Search Results (2,164)

Background/Objectives: Anti-tumour necrosis factor (anti-TNF) medications were historically commonly prescribed as the first-line biologic treatment for chronic inflammatory pouch conditions. However, their use in these conditions is mainly based on retrospective studies of relatively small numbers of patients with short follow up periods. We aimed to describe the long-term outcomes of first-line anti-TNF therapy in a large, multi-centre, multi-national patient cohort with chronic inflammatory pouch conditions. Methods: This was an observational, retrospective, multi-centre, multi-national study. We included patients with chronic inflammatory pouch conditions initially treated with anti-TNF drugs infliximab (IFX) or adalimumab (ADA), who had a follow up of at least 1 year. The primary outcome was anti-TNF treatment persistence, defined as continuation of anti-TNF throughout the study period. The secondary outcome was pouch failure, defined by the need for a defunctioning ileostomy or pouch excision. Results: We recruited 98 patients with chronic inflammatory pouch conditions initially treated with anti-TNF medications—63 (64.3%) treated with IFX and 35 (35.7%) treated with ADA. Average follow up length was 94.2 months (±54.5). At the end of the study period only 22/98 (22.4%) patients were still on anti-TNF treatment. In those in whom the first-line anti-TNF was discontinued, the median time to discontinuation was 12.2 months (range 5.1–26.9 months). The most common cause for anti-TNF discontinuation was lack of efficacy despite adequate serum drug levels and absence of anti-drug antibody formation (30 patients, 30.6%). Loss of response due to anti-drug antibody formation was the cause for discontinuation in 18 patients (18.4%), while 12 patients (12.2%) stopped treatment because of adverse events or safety concerns. Out of the 76 patients discontinuing anti-TNF treatment, 34 (34.7% of the cohort) developed pouch failure, and 42 (42.8% of the cohort) are currently treated with a different medical therapy. Conclusions: First-line anti-TNF therapy for chronic pouch inflammatory conditions is associated with low long-term persistence rates. This is due to a combination of lack of efficacy and adverse events. A significant percentage of patients initially treated with anti-TNF therapy develop pouch failure. Full article

Mechanical components are more difficult to detect at the initial state of failure. To solve this problem, this paper models and simulates the characteristics of an electrostatic oil-line sensor (OLS) wear particles carried in the lubricating oil path are detected. In this study, an OLS that monitors the charge in an oil line using the principle of electrostatic induction is modeled and simulated. The sensor characteristics are simulated and tested using finite element simulation. The sensor efficiency, spatial sensitivity, and length-to-diameter ratio are simulated based on the point charges at different locations. The simulation results show that the sensitivity exhibits different trends when the point charge is inside and outside the probe. The length-to-diameter ratio is proportional to the sensor efficiency, the spatial sensitivity distribution law of multiple charges is consistent with that of a point charge, and the relative deviation rate between the mathematically calculated values and the simulated values is less than 3% under the same conditions. In conclusion, the finite element simulation results of the electrostatic oil line sensor constructed in this study are consistent with the theoretical model calculations and can be used in future mechanical fault diagnosis. Full article

Lacrimal cysts (dacryops), which involve lacrimal tissue, are uncommon in dogs with an obscure/unclear pathogenesis. Compared to the current available literature, this report describes the clinicopathologic and immunohistochemical features of two cases of unusual dacryops in brachycephalic dogs. A three-year-old male Cane Corso was referred with a 1-month history of swelling ventromedial to the left eye associated with blepharospasm and epiphora. Furthermore, a severe lower and upper eyelid entropion and a deep corneal ulcer were present. B-mode ultrasonography and a CT scan revealed a subcutaneous cyst, closely adherent to the maxillary bone. Surgical removal and the correction of entropion were performed. No recurrence and/or complication was detected by seven-year follow-up. Histopathology revealed a cystic structure with single- to double-cell-layered, nonciliated, cuboidal epithelia. Alcian blue stain revealed rare, disseminated goblet cells admixed with epithelial cells. The epithelium was strongly Cytokeratin-positive by immunohistochemistry and appeared lined by several layers of smooth muscle actin (SMA)-positive myoepithelial cells. A 1-year-old male French Bulldog with a 3-month lesion of the third eyelid of the right eye. The lesion (15 mm × 7 mm) beneath the conjunctiva appeared pale-pink, smooth, and multilobulated. Excision was performed by blunt dissection through the conjunctiva on the palpebral surface of the third eyelid. Recovery was uncomplicated, and no recurrence has been noted at three-year follow-up. Cytology of the cystic fluid and histopathology and immunohistochemistry of the cyst wall revealed findings for case 1. To further characterize the SMA-positive spindle cells located directly beneath the cyst-lining epithelium, double-color immunofluorescence for SMA and p63 (a myoepithelial cell marker) was performed on the sample from case 2. The analysis revealed that the SMA-positive cells lacked p63 expression, indicating a non-myoepithelial phenotype. The histological findings in our cases are consistent with previous reports of canine dacryops. The positivity of immunohistochemical staining for SMA in cells directly beneath the epithelium of dacryops in the cases here described in two brachycephalic dogs is consistent with previous reports in dogs and horses but in contrast with a retrospective study about a human dacryops. These results support the conclusion that the pathogenesis of dacryops in dogs should exclude failure of ductular “neuromuscular” contractility. Full article

Background/Objectives: The rising demand for total joint arthroplasty (TJA) and increasing incidence of prosthetic joint infections (PJIs) significantly burden patients and healthcare systems. This retrospective study describes the epidemiology, clinical characteristics and outcomes of PJIs in Iceland from 2003 to 2020. Methods: PJI cases were identified through synovial fluid cultures and ICD codes, with classification per EBJIS criteria. Unlikely cases were excluded. Results: Among 293 cases with a mean age of 70 years, 60% (176/293) were males and 58% (171/293) involved the knee. Over half of infections occurred within two years post TJA, with an incidence rate of 0.94%, increasing significantly over time (p = 0.012). Males had significantly higher incidence rates than females (incidence rate ratio 0.42; p < 0.001). The most common pathogens were coagulase-negative staphylococci (30%, 88/293), and 9% (27/293) of cases were culture-negative. DAIR was the first-line treatment in about 50% (147/293) of cases but it failed in nearly half, contributing to an overall treatment failure rate of 38% (98/259). PJI-related mortality was 2% (6/293). Conclusions: The results indicate an increased incidence, with the highest risk within two years of TJA. Males are at greater risk, while females more commonly undergo TJA. DAIR success rates were lower than reported elsewhere but improved significantly over time. Better methods to prevent PJIs are needed. Full article

Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III–V), beyond its established role in low-grade injuries (grades I–II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I–II) accounted for 43% (n = 105), while high-grade injuries (AAST III–V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes. Full article

Background: Despite recent advances in the management of metastatic renal cell carcinoma (mRCC), real-world outcomes remain heterogeneous, and early treatment failure is common. Predictive biomarkers for time to treatment failure (TTF) outside clinical trials are poorly characterized. Objective: To identify clinical and laboratory predictors associated with early treatment failure in a real-world cohort of mRCC patients treated with immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), or combination regimens. Methods: We conducted a retrospective, single-center analysis of patients with metastatic non-urothelial RCC treated between 2018 and 2023. Cox proportional hazards regression was used to evaluate the association between baseline biological parameters and TTF for each treatment regimen. Results: Among 137 patients receiving first-line therapy, 50 received Ipilimumab + Nivolumab, 49 Sunitinib, and 17 Avelumab + Axitinib. For Ipilimumab + Nivolumab, elevated AST was significantly associated with shorter TTF. For Avelumab + Axitinib, shorter TTF was associated with lymph node metastases, low lymphocyte count, low creatinine, low BMI, and low hemoglobin. For Cabozantinib in subsequent lines, a higher platelet count, ALT, and presence of liver metastases were associated with shorter TTF. No statistically significant predictors were found for Nivolumab used in the second-line setting. Conclusions: Routine, accessible biomarkers such as AST, hemoglobin, lymphocyte count, and creatinine may serve as predictors of treatment failure in specific therapeutic contexts. These findings support risk-adapted strategies and individualized monitoring in real-world clinical practice, though further validation in larger cohorts is warranted. Full article

The use of high-pressure grinding rolls (HPGRs) is increasing in the ore industries as advanced technology is available for this type of comminuting. There are important parameters in these devices, which have many effects on productivity. One of the main reasons for damage on the rolls and, therefore, decreases in the machine’s productivity and efficiency is surface wear. This phenomenon must be carefully understood so that it can be controlled as much as possible through the readjustment and optimization of the effective parameters. In this research, the wear mechanism of HPGRs in a production line for iron ore concentrate was investigated. The results showed that there was greater wear at the center of the rolls and that changes to the chemical and physical properties of the incoming iron compared to the design condition reduced the rolls’ lives. The results showed a failure to perform appropriate mechanical adjustment and improper repair and maintenance. Full article

Modern manufacturing demands real-time, scalable coordination that legacy manufacturing management systems cannot provide. Digital transformation encompasses the entire manufacturing infrastructure, which can be represented by digital twins for facilitating efficient monitoring, prediction, and optimization of factory operations. A Federated Digital Twin (FDT) emerges by combining heterogeneous digital twins, enabling real-time collaboration, data sharing, and collective decision-making. However, deploying FDTs introduces new concurrency control challenges, such as priority inversion and synchronization failures, which can potentially cause process delays, missed deadlines, and reduced customer satisfaction. Traditional concurrency control approaches in the computing domain, due to their reliance on static priority assignments and centralized control, are inadequate for managing dynamic, real-time conflicts effectively in real production lines. To address these challenges, this study proposes a novel concurrency control framework combining Deep Reinforcement Learning with the Priority Ceiling Protocol. Using SimPy-based discrete-event simulations, which accurately model the asynchronous nature of FDT interactions, the proposed approach adaptively optimizes resource allocation and effectively mitigates priority inversion. The results demonstrate that against the rule-based PCP controller, our hybrid DRLCC enhances completion time maximum of 24.27% to a minimum of 1.51%, urgent-job delay maximum of 6.65% and a minimum of 2.18%, while preserving lower-priority inversions. Full article

To improve the ability of line-commutated converters (LCCs) to resist commutation failure (CF) when a fault occurs on the AC side, a novel sub-module-based LCC topology actively resistant to CF is proposed in this paper. The control strategy and the parameters of the proposed sub-module are elaborately designed. The proposed LCC topology can actively resist CF by providing an auxiliary commutation voltage to the AC side, and the sub-module is conducive to the rapid recovery of the thyristor’s forward blocking ability. Additionally, the initial capacitor voltage of the sub-module is designed optimally based on the commutation mechanism. The proposed LCC system can effectively improve the ability to resist CF by increasing the commutation margin of the LCC system. Furthermore, the capacitors are charged and discharged during fault time, so the capacitor voltages do not drop too low and, thus, are better at resisting CF. Matlab/Simulink simulation results verify that the proposed LCC quickens the commutation process, promotes commutation performance, and enhances the immunity of LCCs to CF. Full article

Background/Objectives: The incidence of cardiac morbimortality in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) is unknown. Methods: We analyze the characteristics, incidence, risk factors, and outcomes of cardiac events in AML patients treated for second-line (2L) or third-line (3L) episodes. Results: Among 327 2L AML patients (median age 62 years old), 135 experienced cardiac events, with an incidence of 38.6% non-fatal and 1.3% fatal events at 6 months. The grade 1–2 incidence was 16.8%, and the grade 3–4 incidence was 23.5% at 6 months. Overall, 207 cardiac events occurred in the 2L cohort, the most frequent being hypertension (n = 45), bradycardia (n = 39), QTc prolongation (n = 35), heart failure (n = 33), syncope/presyncope (n = 22), arrhythmia (n = 18), and myocardial ischemia (n = 8). Median OS in the 2L cohort was 9.4 months, 21.4 months in patients with grade 1–2, 8.8 months in patients without a cardiac event, 7.6 months in grade 3–4 patients, and 2.1 months with in 5 patients (p = 0.0035). The multivariate analysis showed prior cardiologic antecedents (p = 0.013), intensive 2L chemotherapy (p = 0.01), and inclusion in a 2L clinical trial (p < 0.001) as independent risk factors for non-fatal cardiac events. Among 189 patients of the 3L cohort, the incidence of non-fatal and fatal cardiac events was 49.2% and 0% at 6 months, respectively. Non-fatal cardiac events were more frequent in patients with prior cardiac antecedents (p = 0.004). Conclusions: In summary, cardiotoxicity is a frequent and challenging complication in R/R AML patients. We identified the risk factors that could be relevant to implementing risk-adapted management guidelines, aiming to reduce morbi-mortality in this difficult-to-treat setting. Full article

Icing disasters can significantly reduce the reliability of overhead transmission lines, while limited budgets of power grid enterprises constrain the scale of investment. To improve investment efficiency, it is essential to balance the reliability and economic performance of anti-icing strategies. Most existing studies on the performance evaluation of anti-icing strategies for transmission lines focus primarily on reliability, neglecting their economic implications. To address this gap, this paper proposes a time-evolution-based performance evaluation model for overhead transmission line anti-icing strategies. First, a lifetime distribution function of transmission lines during the icing period is constructed based on the Nelson–Aalen method and metal deformation theory. Subsequently, a quantitative risk model for iced transmission lines is developed, incorporating the failure rate, value of lost load, and amount of lost load, providing a monetary-based indicator for icing risk. Finally, a performance evaluation method for anti-icing strategies is developed based on the risk quantification model. Implementation cost is treated as risk control expenditure, and strategy performance is assessed by integrating it with residual risk cost to identify the optimal strategy through composite cost analysis. The proposed model enables a comprehensive assessment of anti-icing strategy performance, improving the accuracy of strategy selection and achieving a dynamic balance between implementation cost and transmission line reliability. The case study results demonstrate that the proposed method effectively reduces the risk of failure in overhead transmission lines under ice disasters while lowering anti-icing costs. Compared with two existing strategy selection approaches, the strategy based on this method achieved 46.11% and 32.56% lower composite cost, and 60.26% and 48.41% lower residual risk cost, respectively. Full article

Detecting defects in transmission line insulators is crucial to prevent power grid failures as power systems continue to expand. This study introduces YOL011n-SSA, an enhanced insulator defect detection technique method that addresses the challenges of effectively identifying flaws in complex environments. First, this study incorporates the StarNet network into the backbone of the model. By stacking multiple layers of star operations, the model reduces both parameter count and model size, improving its adaptability to real-time object detection tasks. Secondly, the SOPN feature pyramid network is introduced into the neck part of the model. By optimizing the multi-scale feature fusion of the richer information obtained after expanding the channel dimension, the detection efficiency for low-resolution images and small objects is improved. Then, the ADown module was adopted to improve the backbone and neck parts of the model. It effectively reduces parameter count and significantly lowers the computational cost by implementing downsampling operations between different layers of the feature map, thereby enhancing the practicality of the model. Meanwhile, by introducing the NWD to improve the evaluation index of the loss function, the detection model’s capability in assessing the similarities among various small-object defects is enhanced. Experimental results were obtained using an expanded dataset based on a public dataset, incorporating three types of insulator defects under complex environmental conditions. The results demonstrate that the YOLO11n-SSA algorithm achieved an mAP@0.5 of 0.919, an mAP@0.5:0.95 of 70.7%, a precision of 0.95, and a recall of 0.875, representing improvements of 3.9%, 5.5%, 2%, and 5.7%, respectively, when compared to the original YOLO1ln method. The detection time per image is 0.0134 s. Compared to other mainstream algorithms, the YOLO11n-SSA algorithm demonstrates superior detection accuracy and real-time performance. Full article

This paper provides a reliability analysis of selected components in the electrical power supply systems used for railway traffic control equipment. It includes rectifiers, controllers, inverters, generators, batteries, sensors, and switching elements. The study used failure data from power supply system elements on selected railway lines. The analysis was performed using a mathematical model based on Markov processes. Based on the findings, recommendations were made to improve safety levels. The results presented in the paper could serve as a valuable source of information for operators of power supply systems in railway traffic control, helping them optimize maintenance processes and increase equipment reliability. Full article

The dynamic development of distributed sources (mainly RES) contributes to the emergence of, among others, balance and overload problems. For this reason, many RES do not receive conditions for connection to the power grid in Poland. Operators sometimes extend permits based on the possibility of periodic power reduction in RES in the event of the problems mentioned above. Before making a decision, investors, for economic reasons, need information on the probability of annual power reduction in their potential installation. Analyses that allow one to determine such a probability require knowledge of the reliability indicators of transmission lines and transformers, as well as failure removal times. The article analyses the available literature on the annual risk of outages of these elements and methods to determine the appropriate reliability indicators. Example calculations were performed for two networks (test and real). The values of indicators and times that can be used in practice were indicated. The unique contribution of this article lies not only in the comprehensive comparison of current, relevant transmission line and transformer reliability analysis methods but also in developing the first reliability indices for the Polish power system in more than 30 years. It is based on the relationships presented in the article and their comparison with results reported in the international literature. Full article

The electromechanical composite transmission technology for tracked vehicles demonstrates excellent performance in energy efficiency, mobility, and ride comfort. However, due to frequent operation under harsh conditions, the components of the electric drive system, such as drive motors, are prone to failures. This paper proposes three fault-tolerant control methods for three typical fault scenarios of the electromechanical composite transmission system (ECTS) to ensure the normal operation of tracked vehicles. Firstly, an ECTS and the electromechanical coupling dynamics model of the tracked vehicle are established. Moreover, a double-layer anti-windup PID control for motors and an instantaneous optimal control strategy for the engine are proposed in the fault-free case. Secondly, an anti-windup PID control law for motors and an engine control strategy considering the state of charge (SOC) and driving demands are developed in the case of single-side drive motor failure. Thirdly, a B4 clutch control strategy during starting and a steering brake control strategy are proposed in the case of electric drive system failure. Finally, in the straight-driving condition of the tracked vehicle, the throttle opening is set as 0.6, and the motor failure is triggered at 15 s during the acceleration process. Numerical simulations verify the fault-tolerant control strategies’ feasibility, using the tracked vehicle’s maximum speed and acceleration at 30 s as indicators for dynamic performance evaluation. The simulation results show that under single-motor fault, its straight-line driving power drops by 33.37%; with electric drive failure, the drop reaches 43.86%. The vehicle can still maintain normal straight-line driving and steering under fault conditions. Full article