-directional stability analysis is also conducted using OpenFOam and AVL software. Full article

Electrification has become increasingly common in aerospace due to climate change concerns. After successful applications in general aviation aircraft, electrification is now addressing subregional (up to 19 passengers) and regional aircraft (around 80 passengers). Megawatt-class electric motors are needed both to drive propellers and to act as high-power generators in hybrid–electric propulsion systems. Power levels for this class of aircraft require a proper design of heat management systems capable of dissipating a much higher quantity of heat than that dissipated by traditional cooling systems. The technical solution here explored is based on the addition into a diathermic base liquid of nanoparticles, which can increase (by up to 30%) the thermal conductivity of the refrigerant, also providing large surface area enhancing the heat transfer capacity of base liquids. The Italian Aerospace Research Centre (CIRA), as part of the European research initiative Optimised Electric Network Architectures and Systems for More-Electric Aircraft (ORCHESTRA), developed a thermal management system (TMS) based on impinging jets technology for a 1 MW electric motor. In this work, a numerical verification of the possibility for nanofluids to improve the heat exchange efficiency of a submerged oil impinging jets TMS designed to directly cool the inner components of a 1 MW motor is conducted. Investigations aimed to analyse two nanoparticle types (alumina and graphite) added to diathermic oil with concentrations between 1% and 5% by volume. The application of nanofluids significantly increases final thermal conductivity with respect to conventional coolants, a 60% improvement in heat transfer at a fixed mass flow rate is achieved. Electric motor maximum temperatures are approximately 10% lower than those achieved with solely diathermic oil. This result is significant as a safety margin is needed in all cases where a sudden increase in power occurs. Full article

Objective: To assess the safety of open PC-RPLND at a high-volume national referral centre over the course of several years. Materials and Methods: A retrospective chart review of patients with testicular germ cell tumours (TGCTs) who underwent PC-RPLND at our institution between 2008 and 2023 was conducted. Patient demographics, clinical characteristics, intraoperative and postoperative parameters and adjunctive procedures were recorded. ClassIntra and Clavien Dindo classifications were used to assess intraoperative and postoperative complications, respectively. Results: In total, 165 patients were studied. The median (Q1–Q3) age of patients was 30.5 years (24.75–38.25), and the median maximum diameter of retroperitoneal masses was 50 mm (26.75–81.25). The most common adjunctive procedure was synchronous nephrectomy (n = 18, 11%) followed by vascular procedures (n = 7, 4.3%), ureteric reconstruction (n = 7, 4.3%), and partial hepatectomy (n = 3, 1.9%). Intraoperatively, 20, 8 and 1 patient had a grade I, II or V complication, respectively, according to the ClassIntra classification. The median estimated blood loss was 300 mL (120–740), the median duration of the procedure was 4.9 h (4–6 h) and the median length of stay was 8 days (7–10 days). Histopathological examination of the resected specimen showed teratoma in 51.9% of patients, followed by fibrosis/necrosis in 39.5%. A total of 40 patients (24.7%) experienced at least one complication. Conclusions: PC-RPLND is a complex operation, often accompanied by adjunctive surgical procedures and therefore must be conducted in high-volume referral centres to ensure safety and minimise complications. Full article

Background: Intracranial stenting is still feasible, but its effectiveness is still investigational. Our study investigated outcomes of endovascular treatment in high-volume and low-volume centres. Methods: We retrospectively recruited 36 patients with intracranial atherosclerosis who underwent endovascular treatment from January 2014 to June 2016 at three low-volume centres (n = 18), and a single high-volume centre (n = 18). Detailed periprocedural records, as well as clinical and radiological follow-up data, were revised through at least one-year post-procedure. The outcome parameters included successful revascularization, occurrence of any death, stroke, and/or Transient Ischaemic Attack (TIA) after intervention or during the follow-up period, and restenosis (≥50%). Results: The successful revascularization rate was 97.2%. The 30-day rate of any death, stroke, and/or TIA was 13.9%. At a median clinical follow-up of 18 months, the rate of any death, stroke, and/or TIA was 27.8%. Rates of any death, stroke, and/or TIA at 30 days and 18 months were higher among patients treated in low-volume centres versus those treated in high-volume centres but without reaching statistical significance (22.2% versus 5.6%, p = 0.188; and 38.9% versus 16.7%, p = 0.137, respectively). Conclusions: Although not statistically significant, our study showed a higher incidence of death, stroke and/or TIA among patients treated in the low-volume centre compared to those treated in the high-volume centre. Full article

This study aimed to investigate the post-activation performance enhancement effects of drop jumps (DJs) on lower limb stiffness [leg stiffness (K_leg); vertical stiffness (K_vert)] and the related mechanical [maximal ground reaction force (F_max), vertical displacement of the centre of mass (Δy), and lower limb length (ΔL)] and kinematic parameters [step length (SL), step frequency (SF), flight time (FT), and contact time (CT)] during high-speed treadmill running. For this purpose, 18 male physical education students performed 10 s running bouts on a treadmill at a speed of 6.67 m·s⁻¹ in an experimental condition (EC) or in a control condition (CC). During the EC, following a 5 min treadmill running warm-up at 2.22 m·s⁻¹, the participants were tested pre and 3 min post five DJs, while during the CC, the participants did not perform DJs. The study results revealed that EC significantly increased F_max, Δy, SL, and FT, while SF decreased after performing drop jumps (mean differences: 0.026 ± 0.007 kN, p = 0.003; 0.001 ± 0.001 m, p = 0.025; 0.034 ± 0.013 m, p = 0.019; 0.05 ± 0.001 s, p = 0.005 and −0.057 ± 0.023 Hz, p = 0.026, respectively). K_leg and K_vert showed no significant differences (p > 0.05) following the preconditioning exercise. The findings suggest that a plyometric stimulus of low volume and a short recovery period prior to high-speed treadmill running may be beneficial to acutely improve running mechanical and kinematic parameters without affecting lower limb stiffness. Full article

Aircraft cabins have high occupant densities and may introduce the risk of COVID-19 contamination. In this study, a segment of a Boeing 767 aircraft cabin with a mixing type of air distribution system was investigated for COVID-19 deposition. A section of a Boeing 737-300 cabin, featuring four rows with 28 box-shaped mannequins, was used for simulation. Conditioned air entered through ceiling inlets and exited near the floor, simulating a mixed air distribution system. Cough droplets were modeled using the Discrete Phase Model from two locations: the centre seat in the second row and the window seat in the fourth row. These droplets had a mean diameter of 90 µm, an exhalation velocity of 11.5 m/s and a flow rate of 8.5 L/s. A high-quality polyhedral mesh of about 7.5 million elements was created, with a skewness of 0.65 and an orthogonality of 0.3. The SIMPLE algorithm and a second-order upwind finite volume method were used to model airflow and droplet dynamics. It was found that the ceiling accounted for the maximum concentration followed by the seats. The concentration of deposits was almost 50% more when the source was at window as compared to the centre seat. The Covid particles resided for longer duration when the source was at the centre of the cabin than when it was located near the widow. Full article

Many regions in Europe face increasing issues with flooding and droughts due to changing rainfall patterns caused by climate change. For example, higher rainfall intensities increase urban flooding. Nature-based solutions (NbS) are suggested as a key mitigation strategy for floods. This study aims to address and mitigate the challenges faced in Tivoli natural park in Ljubljana regarding high peak discharges and low-flow issues in the creek entering the sewer system. The study involves setting up, calibrating and validating a Hydrologic Engineering Centre–Hydrologic Modelling System (HEC-HMS) model using available data. This study analyses NbS, such as small ponds, green roofs and permeable paving, to reduce peak discharge. Runoff was reduced by an average of 32.4% with all NbS implemented and peak discharge by 20 L/s. Permeable parking performed best, with an average runoff reduction of 6.4%, compared to 4.8% for permeable streets and 5.9% for green roofs. The ponds reduced peak discharge, although their effectiveness varied between rainfall events. Rainfall events with higher volumes and durations tended to overwhelm the proposed solutions, reducing their effectiveness. The ability of HEC-HMS to model NbS is also discussed. The curve number (CN) parameter and impervious % alterations to simulate NbS provided quantitative data on changes in runoff and discharge. Full article

Purpose: To determine the diagnostic accuracy of quantitative diffusion-weighted (DW) MRI apparent diffusion coefficient (ADC) and tumour volumes to differentiate between malignant (neuroblastoma (NB)) and benign types of neuroblastic tumours (ganglioneuroma (GN) and ganglioneuroblastoma (GNB)) using different region-of-interest (ROI) sizes. Materials and Methods: This single-centre retrospective study included malignant and benign paediatric neuroblastic tumours that had undergone DW MRI at diagnosis. The outcome was diagnostic accuracy of the tumour volume from structural and ADC DW MRI, in comparison to histopathology (reference standard). Results: Data from 40 patients (NB, n = 24; GNB, n = 6; GN, n = 10), 18 (45%) females and 22 (55%) males, with a median age at diagnosis of 21 months (NB), 64 months (GNB), and 133 months (GN), respectively, ranging from 0 to 193 months, were evaluated. The area under the receiver operating characteristic (AUROC) curve for ADC for discriminating between neuroblastic tumours’ histopathology for a small ROI was 0.86 (95% CI: 0.75–0.98), and for a large ROI, 0.83 (95% CI: 0.71–0.96). An ADC cut-off value of 1.06 × 10⁻³ mm²/s was able to distinguish malignant from benign tumours with 83% (68–98%) sensitivity and 75% (95% CI: 54–98%) specificity. Tumour volume was not indicative of malignant vs. benign tumour diagnosis. Conclusions: In this study, both small and large ROIs used to derive ADC DW MRI metrics demonstrated high accuracy to differentiate malignant from benign neuroblastic tumours, with the ADC AUROC for the averaged multiple small ROIs being slightly greater than that of large ROIs, but with overlapping 95% CIs. This should be taken into consideration for standardisation of ROI-related data analysis by international initiatives. Full article

Introduction: Given the high risk of peri-operative morbidity and mortality associated with open repair, endovascular repair for thoraco-abdominal aneurysms is increasingly performed. This study aims to describe mid to long-term results for patients who were treated with COOK Custom-Made Endograft Device at a single Southeast Asian tertiary centre. Methods: Mid to long-term results of patients treated from 2012 to 2022 were retrospectively reviewed. Indications for treatment were aortic diameter > 5.5 cm, enlargement > 5 mm in 6 months or high-risk morphology. Clinical, operative, early to late complications and reintervention details were captured. The endpoints were technical success, primary patency and primary assisted patency. Results: Electronic medical records of 29 consecutive patients (64.4 ± 1.6 years old; 26/29 males 89.6%) were reviewed. 24/29 (83%) were hypertensive, and 20/29 (69%) were smokers. The mean diameter was 5.5 cm, and the majority were treated for Crawford type IV (19/29, 65.5%). Endograft deployment was 100%. Catheterisation of fenestration was successful in 109/116 (94%). 30-day mortality and morbidity were observed in 12/29 (41%), for which access site complications were most common. No significant haemorrhage or graft explant was recorded. The mean follow-up period was 32.4 months (range 1–108 months). Primary patency was 92.9% (95% CI: 83.8–100.0) at 6 months and decreased to 77.7% (95% CI: 63.4–95.2) at 24 months. Sac shrinkage or stability was noted in 17/29 (58.6%). Re-intervention was performed in 9/29 (31%) for limb occlusion (2/9, 22.2%), renal artery stent occlusion (1/9, 11.1%) and endoleaks (6/9, 66.6%). Assisted patency was maintained at 100% for 12 months before decreasing to 66.7% (95% CI: 37.9–100.0) at 24 months. Conclusions: The study reports the first mid-long-term result in this region, though limited by the sample size. Re-intervention at 30% suggests that disease and procedures remain challenging, emphasising the need to assimilate lessons and experience at high-volume centres. Full article