Search Results (2,846)

Background and Objectives: Patellofemoral pain (PFP) is the most prevalent running-related injury due to underlying biomechanical factors, particularly among female runners. Although instrument-assisted soft tissue mobilization (IASTM) is a popular therapeutic technique, the optimal application site for the short-and long-term outcomes of PFP has not been well established. This aim of this study was to compare the immediate and short-term (1-week) effects of a single IASTM treatment applied to the hip and knee versus the knee alone on running-related pain. Range of motion (ROM), muscle strength, and functional performance were also assessed to compare change between the two treatment conditions. Materials and Methods: Twenty-eight female runners with PFP were randomly assigned to either the Hip and Knee (HK) group (n = 14) or the knee-only (K) group (n = 14). The HK group received a 7-min IASTM treatment targeting the quadriceps, patella, iliotibial band (ITB), and gluteus medius, whereas the K group received a 3-min treatment targeting the quadriceps and patella. Visual analog scale (VAS), hip adduction ROM, hip abduction/external rotation strength, and step-down test scores were measured at baseline, immediately post-intervention, and 1 week later. Results: Running-related pain significantly decreased in both groups (main effect of time, p < 0.001) from baseline (HK: 5.49 ± 2.14 [95% CI: 4.78–6.68]; K: 5.30 ± 1.45 [95% CI: 4.69–5.91]) to week 1 (HK: 1.30 ± 1.08 [95%CI: 0.69–1.90]; K: 1.57 ± 1.20 [95%CI: 0.93–2.21]). However, no significant difference was found between the groups. Significant improvement was also observed in hip adduction ROM (p < 0.001), hip abduction strength (p = 0.02), step-down pain (p < 0.001), and patellofemoral function (p < 0.001) immediately after the intervention, which was sustained at the 1-week follow-up. However, no significant difference was found between the groups. Also, hip external rotation strength showed no significant change over time or between groups (p = 0.737). Conclusions: A single IASTM session effectively reduced pain and improved function in female runners with PFP. However, the hip treatment did not show a significant additional benefit compared with knee treatment alone. IASTM can provide immediate and short-term relief of pain and functional limitations. Full article

The concept of shared space is proposed to improve the safety and health of vulnerable road users (VRUs) by promoting walking and cycling. However, despite the documented benefits of shared spaces, concerns were raised about the frequency and severity of road user interactions in shared spaces. Thus, the objective of this study is to investigate the microscopic behaviors and psychological characteristics of vulnerable road user interactions (i.e., pedestrian–e-bike interactions and pedestrian–cyclist interactions) in non-motorized shared spaces and their interplay mechanisms. We identify a total of 334 interactions in the same- and opposite-direction using the Dutch Objective Conflict Technique for Operation and Research (DOCTOR) method at four locations in Shenzhen city, China. Trajectories of road users involved in these interactions were extracted to identify key points in trajectories and interaction phases, considering both microscopic behaviors and psychological factors synthetically. The study also compared lateral and longitudinal decision distances, maneuvering distances, maneuvering time, and safety zones across different characteristics, including severity levels, road user types, genders, and whether road users carry large items or not. The results show that the main characteristic of the interaction’s starting and ending points changes in the lateral direction. Road users have a stronger sense of security in swerve-back phases. The average lateral psychological safety distance in shared spaces is about 1.125 m. Moreover, the average safety zone area for road users in opposite and same-direction interactions are 4.83 m² and 9.36 m², respectively. Road users carrying large items perceived a higher risk in shared spaces and required longer lateral psychological safety distances and larger safety zones. The findings of this study can be used to better design shared space facilities, considering the perceived risk of road users and their interactions and psychological behavior. Full article

Objective: This pilot study compared the positions of the antero-lateral (standard) and antero-posterior (alternative) pads in a simulated cardiac arrest scenario in athletes wearing a wetsuit. Methods: Seventeen undergraduate physical education students were instructed to attend to a simulated victim, with no signs of life, dressed in a wetsuit. In a randomized fashion, they were instructed to place the defibrillator pads in the standard position (antero-lateral) or in the antero-posterior option. The variables analyzed were the time required to perform the procedure and the difficulty and fatigue perceived by the rescuers. Results: Thirty-four interventions were analyzed (17 with each technique), showing that with the antero-posterior option, the time required to expose the area was less (median 6.2 vs. 12.7 s, p = 0.001), but more time was required to dry it (median 31.0 vs. 18.4 s, p = 0.002). No significant differences were found between the two options in the total time from onset to first flush or in the perception of difficulty and fatigue. Conclusions: In the case of caring for a cardiac arrest victim wearing a wetsuit, the alternative of placing the defibrillator pads in the antero-posterior position is not a significant advantage over the standard position. Both configurations may be considered acceptable in prehospital aquatic settings, depending on situational constraints and rescuer preference. Full article

Compaction quality is a critical factor in ensuring the long-term performance of subgrade structures; however, traditional testing methods are limited by their destructive nature and delayed feedback. To address these shortcomings, this study proposes a dynamic identification method for subgrade compaction based on embedded attitude sensors. A customized sensor unit integrated with an inertial measurement module was embedded in soil samples to record triaxial acceleration and attitude angles during the compaction process. Signal processing techniques, including an improved wavelet-based denoising strategy, were employed to separate long-term compaction trends from transient impact disturbances. Attitude features such as cumulative angular change, angular velocity, root mean square values, and a comprehensive inclination index were extracted as predictive variables. Ridge regression, random forest, and XGBoost models were constructed to establish the mapping relationship between attitude features and compaction degree. Experimental results on clay, loam, and sand samples indicate that the yaw angle is most sensitive to vertical settlement, while pitch and roll angles provide complementary information on lateral and rotational behaviors. Comparative analysis of filtering methods shows that the transient masking interpolation (TMI) approach outperforms the traditional asymmetric wavelet thresholding (AWT) method in effectively preserving baseline trends. Among the regression models, XGBoost demonstrated the best predictive performance, achieving an R² exceeding 0.995 at high compaction levels. The proposed method has been experimentally demonstrated as a laboratory-scale proof of concept, showing strong potential for future real-time field application, offering a novel technological pathway for intelligent quality control in road construction. Full article

This study presents a novel approach that integrates Discrete Event Simulation (DES) with Design of Experiments (DOE) techniques, framed within a stochastic optimization context and guided by a multi-objective goal programming methodology. The focus is on enhancing the operational efficiency of an emergency department (ED), illustrated through a real-world case study conducted in a Chilean hospital. The methodology employs Response Surface Methodology (RSM) to explore and optimize the impact of four critical resources: physicians, nurses, rooms, and radiologists. The response variable, formulated as a goal programming function, captures the aggregated patient flow time across four representative care tracks. The optimization process proceeded iteratively: early stages relied on linear approximations to identify promising improvement directions, while later phases applied a central composite design to model nonlinear interactions through a quadratic response surface. This progression revealed complex interdependencies among resources, ultimately leading to a local optimum. The proposed approach achieved a 50% reduction in the aggregated objective function and improved individual patient flow times by 7% to 26%. Compared to traditional metaheuristic methods, this simulation–optimization framework offers a computationally efficient alternative, particularly valuable when the simulation model is complex and resource-intensive. These findings underscore the value of combining simulation, RSM, and multi-objective optimization to support data-driven decision-making in complex healthcare settings. The methodology not only improves ED performance but also offers a flexible and scalable framework adaptable to other clinical environments seeking resource optimization and operational improvement. Full article

Background and Objectives: Partial gluteal tendon tears in native hips are often misdiagnosed as greater trochanteric pain syndrome, resulting in ineffective conservative treatment and persistent symptoms. Although surgical repair techniques exist, data on objective strength outcomes in non-arthritic hips remain limited. The objective of this study was to evaluate pain reduction, patient-reported outcomes (PROMs), and isometric hip abductor strength following mini-open, knotless double-row repair using the Hip Bridge technique. Material and Methods: This retrospective, single-center cohort study (Level III) with prospective outcome evaluation included 27 patients (mean age 53 years, BMI 27 kg/m²) with partial gluteal tendon tears and no advanced osteoarthritis (Tönnis grade ≤ 1), treated between 2015 and 2022 using the mini-open, knotless double-row Hip Bridge technique. The mean follow-up was 29.3 ± 24.3 months (minimum 6 months). Diagnosis was confirmed by 3-Tesla MRI, and other sources of lateral hip pain were excluded. Clinical outcomes included the Visual Analog Scale (VAS), modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), normalized Western Ontario and McMaster Universities Osteoarthritis Index (nWOMAC), and Copenhagen Hip and Groin Outcome Score (HAGOS). Isometric hip abductor strength was assessed in 22 patients using a dynamometer, comparing the operated and contralateral limbs. Results: Postoperative satisfaction was high: 93% would undergo surgery again, 88% reported improved Trendelenburg gait, and 85% noted subjective strength gains. Pain improved significantly from VAS 8 (range, 3 to 10) preoperatively to VAS 2 (range, 0 to 7) postoperatively (p < 0.001); 100% reported pain relief. Patient-reported outcome scores were mHHS, 84.2; nWOMAC, 86.5; HOS, 80.7; and HAGOS, 70.7. Isometric strength testing showed significant improvement on the operated side (Fmax: p = 0.006; Fmean: p = 0.009). The mean limb symmetry index was 118% for Fmax and 122% for Fmean. Conclusions: Mini-open, knotless double-row repair of partial gluteal tears in non-arthritic hips yields adequate pain relief, high satisfaction, and objective strength recovery. The Hip Bridge technique could be an effective option after failed conservative treatment. Future prospective comparative studies are warranted to validate mid-term outcomes and establish long-term efficacy. Full article

Purpose: This study aimed to quantitatively compare the resected bony wedge volume and evaluate discrepancies in the non-overlapping lateral osteotomy surface areas among four closed-wedge high tibial osteotomy (CWHTO) techniques. Materials and Methods: Eleven knees from 10 patients who underwent high tibial osteotomy at our hospital (2016–2023) were analyzed using preoperative three-dimensional computed tomography. Representative cases were selected based on sex, the presence of proximal tibia vara, and a high joint line convergence angle. A subgroup analysis was then conducted. Surgical simulations were performed on reconstructed bone models using four different CWHTO techniques (conventional, oblique, hybrid 2:1, and hybrid 3:1) at three target angles (12°, 15°, and 18°). Osteotomy surface area and bony wedge volume were calculated and compared. Results: Distal osteotomy surface areas for the oblique, hybrid 1, and hybrid 2 techniques were 91%, 83%, and 72% of the conventional technique, respectively. Resected bony wedge volumes were 86%, 52%, and 38% of the conventional technique, respectively. Volumes decreased in the order of conventional, oblique, hybrid 3:1, and hybrid 2:1. Hybrid techniques showed significantly smaller resection volumes than the conventional and oblique techniques. The non-overlapping lateral osteotomy surface areas for oblique, hybrid 1, and hybrid 2 were 41% (lateral), 22% (medial), and 22% (medial) of the conventional technique, respectively. Only the conventional technique showed a statistically significant difference. Conclusions: Hybrid CWHTO techniques resulted in less bony wedge resection and fewer non-overlapping osteotomy surfaces compared with conventional and oblique techniques. Hybrid CWHTO may offer potential advantages in bone stock preservation and reduced lateral overhanging area. Full article

Background and Objectives: Implant osseointegration has been widely studied over the past few decades, particularly focusing on surface modifications that aim to improve integration. However, the literature includes few studies regarding the role of the endosteum in early osteointegration. Therefore, the aim of the present work is to approach the technique of implant insertion into bones with marrow, with an emphasis on the use of implants that are long enough to achieve marrow penetration. Materials and Methods: Titanium implants were inserted into the femurs of eight eleven-month-old rabbits. Fourteen days later, the animals were euthanized in accordance with the current legal and ethical guidelines. The histological processes that occur at the bone–implant interface were investigated. Histological sections of the bone–implant interface were colored using the Trichrome’s Goldner method, and were further analyzed and photographed using an Olympus microscope. Results: The histological analysis showed that during the initial osteointegration phases, the newly formed bone originated from the endosteal–medular zone. Periostal proliferation was observed only during the early stages. The bone that proliferated on the implant’s endosteal/medullary interface exhibited a surface area approximately 6 times larger than that of the bone formed on the osteal surface. Also, its length was approximately 25% longer. Conclusions: The bone tissue that proliferates on the endosteal and marrow surface of the implant increases significantly the bone–implant interface, and creates the setting for a good secondary stability. The findings suggest several clinical implications, as follows: penetrating the bone marrow during the insertion of short implants allows for increasing the bone–implant interface; the flap should be carefully managed; the integrity of the periosteum must be kept, as this is a key anatomical structure in cases of deficient bone marrow (i.e., severe mandible atrophy or vertical ridge augmentations). Full article

The insistent presence of detrimental chemical dyes, such as methylene blue (MB), in aquatic ecosystems creates a significant environmental fear that requires the development of innovative and effective remediation methods. This study examines the production and application of a novel carboxylate cellulose nanocrystal-silica-titanium dioxide (CCNC-silica-TiO₂) hybrid composite aerogel designed to enhance the photocatalytic degradation of methylene blue (MB). Carboxylic groups were incorporated into cellulose nanocrystals (CNCs) derived from sugarcane bagasse (SCB) waste to improve their dye adsorption capacity. The CCNCs were later incorporated into a silica aerogel matrix using a sol–gel method, followed by the introduction of TiO₂ nanoparticles. Characterization techniques, including FTIR and XRD, confirmed the successful chemical functionalization and composite synthesis. SEM analysis revealed a highly porous three-dimensional architecture, whilst BET surface area assessment showed that the CCNC-SiO₂-TiO₂ aerogel possessed a significant specific surface area of 448.69 m²/g. Under ultraviolet light, the hybrid aerogel demonstrated remarkable photocatalytic performance, achieving a 93% degradation rate of methylene blue, far above the 22% recorded in a CCNC-silica control. The degradation kinetics followed a pseudo-first-order model. The composite demonstrated significant reusability, maintaining over 70% efficiency after five consecutive cycles. The findings indicate that the adsorptive capacity of carboxylate CNCs, together with the photocatalytic efficiency of TiO₂, improves the efficacy, stability, and longevity of the CCNC-SiO₂-TiO₂ aerogel in wastewater treatment. Full article

Background: Breast-conserving surgery (BCS) combined with radiotherapy achieves oncologic outcomes comparable to mastectomy while preserving breast integrity. However, resections of more than 20% of breast volume or those in challenging quadrants may compromise cosmetic results. Level II oncoplastic techniques using volume replacement flaps aim to address this. The lateral intercostal artery perforator (LICAP) flap is a reliable, muscle-sparing option for lateral and central–lateral breast defects. This study reports our initial experience with LICAP in Level II oncoplastic breast reconstruction. Methods: A retrospective review was conducted of women undergoing BCS with LICAP reconstruction between March 2024 and March 2025. The primary outcome was flap-related complications within 90 days. Secondary outcomes included operative time, hospital stay, donor-site morbidity, and six-month aesthetic results using the Harvard scale and BREAST-Q^® module. Results: Nine women underwent LICAP reconstruction. All tumours were ≤pT2 with negative margins. Mean operative time was 128 min, and the median hospital stay was 2 days. One minor flap-related complication (seroma, 11%) occurred, which was managed conservatively without re-operation or delay in adjuvant therapy. At six months, all patients achieved good or excellent Harvard scores. The mean BREAST-Q^® satisfaction score was 79 ± 12. Conclusions: LICAP reconstruction is safe, efficient, and provides reliable early aesthetic and patient-reported outcomes. Its low complication rate, high satisfaction, and minimal morbidity support its broader adoption, while larger prospective studies are needed to assess long-term results and refine indications. These findings also underline the role of LICAP reconstruction as part of a personalized surgical strategy, where the choice of technique is tailored to individual anatomy and expectations. Full article

Accurate differentiation between Coilia brachygnathus and Coilia nasus is imperative for the effective management of fisheries, the conservation of aquatic ecosystems, and the mitigation of commercial fraud. Current morphological identification remains challenging due to their high morphological similarity—particularly for processed samples—while conventional molecular methods often lack the speed or specificity required for field applications or high-throughput screening. In this study, a novel integrated approach was developed and validated, combining TaqMan quantitative real-time PCR (qPCR). for precise genotyping of C. brachygnathus and C. nasus with Recombinase Polymerase Amplification coupled with Lateral Flow Dipstick (RPA-LFD) for rapid on-site screening. First, species-specific RPA-LFD assays were designed to target the mitochondrial COI gene sequence. This enabled visual detection within 10 min at 37 °C, with a sensitivity of 10² copies/μL, and required no complex equipment. A dual TaqMan MGB qPCR assay was further developed by validating stable differentiating SNPs (chr21:3798155, C/T) between C. brachygnathus and C. nasus, using FAM/VIC dual-labeled MGB probes. Results showed that this assay could distinguish the two species in a single tube: for C. brachygnathus, Ct values in the FAM channel were significantly earlier than those in the VIC channel (ΔCt ≥ 1), with a FAM detection limit of 125 copies/reaction; for C. nasus, only VIC channel amplification was observed, with a detection limit as low as 12.5 copies/reaction. Validation with 171 known tissue samples demonstrated 100% concordance with expected species identities. This integrated approach effectively combines the high accuracy and quantitative capacity of TaqMan qPCR for confirmatory laboratory genotyping with the speed, simplicity, and portability of RPA-LFD for initial field or point-of-need screening. This reliable, efficient, and user-friendly technique provides a powerful tool for resource management, biodiversity monitoring, and ensuring the authenticity of high-quality C. brachygnathus and C. nasus. Full article

Introduction and Objectives: Local recurrence (LR) in patients treated with surgery for renal cell carcinoma (RCC) remains a significant clinical challenge that requires thorough investigation. Our study aimed to identify the relative risk factors and explore the optimal clinical management of LR. Materials and Methods: We conducted a non-randomized, observational, retrospective multicentric registry involving multiple Italian urological centers. We included patients treated with surgery (either nephron-sparing or radical nephrectomy) who later developed LR, defined as recurrence in the ipsilateral kidney or renal fossa. Patients with hereditary syndromes or metastatic disease at the time of LR diagnosis were excluded. Results: We reported 135 cases of LR with the following characteristics: most primary lesions were monofocal (85.7%), with a median size of 42 mm (23–53), the median R.E.N.A.L. score was 7 (6–8), and the median Padua score was 7 (6–9). Patients were treated with robot-assisted techniques in 59% of cases, laparoscopic surgery in 32.4%, and open surgery in 8.6%. Nephron-sparing surgery was performed in 75.2% of cases. Ischemia occurred in 61% of the cases, with a median ischemia time of 21 min (15.5–24). Intraoperative complications occurred in 3.8% of cases, while postoperative complications were reported in 13.8%, all of which were grade ≤3 according to the Clavien–Dindo classification. The primary tumors were pT1a in 43.5% of cases, pT1b in 26.3%, pT2 in 14.7% and pT3 in 15.5%. Histologically, 84% of cases were clear cell, 11.3% papillary type 1 or 2, and 3.7% chromophobe. Sarcomatoid/rhabdoid variants were present in 10.5% of cases. The median rate of LR was 1.3% (range 0.2–3.6), while the median time to LR was 18 months (12–39). LR occurred in the ipsilateral kidney in 70.5% of cases and in the ipsilateral renal fossa in 29.5%. The median rate of PSM in LR cases at initial surgery was 2.4% (range 0–4.3), while the median rate of negative surgical margin (NSM) in LR cases at initial surgery was 0.1 (0–0.3). Following LR diagnosis, most patients (49.2%) underwent surgery, 29.1% received cryoablation or radiotherapy, 17.1% received systemic treatment alone, and 4.6% followed a watchful waiting/active surveillance approach. At a median follow-up of 62 months, the highest oncological control in terms of 5-year cancer-specific survival and overall survival rates was achieved in surgically treated patients. The PSM, the histological variant, and their combination were found to be independent variables correlated with the occurrence of LR, with relative risks of 3.62, 2.71, and 8.12, respectively. Conclusions: LR after nephron-sparing or radical nephrectomy represents a significant clinical dilemma. Known risk factors are not always sufficient to predict recurrence, emphasizing the necessity of consistent radiological follow-up per guideline recommendations. Early detection of recurrence and a multidisciplinary approach involving expert centers are crucial for optimizing patient outcomes. Full article

This study aimed to compare effects on homeostasis and postoperative outcomes of two surgical techniques for umbilical hernia repair in calves. Fifty-two calves were enrolled and randomly assigned to two groups: Group A (open technique) and Group C (closed technique). This was a prospective controlled clinical trial. Sedation was induced with romifidine, and butorphanol. Cardiopulmonary parameters, sedation scores, and body temperature were recorded at multiple perioperative timepoints (T0–T8). Postoperative pain was assessed using the UNESP-Botucatu UCPS-IV scale. Oxidative stress was evaluated by measuring serum malondialdehyde (MDA) and plasma serotonin (5-HT) concentrations at T0 and 36 h postoperatively T9. Physiological parameters remained within normal limits in both groups. Postoperative pain scores were significantly lower in Group C than in Group A (p < 0.001), with later onset of rescue analgesia 40 vs. 30 min post-standing, respectively, p < 0.001. MDA levels increased postoperatively in both groups, with a greater rise in Group A (p < 0.001), 5-HT decreased in Group A and increased in Group C (p = 0.020). The closed surgical technique for umbilical hernia repair, avoiding peritoneal opening, was associated with reduced postoperative pain and oxidative stress, suggesting it is a less invasive than the open surgical technique. Full article

Background: Circumferential or near-circumferential colorectal lesions are challenging to remove endoscopically; therefore, they are often surgically managed. There are limited data on the outcomes of endoscopic submucosal dissection (ESD) for these lesions, usually from Eastern settings, where ESD is more well established. Objective: The objective of the study was to retrospectively analyze the outcomes of circumferential colorectal ESD in a Western center. Methods: Consecutive patients referred for endoscopic resection of colorectal lesions between January 2015 and April 2025 were included if they had undergone ESD for colorectal laterally spreading tumors with ≥90% involvement of the luminal circumference. Results: Overall, 53 patients were enrolled (26 females, 49.1%; 70.6 ± 9.3 years). Mean lesion size was 91.8 ± 25.3 mm. The most frequent lesion location was the rectum (n = 36, 67.9%). Thirty-three lesions (62.3%) were circumferential, and twenty (37.7%) were near-circumferential. Median procedural time was 160.0 min (IQR 112.0–200.0 min). Histological analysis revealed high-grade dysplasia in 25/53 cases (47.2%) and adenocarcinoma in 28 patients (52.8%). Resection was en bloc in 51 cases (96.2%) and R0 in all cases (100%). Curative resection was achieved in 21 out of 28 adenocarcinoma patients (75%). Adverse events were intra-procedural major bleeding (n = 19, 18.9%), post-procedural bleeding (n = 2, 3.8%), delayed bleeding (n = 1, 1.9%), and intra-procedural perforation (n = 3, 5.7%). Post-ESD stricture was observed in 18.9% of cases (10/53); three of these (30%) were asymptomatic. All were successfully managed endoscopically. Patients who developed strictures had a longer median procedural time (206 min vs. 145 min, p = 0.0061) and a larger mean lesion size (110 mm vs. 90 mm, p = 0.035). Conclusions: ESD for colorectal circumferential and near-circumferential lesions was safe and effective in a Western expert center, supporting the use of this technique in this subset of lesions. Strictures are a common consequence that can be effectively managed endoscopically. Full article

This study aimed to evaluate the placement accuracy and reproducibility of Surface Guided Radiotherapy (SGRT) compared with the conventional tattoo/laser method in patients undergoing radiotherapy for abdominal malignancies. A retrospective analysis was conducted on 43 patients treated with either SGRT (Group A) or the tattoo/laser technique (Group B). Patients in both groups underwent CBCT to quantify the positioning shifts in the vertical (Svrt), lateral (Slat) and longitudinal (Slng) axes, as well as the total shift. Statistical indicators including median, interquartile range (IQR), and range were calculated, and Mann–Whitney U tests were performed due to non-normal data distribution. Median values in all axes were same between groups: Svrt = 0.4 cm, Slat = 0.2 cm, Slng = 0.4 cm. Group A showed a higher total median shift equal to 0.8 cm versus 0.7 cm of Group B. However, IQRs were smaller in the Group B for all directions and total shift, indicating greater method consistency. Statistically significant differences (p < 0.05) were observed in all axes, except the vertical. These findings suggest that, while SGRT achieves comparable median alignment, its use in a highly variable anatomical region such as the abdomen may be associated with greater setup variability. Full article