Search Results (1,989)

Objective: The objective of this study was to choose the optimal anesthesia method for gastric cancer patients undergoing surgery with lymph node dissection. Materials and Methods: The study included 53 patients with stage T1-4aN0-3M0 gastric cancer, who underwent radical surgery with xenon and dexmedetomidine (DMM) anesthesia in combination with epidural analgesia (main group, 27 patients) or with sevorflurane anesthesia in combination with epidural analgesia (comparison group, 26 patients). All patients underwent monitoring of hemodynamic parameters, blood coagulation system, thromboelastometry, and inflammation and metabolic parameters (interleukins, hormones and glucose levels), with an assessment of complications according to the Clavien-Dindo classification and the intensity of postoperative pain. Results: Awakening and extubation times, narcotic analgesic consumption, and Numeric Rating Scale pain scores were lower in the xenon + DMM group than in the sevoflurane group (p < 0.05). The overall number of patients experiencing complications did not differ significantly between anesthesia types; however, significant differences were found in the total number of complications (p = 0.003), the number of complications according to Clavien-Dindo I (p = 0.043) and II (p = 0.019), and the incidence of postoperative nausea and vomiting (p = 0.042). Conclusions: The BIS monitoring data obtained showed a sufficient level of anesthesia depth during surgery in both groups; however, post-anesthesia depression persisted longer in patients in sevoflurane group. Mathematical models for predicting Clavien-Dindo IIIb-V complications and severe postoperative pain syndrome are characterized by high sensitivity and specificity. They include simple clinical and laboratory parameters as well as type of anesthesia as predictors. The limitations of predictive models are also discussed in the article. Full article

Under high-altitude, low-Reynolds-number conditions, flow instability in confined dual-fan configurations severely limits the propulsion and thermal management efficiency of heavier-than-air aircraft. This study establishes a high-fidelity 3D transient numerical model using curvature-corrected shear stress transport (SST) turbulence modeling, integrated with proper orthogonal decomposition (POD), dynamic mode decomposition (DMD), and nonlinear stability analysis to investigate rotational direction control mechanisms. Results indicate that co-rotating configurations trigger intense low-frequency pulsations and significant flow skewness due to wall-adhesion effects. Conversely, the counter-rotating layout reconstructs vortex topology by forming a strong interaction shear layer, which enhances local momentum exchange and suppresses large-scale coherent structures. While counter-rotation exhibits a higher initial growth rate, its significantly enhanced nonlinear aerodynamic damping forces the flow into a low-amplitude quasi-steady state, reducing inlet non-uniformity by 74% and increasing mass flow by 5.19%. These findings clarify the physical mechanisms of vortex interference in regulating stability and provide critical design insights for optimizing compact propulsion systems in heavier-than-air high-altitude platforms, such as long-endurance UAVs. Full article

Background: This longitudinal study examined the clinical outcomes of physiotherapy interventions in patients with chronic low back pain, specifically observing the interactions between demographic characteristics, physical metrics, and psychological variables. Methods: A cohort of n = 150 patients, Final n = 123 (18% attrition rate), was assessed using a one-group pre-test/post-test design, with primary outcome measures including Health-Related Quality of Life, the Perceived Stress Scale, and the Numerical Pain Rating Scale. Participants received eight standardized sessions over 4 weeks, including electro-physical agents combined with individualized kinesiotherapy. Data analysis/synthesis was performed via Multiple Correspondence Analysis (MCA) to map associations between categorical variables and treatment responses. Results: The predominant clinical profile found was a middle-aged female with moderate educational attainment, presenting with a Body Mass Index in the overweight range and moderate-to-high baseline pain intensity. MCA revealed distinct phenotypic trends: longer Work Experience was associated with lower baseline Quality of Life (QoL) and heightened stress/pain levels. In contrast, patients characterized by higher education and significant Work Experience demonstrated notable post-intervention QoL gains. High baseline QoL served as a predictor for sustained improvement and pain attenuation, while elevated pre-intervention pain scores were consistently linked to perceived unmet clinical needs and exacerbated stress. Conclusions: MCA successfully mapped non-linear clusters—such as the “Socio-Psychological Barrier” profile—that traditional univariate methods fail to visualize, suggesting that “individualized care” must prioritize health literacy among patients experiencing extensive work-related strain. Full article

The present study deals with the problem of irregular temperature distribution, simultaneous under-firing and over-firing, and their resultant efficiency and quality problems in a mechanical lime vertical kiln powered by domestic waste flue gas. The numerical simulation and structure optimization were carried out based on a 150 kg/h pilot-scale kiln. This combined model was built on the ANSYS Fluent 2022 R1 platform with UDF and UDS, incorporating limestone decomposition kinetics to enable the solution of gas and solid energy equations separately, and simulation of complex transfer and reaction processes. To correct the separation of flows at one inlet, a symmetric four-direction (00, 900, 1800, 2700) air intake plan was suggested. The findings show that this design essentially transforms the internal flow field into uniform and symmetrical temperature and concentration distributions. The calcination region contained both gas and solid temperatures in the optimum range to produce active lime. Specifically, the optimized kiln achieved a temperature range of 1190–1450 K in the calcination zone, a decomposition rate of approximately 82.7% (compared to 5.3% in the original model), and an increase in effective CaO content from 81.7% to 87.7%, with validation errors below 15%. It was demonstrated that the model is reliable, since the outlet simulated values correlated well with the measured ones. The preheating, calcining, and cooling zones’ heights of the optimized kiln adhered to the design requirements. This research is innovative in its application of a multi-physics coupling model with a varying heat source in a kiln and, in turn, identifies the synergism improvement process in the flow, temperature, concentration, and reaction fields. Full article

Background/Objectives: Sacroiliac joint (SIJ) dysfunction is a common yet frequently underdiagnosed cause of chronic low back pain. This study aimed to compare the clinical effectiveness of ultrasound-guided corticosteroid and ozone injections in patients with chronic low back pain due to SIJ dysfunction. Methods: This comparative clinical study included 64 patients with chronic sacroiliac joint (SIJ) dysfunction who received ultrasound-guided SIJ injections with either corticosteroid (n = 31) or ozone (n = 33). Participants had a mean age of 45.0 ± 7.7 years, and the sex distribution was 42/22 (female/male). Pain intensity was assessed using the Numeric Rating Scale (NRS), disability using the Oswestry Disability Index (ODI), and quality of life using the Short Form-12 Physical (PCS) and Mental (MCS) Component Summary scores. Outcomes were evaluated at baseline, 3 months, and 6 months. Longitudinal changes were analyzed using two-way repeated-measures ANOVA (group × time) with Bonferroni-adjusted post hoc comparisons. Effect sizes were calculated using Cohen’s d. Normality and homoscedasticity were assessed (Shapiro–Wilk and Levene tests), and baseline comparisons were performed using appropriate parametric or non-parametric tests. Results: Both treatments significantly improved pain, disability, and quality of life at 3 months (p < 0.01). However, improvements were significantly greater and more durable in the ozone group across all outcomes at both 3 and 6 months (p < 0.01). At 6 months, between-group differences favored ozone for NRS (mean difference −2.81; Cohen’s d = −2.36), ODI (−6.05; d = −1.46), SF-12 PCS (+4.24; d = 1.24), and SF-12 MCS (+4.22; d = 0.83). A ≥50% pain reduction was achieved at 3 months in 97.0% of ozone-treated patients versus 45.2% of corticosteroid-treated patients (p < 0.01) and persisted at 6 months in 18.2% and 0% of patients, respectively (p < 0.05). The magnitude of improvement in the ozone group exceeded commonly reported Minimal Clinically Important Difference (MCID) thresholds for chronic low back pain outcomes, supporting clinical relevance. Conclusions: Ultrasound-guided ozone injection provided greater and more durable improvements in pain relief, functional status, and quality of life compared with corticosteroid injection in patients with SIJ dysfunction. Full article

Background: Facial expressions of pain are essential for pain assessment, yet subjective pain reports often vary between sexes. Traditional self-report measures are prone to bias, and objective methods are needed for more reliable pain evaluation. Objective: To develop and validate a subjectivity-free automated tool to assess acute low back pain using facial expressions recorded during a functional spinal extension task. Participants: Thirty healthy adults, aged 18–40 years. Methods: Participants received intramuscular injections of hypertonic (pain) and isotonic (placebo) saline in the lumbar region during separate sessions. Facial expressions were video-recorded during a submaximal lumbar extension task and analyzed using a custom software based on Haar Cascade and Local Binary Pattern Histogram algorithms, which are techniques that do not require neither training data nor subjective labeling, contrary to what happens in deep learning solutions. Results: The tool successfully detected significant differences in facial expressions between pain, placebo, and pain-free conditions (p < 0.001). Test–retest reliability was good (ICC = 0.85). While both sexes showed similar facial expression patterns during pain, males reported higher pain scores on the numeric rating scale (p < 0.01). Pain significantly reduced steadiness of force in both sexes. Conclusion: The automated tool objectively quantified facial expressions associated with acute low back pain and revealed sex-related differences in subjective pain perception. This multimodal approach integrating expression analysis, physical performance, and self-report may enhance the accuracy of pain assessment in physiotherapy settings. Full article

In the transition toward the circular economy and high-rate manufacturing, thermoplastic composites (TPCs) are increasingly outperforming conventional thermosets due to their superior fracture toughness, recyclability, and rapid processing capabilities. Among available joining techniques, fusion bonding stands as the main mechanism for structural integration, as it bypasses the fundamental limitations of traditional assembly: the weight penalties and stress concentrations inherent in mechanical fastening, as well as the long cycle times and interfacial weaknesses often associated with adhesive bonding. This paper provides a comprehensive evaluation of welded TPC joints through a dual-methodological approach: a historical narrative review tracing the evolution of fusion bonding principles, and an in-depth literature review of 25 key articles published since 2015. The analysis focuses on the intersection of experimental characterization—quantifying interfacial strength and fracture energy—and numerical modeling techniques, such as Cohesive Zone Modeling (CZM) and progressive damage analysis. By categorizing recent advancements into specific thematic pillars, this study correlates process-induced phenomena with macro-scale mechanical performance and virtual predictive accuracy. The findings synthesize decades of foundational knowledge with cutting-edge research trends, highlighting the transition from empirical testing to computational design. This work serves as a roadmap for achieving standardized, high-performance thermoplastic assemblies in safety-critical applications. Full article

Objective: The objective of this study was to evaluate the efficacy of a ropivacaine-loaded poloxamer 407 (P407)-based thermosensitive hydrogel applied at the subfascial site compared with a continuous local anesthetic delivery system using a catheter for postoperative pain control after cesarean section (CS), in combination with standard intravenous patient-controlled analgesia (IV-PCA). Methods: This single-center, prospective randomized controlled trial included 72 pregnant women undergoing CS between April and October 2025. Participants were randomly assigned to receive either ropivacaine hydrogel or catheter-based ropivacaine infusion, both in conjunction with IV-PCA. Primary outcomes included numeric rating scale (NRS) pain scores at 3, 6, 12, 24, and 48 h postoperatively. Secondary outcomes included the time to first NSAID request and the cumulative use of rescue NSAIDs. Results: There were no significant differences in baseline characteristics between the groups. NRS pain scores did not differ significantly at any time point, although they varied significantly over time within each group. The hydrogel group showed a statistically significant delay in the time to first NSAID request (6.3 ± 5.1 h vs. 5.0 ± 6.1 h, p = 0.049) and higher cumulative NSAID use (2.4 ± 1.7 vs. 1.6 ± 1.2, p = 0.035). No serious complications were observed in either group. Conclusion: The ropivacaine hydrogel provided postoperative pain control comparable to that of the continuous catheter system, with no statistically significant differences in NRS scores observed between groups. Given its ease of use, absence of catheter-related concerns, and substantially lower total anesthetic dose, the P407-based hydrogel may represent a practical and patient-friendly alternative for post-cesarean analgesia. Full article

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary. Full article

Background/Objectives: Mycosis fungoides (MF) and Sézary syndrome (SS) are chronic cutaneous T-cell lymphomas frequently associated with pruritus, psychological distress, and impaired quality of life (QoL). While the impact of MF/SS on patients’ quality of life is well recognized, data on the burden experienced by cohabitants remain limited. The aim of this study was to assess dermatology-specific quality of life in patients with MF/SS and their cohabitants and to explore its associations with pruritus severity, depressive symptoms, and disease stage. Methods: This cross-sectional study included 25 patient–cohabitant pairs (25 patients with MF/SS and their cohabitants living in the same household) recruited at a tertiary dermatology center. Patients completed the Dermatology Life Quality Index (DLQI), Beck Depression Inventory I (BDI-I), and pruritus intensity scales (Numeric Rating Scale and Visual Analogue Scale), whereas cohabitants completed the Family Dermatology Life Quality Index (FDLQI) to assess the family burden of the disease. Associations between quality-of-life measures, clinical characteristics, pruritus, and depressive symptoms were analyzed. Results: Patients reported moderate impairment in dermatology-specific quality of life (mean DLQI score of 9.3 ± 6.1), which was significantly greater in patients with advanced-stage disease (p = 0.022). Cohabitants also experienced moderate impairment in quality of life (mean FDLQI score of 8.0 ± 4.8), independent of disease stage. DLQI scores showed significant positive correlations with pruritus severity, depressive symptoms, and cohabitants’ FDLQI scores. Pruritus severity was a key determinant of impaired quality of life but did not differ significantly between disease stages. Conclusions: MF/SS are associated with a substantial multidimensional burden affecting both patients and their cohabitants. Quality-of-life impairment in family members correlates closely with patient-reported symptoms and well-being, supporting the concept of MF/SS as conditions affecting the patient–family unit. Incorporating caregiver perspectives and systematic symptom assessment may improve holistic management of MF/SS. Full article

We investigate the use of non-invasive, dual-wavelength (630 nm red/940 nm near-infrared) LED irradiation of the skull for relieving chronic neck and shoulder pain. A low-energy device was applied bilaterally for 15 min, with assessments of pain performed using the numeric rating scale (NRS), muscle relaxation assessed via infrared thermography, and autonomic function determined through heart-rate variability (HRV) analysis. The results demonstrated a mean NRS score reduction of 2.4 points, a 0.6 °C increase in cervical skin temperature, and a significant increase in HRV’s root mean square of successive differences, indicating improved autonomic regulation. This technique shows promise for effectively relaxing muscles, alleviating pain, and enhancing autonomic function. Full article

High-pressure water injection (HPWI) can rapidly replenish the formation energy of low-permeability reservoirs, but it may trigger multi-scale fractures, leading to premature water breakthrough between injection and production wells. To identify the main causes and regulate the mainstream line (i.e., the preferential flow path with the highest streamline density/flow rate), a two-zone and five-point numerical model was developed. This model couples the static damage zone (dominated by micro-fractures) and the fracture development zone (dominated by macro-fractures). Through sensitivity analysis, the ways in which micro-fracture damage and macro-fracture geometry control the evolution of seepage patterns and the risk of water breakthrough were quantified. The results show that in the representative scenarios of this paper, micro-fracture damage is mainly associated with an increased risk of water breakthrough by forming equivalent weakening zones and enhancing the directional extension trend of main fractures. The scale of macro-fractures has the strongest correlation with the water breakthrough response. When the fracture scale increases to a certain proportion close to the well spacing, the seepage mode changes from “fracture + matrix cooperation” to “main-fracture-dominated short-circuit channel”. Based on this, a design and verification of a combined control scheme of “chemical profile control + cyclic water injection” was proposed and carried out in well groups with high water cut and strong channeling. Simulations show that this combination helps to weaken the flow conductivity of preferential channels and improve the uniformity of the flow field. This paper can provide technical support for the prevention, control, and early warning of water breakthrough and the regulation of main flow lines in the high-pressure water injection development of similar low-permeability reservoirs. Full article

Based on temperature–stress coupling simulation, a thermal source model for nanosecond pulsed hollow cathode electron beam surface modification is proposed. Dynamic thermal-stress changes from beam–surface interaction and their influence on micro–nano characteristics were systematically investigated. By analyzing maximum temperature/stress dynamics, cross-sectional remelted layer variations, and heating/cooling rates, the temperature and stress distribution in the micron-scale surface layer was comprehensively revealed, validating the model’s rationality. Combined with low, medium, and high pulse count experiments, the effects of thermal and stress factors on surface morphology and grain refinement were studied, elucidating underlying mechanisms through numerical correspondence. Results show irradiation effects confined to a 1.5–2 mm localized region, with extreme temperature changes (~10³ K) and stress variations (10³–10⁴ MPa) within tens of nanoseconds. Heating rates reached 10¹¹ K/s, cooling rates 10⁹–10¹⁰ K/s, exceeding microsecond pulsed beams by one to two orders. Simulated remelting zone diameter and thickness agreed well with experiments, confirming model validity. Grain refinement is primarily driven by rapid temperature distribution, generating instant solidification nucleation sites, with a secondary contribution from high-stress-induced plastic deformation forming sub-grains. Full article

This article reports findings from a series of learning episodes in the form of case studies from inside English teaching classrooms that use music and literary extracts to make English Language and its possible applications and interpretations alive to students. Central to this exploration is the concept of artistry, characterised here as a nuanced practice involving four interrelated elements: the possession of an idea worth expressing, the imaginative ability to conceive its expression, the technical skill to work with materials, and the sensibilities required to make delicate, evocative adjustments. For the tens of thousands of young people in the Further Adult, Vocational and Education (FAVE) sector in England retaking GCSE English every year, artistry is an often neglected but vital concept that is routinely overshadowed by more pragmatic and reductive interpretations of the English Language curriculum. Low national achievement rates for re-sitting students do little to incentivize institutions and teachers in experimenting with their curriculum. Moreover, many re-sitting students become demotivated and disengaged due to numerous previously failed attempts to achieve a pass grade. This small-scale, qualitative research study explores and proposes new possibilities regarding how the FAVE GCSE English curriculum can be realised in engaging and meaningful ways. Concepts of artistry are put to work with students in the FAVE GCSE English classroom to bring to the fore how these ideas in the GCSE English Language curriculum might be brought to life in ways which develop understanding and foster interest in the study of English Language. Full article

Slow lateral wandering and trochoidal-like motion are commonly observed in intense atmospheric vortices, yet most reduced-order vortex models assume a fixed axis or represent centre motion as purely advective. In this work, we propose a minimal reduced-order framework in which slow gyroscopic precession is introduced as an explicit degree of freedom superimposed on a rapidly rotating vortex core. The vortex is represented by a Burgers–Rott-type velocity field with time-dependent stretching rate and circulation, while the vortex centre undergoes a slow precessional motion governed by a time-dependent rate ${\Omega }_p\left(t\right)$. The evolution of the vortex parameters is coupled to environmental variability through simple relaxation laws driven by standard large-scale diagnostics, including convective available potential energy, vertical shear, and background vorticity. A tracker-only analysis of tropical cyclone best-track data is used to constrain the appropriate dynamical regime at the track scale, indicating that observed centre wandering typically occurs in a slow-precession limit P = ${\Omega }_p/{\omega }_c\ll 1$. Numerical demonstrations in cyclone-like configurations show that, despite the smallness of the precession number, cumulative lateral displacement and enhanced Lagrangian dispersion can develop over the vortex lifetime. The proposed framework is intended as a proof-of-concept reduced-order model that isolates the role of weak, environmentally forced precession in modulating vortex wandering and transport, and complements more detailed numerical and observational studies. Full article