Search Results (1,395)

Modern machine tools are safety-critical mechatronic systems, yet shop floor maintenance from abnormal events still relies heavily on scarce expert know-how and time-consuming manual searches across heterogeneous controller documentation. This paper presents an on-premise multimodal AI assistant. It integrates large language models with retrieval augmented generation and real-time machine signals to support operator-in-the-loop fault diagnosis. The proposed system provides three tightly coupled functions: (1) alarm-grounded guidance, which answers controller alarms and recommends corrective actions by grounding generation on manuals, maintenance procedures, and historical alarm cases; (2) parameter-aware reasoning, which injects live process and health indicators (e.g., spindle temperature, vibration, and axis states) into the reasoning context through an industrial data pipeline, enabling context specific troubleshooting; and (3) vision enabled support, which retrieves similar visual cases and generates concise visual instructions when text alone is insufficient. The assistant is deployed within an intranet environment to satisfy industrial security and privacy requirements and is orchestrated via lightweight tool calling for seamless integration with existing shop floor systems. Experiments on real machine tool alarm scenarios demonstrate that the proposed system achieves 82% answer correctness for alarm Q&A and improves response consistency and time-to-resolution compared with baseline keyword search and template-based guidance. The results suggest that grounded, multimodal chatbot assistants can act as practical AI-based feedback and decision support mechanisms for mechatronic production equipment, bridging human skill gaps while enhancing reliability and maintainability. Full article

Objectives: This study aims to define the surgical anatomy, technical feasibility, advantages, and limitations of the TPPA through detailed cadaveric dissection and a representative clinical case, evaluating its potential as a safe and effective alternative to traditional approaches to the mesiotemporal lobe. Methods: A cadaveric dissection was performed on one adult head injected with colored latex, using standard microsurgical instruments and high-definition video documentation. Each procedural step was recorded and illustrated with cadaveric photographs. Additionally, a clinical case of mesiotemporal cavernous hemangioma resected via TPPA is presented, including an operative video. Results: The dissection demonstrated a direct and safe trajectory to the amygdala and hippocampal head, with clear identification of key vascular and white matter landmarks. In the clinical case, the lesion was completely resected with no postoperative neurological deficits. Conclusions: The TPPA represents a novel microsurgical corridor to the mesiotemporal region, minimizing cortical disruption, Sylvian fissure dissection, and manipulation of middle cerebral artery branches. Although its exposure is limited posteriorly, the TPPA could offer an optimal balance between functional preservation and surgical accessibility, constituting a valuable addition to the modern microsurgical armamentarium. Full article

Background/Objectives: The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (CSIs) are associated with an increased risk of reoperation following matrix-associated or autologous chondrocyte implantation (MACI/ACI). Secondary aims included comparing reoperation-free survival, patient-reported outcomes (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective cohort study was conducted on adults undergoing primary MACI/ACI between 2011 and 2023 at a single academic institution. Patients with documented CSI status and ≥2 years of follow-up were included. Exclusion criteria were prior MACI/ACI, osteochondral allograft transplantation, multi-ligament reconstruction, or inadequate follow-up. Propensity score matching (2:1, no steroid/steroid) based on age, sex, BMI, laterality, procedure type, and prior surgery yielded 138 matched patients (92 no steroid, 48 steroid). The primary outcome was ipsilateral reoperation, analyzed as a binary outcome, with Kaplan–Meier reoperation-free survival and restricted mean survival time (RMST). PROMs and PASS achievement were also assessed. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up (6.55 ± 3.74 vs. 6.73 ± 3.99 years; p = 0.80) were similar. Graft failure rates were identical (4.3% each; p = 1.00). Reoperation occurred in 21.7% of patients without CSI and 23.9% with CSI (p = 0.83). CSI was not associated with reoperation (adjusted OR 2.28; 95% CI 0.54–9.95; p = 0.26). No significant difference in reoperation-free survival or PROMs was observed. Conclusions: Preoperative intra-articular corticosteroid injections were not associated with increased reoperation risk, inferior reoperation-free survival, or worse functional outcomes following MACI/ACI. Full article

Background/Objectives: Cervical facet-mediated pain is a significant underlying factor of persistent neck pain (CNP). Pulsed radiofrequency (PRF) or conventional radiofrequency (CRF) has been introduced as a treatment alternative. However, comparative clinical data remain limited. Methods: This single-center retrospective cohort study analyzed patients with cervical facet-mediated pain who underwent PRF (n = 40) or CRF (n = 44) between January 2023 and December 2024. The success of the procedure was assessed using the Numeric Rating Scale (NRS) and the Neck Disability Index (NDI) before the procedures and at 1, 3, 6, and 12 months following the injections. Patients’ feedback was evaluated using the Global Perceived Effect (GPE) scale. Results: For both groups, a substantial decrease in the mean pain and disability severity was recorded between the initial measurement and the first, third, and sixth months of follow-up, but the outcomes were significant only in the CRF group at the 12th month. The groups did not show a substantial difference in terms of pain relief, disability improvement, medication use, or patient satisfaction at one and three months (p > 0.05), but at six and 12 months, patients treated with CRF showed significantly greater outcomes (p < 0.001). No notable difference in complication rates was found between the PRF (10%) and CRF (16%) groups (p = 0.53). Conclusions: Both pulsed and conventional radiofrequency ablation effectively reduced pain and improved function in the early-midterm follow-up. However, CRF provided more sustained relief and greater patient-reported success at 6 and 12 months, without an increase in complication rates, suggesting that CRF may offer a more durable long-term treatment option. Full article

A new procedure for diagnosing damage to the fuel injection system of marine engines, along with vibration acceleration signal symptoms, is explored with a related built, developed, and tested measuring system. This work fills an important gap given the current lack of a scientific solution to this problem. A vibration acceleration signal sensor, mounted on a holder elaborated on by the authors, is positioned on the injection pipe between the injection pump and the injector. The output signals from the sensor are sent to an acquisition and analysis system, which is used for processing the signals in the time, amplitude, frequency, and time–frequency domains. Experimental choices, using multiple parameters for a given signal analysis field, are based on the location of the optimal sensor, the direction of the sensor mounting, and the selection of a cumulative diagnostic symptom. The vibration acceleration signals recorded along the injection pipe are found to have the strongest magnitude. This article compares diagnostic values from these signals with previously determined upper and lower limits. As a result, the tested fuel injection system is classified as either able or disabled, using unparalleled tolerance ranges given for both the upper and lower limits. The values of the limits are determined based on the average value for an ability state plus or minus three times the standard error of this mean, which has not been reported in the literature previously. Multiple regression models are developed that relate identified symptoms to the state features of the fuel injection system. In addition, artificial neural networks and machine learning are used to detect developing damage. The probability of correctly classifying the states of the diagnostic parameters is 0.467, alongside a diagnostic accuracy of ≤±4%, with the network correctly classifying the state when the testing accuracy is at least 70.0%. Full article

Background and Objectives: Minor otologic procedures in adults are often performed under local anesthesia, either via injection or topical application, thereby avoiding general anesthesia-associated risks. This study aims to compare pain levels with the use of a lidocaine spray versus lidocaine injections. Materials and Methods: Fifty adult patients underwent local anesthetic myringotomy and ventilation tube placement, 30 unilaterally, and 20 bilaterally. Lidocaine injections were administered to 29 patients, and 21 received a lidocaine spray. Postoperatively, they were asked to mark their perceived pain level on a visual analogue scale (VAS, 0–100 mm), verbal rating scale (VRS, 0–3), and numeric rating scale (NRS, 0–10). Data normality was assessed using the Shapiro–Wilk test, continuous variables were analyzed using analysis of variance (ANOVA), and VRS outcomes were analyzed using binary logistic regression. A p-value ≤ 0.05 indicated statistical significance. Results: Pain levels were low in both groups, although consistently lower in the topical lidocaine group. The average VAS score was 23.14 mm (±14.69) for injection versus 9.76 mm (±11.41) for topical anesthesia (ANOVA, p = 0.002), while NRS scores averaged at 2.41 (±1.57) and 1.19 (±1.17), respectively (ANOVA, p = 0.009), indicating significantly lower pain with topical lidocaine. Logistic regression of the VRS indicated the same trend, although it did not reach statistical significance (OR = 0.153, 95% CI:0.017–1.389, p = 0.095). Conclusions: Lidocaine spray was associated with lower pain levels compared to lidocaine injections in patients undergoing myringotomy and ventilation tube placement. Our findings suggest that topical anesthesia may represent an effective alternative, offering a less invasive approach and reducing the needle-related psychological distress of patients. Full article

The steady operation of underground gas storage (UGS) is significant for securing national energy. However, long-term cyclic injection-production operation causes the dynamic changes in formation stress, potentially leading to fault reactivation and slippage. This could affect the seal performance of the fault zone and cause disastrous consequences. In this paper, a mechanical analysis model for fault slip is constructed to study the dynamic seal performance in response to long-term injection-production cycles. An intelligent approach is proposed to predicate the fault slip value based on machine learning algorithms. It can realize long-term prediction of fault slip value under a new condition of injection-production operation. The study shows that (1) formation pressure tends to accumulate near the fault zone due to the low permeability, and the interface of the reservoir layer, cap layer, and fault zone is the seal weak position of UGS; (2) the response of fault slip is driven by the injection-production rate and the reservoir pressure. There is a significant coupling relationship between the fault slip value and the accumulated injection gas volume; (3) the intelligent prediction approach can capture the nonlinear dynamic characteristics of slip tendency accurately, and it exhibits good prediction performance and generalization ability under the new operating condition. This study effectively assesses the dynamic risk for fault slip of depleted hydrocarbon reservoir UGS during the long-term injection-production procedure. It provides an effective technical approach for fault slip tendency analysis and injection-production process optimization, which is important for the sustainable operation of UGS reducing the risk of seal failure and supporting gas storage security. Full article

Background/Objectives: Intravitreal injections (IVIs) are increasingly performed in outpatient settings, raising concerns regarding how to guarantee operating-theatre-level environmental safety. Mobile laminar airflow (LAF) units may create an ultraclean instrument field, but microbiological evidence from real-world IVI clinics is limited. Methods: We performed environmental monitoring during three IVI sessions, each including approximately 20 injections per session, in an outpatient procedure room equipped with a mobile LAF device (Operio Toul Mobile). Airborne microbial contamination was measured with a SAS Super 100 impactor (1 m³ per sample) at two locations, the procedure-room air and the LAF field, across seven predefined time points (T₋₁to T₅). Surface contamination of the instrument-covering drape was assessed at mid- and end-session using 24 cm² contact plates on four culture media. Colonies were expressed as CFU/m³ or CFU/24 cm² and analysed using a two-way repeated-measures ANOVA (location × time), with Holm-adjusted within-session paired post hoc comparisons at each time point. Results: During LAF operation (T₀–T₄), mean airborne load was 89.8 ± 10.8 CFU/m³ in room air versus 10.9 ± 4.6 CFU/m³ under LAF, corresponding to an 87.9% mean reduction (Holm-adjusted p < 0.01). At T₋₁ and T₅ (LAF off), counts were not significantly different between locations. Airborne microbial species consisted mainly of skin/oral commensals; no obligate pathogens were detected. All 24 drape samples showed 0 CFU. Conclusions: In this high-throughput outpatient IVI clinic, the mobile LAF device maintained a stable ultraclean microenvironment at the instrument field despite moderate background room contamination, supporting its use as an adjunct to standard aseptic measures, without the need to change the covering drape during the session. Full article

A robust and unified reversed-phase high-performance liquid chromatography (RP-HPLC) method was developed and validated for the simultaneous quantitative analysis of pitavastatin calcium and fenofibrate in dual-layer tablet formulations. Although individual analytical methods for each active pharmaceutical ingredient have been reported, a single analytical procedure applicable to both assay and dissolution testing of this fixed-dose combination has not been sufficiently established. In this study, a single RP-HPLC method was optimized to support both quality control purposes, thereby improving analytical efficiency and reducing method-related variability. Chromatographic separation was achieved using a C18 column (4.6 × 150 mm, 5 µm) under isocratic conditions, with a flow rate of 1.1 mL/min, an injection volume of 40 µL, and UV detection at 245 nm. The total run time was 10 min. The method was validated in accordance with ICH guideline Q2(R1) for system suitability, specificity, linearity and range, accuracy, precision (repeatability and intermediate precision), limits of detection and quantitation, and solution stability. Validation was conducted for both assay and dissolution samples using the same chromatographic conditions. The method demonstrated excellent linearity over the validated concentration ranges for both assay and dissolution analyses (r² ≥ 0.99). Accuracy and precision results satisfied the predefined acceptance criteria for assay (98.0–102.0%) and dissolution-related quantification (95.0–105%), with relative standard deviation values not exceeding 2.0%. The method showed adequate sensitivity, specificity, and solution stability, confirming its suitability for routine analysis. Application of the validated method to finished dual-layer tablets demonstrated reliable assay results and clearly distinguished the rapid dissolution of pitavastatin calcium from the delayed dissolution behavior of fenofibrate. Overall, the developed RP-HPLC method provides a validated analytical platform capable of supporting both assay and dissolution testing of pitavastatin–fenofibrate dual-layer tablets. Beyond routine validation, the proposed analytical framework demonstrates how a single chromatographic condition can support multiple quality attributes, offering an analytically integrated approach for supporting multiple quality attributes in complex combination drug products. Full article

Objectives: This study aimed to investigate the usefulness and safety of sentinel lymph node (SLN) mapping in comparison to other types of lymph node dissection in patients with uterine corpus cancers. Methods: Retrospective data from 161 patients subjected to uterine corpus cancer staging with SLN mapping with indocyanine green (ICG) dye were collected. Results: SLN procedure was associated with a complication rate of 0%, a median number of dissected lymph nodes of 2 (range 0–13), and a median hospitalization following surgery of 5 (range:2–23) days. Systemic lymphadenectomy and one-sided pelvic lymph node resection were associated with the highest percentage of complications (12% and 25%; p = 0.0030), while the post-surgery course was uneventful for the selective lymphadenectomy group and SLN. Complication rates were the highest in patients with obesity and severe obesity (5.1% and 9.1%, respectively). The number of lymph nodes resected dropped numerically with increasing BMI. Successful ICG injection and SLN mapping were significantly more frequent in SLN procedures. Conclusions: Our study showed that SLN mapping was characterized by a low complication rate and short hospitalization following surgery, and obesity appeared to be related to a higher complication rate. Tailored surgical strategies and individualized patient selection are crucial for the success of SLN mapping; therefore, factors associated with successful SLN mapping with ICG need further exploration. Full article

The Cinnamomum camphora seed kernel (CCSK) shows great promise as a natural source of bioactive alkaloids. However, there is little data about recovering alkaloids from CCSK by-products after oil extraction using an aqueous method. This study aimed to establish an efficient technology for enriching CCSK alkaloids (including magnoflorine, lindoldhamine and N,N-methyldomesticinium) using macroporous resin technology. The results showed that XR918C resin was the most suitable adsorbent due to its high adsorption/desorption capacity for CCSK alkaloids. The adsorption process was best described by Langmuir isotherm models and pseudo-second-order kinetics; it was spontaneous and physical in nature. The optimum procedure for CCSK alkaloids enrichment using XR918C resin was as follows: for adsorption, the injection flow rate and sample volume were 2.0 BV/h and 7.0 BV, respectively; for desorption, the eluent type, elution flow rate and volume were 80% ethanol, 2.0 BV/h and 6.0 BV, respectively. Furthermore, the scale-up of the CCSK alkaloid enrichment process was performed under optimal conditions. Following the 10-fold scale-up enrichment, the content of CCSK alkaloids was raised 4.41-fold, with a recovery rate of 89.19 ± 0.01%. After nine regeneration cycles, the efficiency of the XR918C resin remained stable, indicating its good reusability. In addition, CCSK alkaloids exhibited strong in vitro antioxidant activity. This study provides a useful reference for the industrial-scale enrichment of CCSK alkaloids. Full article

Background/Objectives: The rise of artificial intelligence is injecting intelligence into the healthcare sector, including surgery. Vision-based intelligent systems that assist surgical procedures can significantly increase productivity, safety, and effectiveness during surgery. Surgical instruments are central components of any surgical intervention, yet detecting and locating them during live surgeries remains challenging due to adverse imaging conditions such as blood occlusion, smoke, blur, glare, low-contrast, instrument scale variation, and other artifacts. Methods: To address these challenges, we developed an advanced segmentation architecture termed the frozen-filters-based morphology-aware segmentation network (FFMS-Net). Accurate surgical instrument segmentation strongly depends on edge and morphology information; however, in conventional neural networks, this spatial information is progressively degraded during spatial processing. FFMS-Net introduces a frozen and learnable feature pipeline (FLFP) that simultaneously exploits frozen edge representations and learnable features. Within FLFP, Sobel and Laplacian filters are frozen to preserve edge and orientation information, which is subsequently fused with learnable initial spatial features. Moreover, a tri-atrous blending (TAB) block is employed at the end of the encoder to fuse multi-receptive-field-based contextual information, preserving instrument morphology and improving robustness under challenging conditions such as blur, blood occlusion, and smoke. Datasets focused on surgical instruments often suffer from severe class imbalance and poor instrument visibility. To mitigate these issues, FFMS-Net incorporates a progressively structure-preserving decoder (PSPD) that aggregates dilated and standard spatial information after each upsampling stage to maintain class structure. Multi-scale spatial features from different encoder levels are further fused using light skip paths (LSPs) to project channels with task-relevant patterns. Results/Conclusions: FFMS-Net is extensively evaluated on three challenging datasets: UW-Sinus-surgery-live, UW-Sinus-cadaveric, and CholecSeg8k. The proposed method demonstrates promising performance compared with state-of-the-art approaches while requiring only 1.5 million trainable parameters. In addition, an open-source large language model is integrated for non-clinical summarization of the surgical scene based on the predicted mask and deterministic descriptors derived from it. Full article

Extended reality (XR) has increasingly been applied to nursing practicum education; however, most systems rely on controller-based interfaces that limit precise capture of continuous fine motor performance and objective assessment. This study developed and validated a sensor-integrated, controller-free XR nursing practicum system (Smart Nursing v1.0) grounded in continuous precision sensing. Based on internationally standardized intravenous injection protocols, the system integrated optical hand tracking and speech recognition to quantify hand kinematics, spatial accuracy, procedural sequencing, and verbal compliance. A three-phase validation framework was implemented. Internal technical verification confirmed stable real-time performance (≥60 FPS) and consistent action recognition. In a user-based study involving 63 undergraduate nursing students, XR-based automated scores demonstrated high agreement with expert instructor ratings (ICC = 0.932, 95% CI = 0.91–0.96, p < 0.001). XR baseline scores significantly predicted post-training performance (β = 0.632, p < 0.001) and showed significant incremental validity beyond instructor pre-training scores (ΔR² = 0.186, p < 0.001). Independent verification confirmed high recognition accuracy (100%) and system stability. These findings indicate that precision sensing enables XR environments to function as reliable performance measurement systems, supporting standardized non-face-to-face nursing practicum education. Full article

Background: Hyaluronic acid (HA) hydrogels are the most widely used injectable fillers for facial rejuvenation. A new generation of HA fillers crosslinked with poly(ethylene glycol) diglycidyl ether (PEGDE) has been developed to enhance cohesiveness, tissue integration, stability, and longevity while minimizing swelling and immunogenicity. Owing to their distinct viscoelastic properties, PEGDE-crosslinked HA fillers may require product-specific selection and adapted injection techniques. Objective: The objective of this study is to provide practical, expert-based recommendations for the safe and effective use of PEGDE-crosslinked HA hydrogels in facial aesthetic treatments. Methods: A multidisciplinary panel of nine Italian experts in aesthetic medicine, each with more than 15 years of experience using HA fillers, developed consensus recommendations based on clinical practice and available evidence. A pre-meeting questionnaire informed structured discussions during a face-to-face meeting held in Paris in January 2024. The nominal group technique was applied, with consensus defined as agreement by at least 80% of panel members. Results: Consensus was reached on product selection, injection planes, delivery devices, techniques, and typical treatment volumes for PEGDE-HA hydrogels across multiple facial regions, including the forehead, temples, midface, nasolabial folds, chin, jawline, and lips. Recommended injection techniques included microbolus, macrobolus, and retrograde linear threading, with placement ranging from superficial subcutaneous to supraperiosteal planes depending on the anatomical area and clinical indication. Typical injection volumes generally ranged from 0.1 to 0.5 mL per side. Optional ultrasound mapping was considered beneficial in selected high-risk or superficial procedures to improve anatomical safety. Conclusions: These expert consensus recommendations provide practical guidance for clinicians using PEGDE-crosslinked HA hydrogels in facial rejuvenation. Tailoring product characteristics to injection depth, technique, and regional anatomy may help optimize clinical outcomes and procedural safety. Future research priorities include prospective comparative studies with other crosslinking technologies, standardized reporting of adverse events, long-term outcome registries, and further evaluation of ultrasound-guided injection strategies. Full article

Shoulder spasticity is a common consequence of upper motor neuron lesions and may be associated with soft tissue contractures, limiting functional recovery. While both cryoneurolysis and tendon lengthening procedures are used individually in refractory cases, their combined effect has not been clearly established. It is consequently necessary to assess the efficacy of combining cryoneurolysis and percutaneous pectoral tenotomy in reducing shoulder spasticity and improving passive range of motion in patients with refractory shoulder spasticity and contracture. This retrospective, single-centre cohort study included 15 adults (≥19 years) with chronic shoulder spasticity and clinically confirmed musculotendinous contracture, previously treated with botulinum toxin injections without sufficient functional response, and free of pharmacological effects (last injection >4 months prior). All patients underwent cryoneurolysis targeting motor branches to the pectoral muscles. Outcomes included Modified Ashworth Scale (MAS) and shoulder Passive Range Of Motion (PROM). The combined approach provided significant improvements in spasticity severity for shoulder flexion (p < 0.01) and abduction (p < 0.01), and significant improvements in maximum PROM for shoulder flexion (p < 0.0001) and abduction (p < 0.0001). Combining cryoneurolysis and pectoral tenotomy appears feasible, safe, and clinically beneficial in selected patients with both spasticity and tendon contracture. Cryoneurolysis addresses the neural component, while tenotomy may restore mechanical excursion. This sequential diagnostic and therapeutic approach may enhance personalized management of mixed spastic–contracture shoulder limitations and could be applicable to other joints. Full article