Search Results (92)

Heavy-duty forklifts possess substantial kinetic energy during braking, which is currently wasted due to a lack of recovery in conventional systems. To ensure braking safety, an electro-hydraulic–mechanical compound braking system is necessary. However, the uncoordinated distribution between regenerative and mechanical braking torque leads to braking torque fluctuations, compromising safety, comfort, and recovery efficiency. This paper constructs a parallel hydraulic hybrid power system for heavy-duty forklifts based on a four-quadrant pump/motor, enabling braking energy recovery and reuse via the pump/motor and an accumulator. A compound braking strategy based on the ideal braking force distribution and multi-sensor information fusion is proposed. The system incorporates various sensors, including pressure, speed, flow, and pedal displacement sensors, to monitor system status and driver intention in real time, providing precise data for coordinated control. Feasibility is verified through AMESim simulation and real vehicle tests. The control system based on sensor feedback maximizes braking energy recovery while ensuring braking safety and comfort, achieving a 12.2% energy-saving rate and significantly improving the vehicle’s economy and range. Full article

Background: Postoperative wounds may arise from several etiologies, including open partial pedal amputation, postoperative infection, and dehiscence of surgical sites from wound failure or patient compliance issues. If negative pressure wound therapy is the gold standard, its application in the toes area could be challenging, and as a consequence, standard care is most likely used. The control of the wound microenvironment, both in terms of pH levels and presence of reactive oxygen species, is a key part of the normal wound-healing process. This study evaluated the effectiveness of an oxygen-enriched oil-based device (OEOd) in post-surgical diabetic foot ulcers (DFUs). Methods: This prospective controlled comparative pilot study enrolled 40 patients with diabetes mellitus and post-surgical foot wounds (narrow and deep lesions, including tunneling ulcers) treated at the Diabetic Foot Unit of San Donato Hospital, Arezzo (March 2024–April 2025). Patients were allocated into two groups: those treated by the standard wound care (n = 20) and those treated by OEOd (n = 20). The primary outcome was complete wound healing at 16 weeks; other exploratory endpoints were wound area reduction at 4 and 16 weeks, onset of infection, need for re-intervention, and adverse events. Results: Complete wound healing was achieved in 85.0% of OEOd patients versus 45.0% in the control group (p = 0.020). At 16 weeks, wound area reduction was significantly greater in the OEOd group compared with standard therapy (89.8% vs. 64.0%, p = 0.013). Although infection rates (10.0% vs. 35.0%, p = 0.130) and need for re-intervention (0% vs. 25.0%, p = 0.056) did not reach statistical significance, both favored the OEOd group. No adverse events were reported. Conclusions: OEOd significantly improved the chance of healing post-surgery and showed favorable trends in reducing complications, with an excellent safety profile. Larger randomized controlled trials are warranted to confirm these findings and assess long-term outcomes. Full article

Objective: This study aimed to compare thromboangiitis obliterans (TAO) and diabetic peripheral vascular disease (DPVD), the two major causes of distal limb ischemia, within a single analytical framework. The comparison was not limited to practical biomarkers that could support differential diagnosis but was based on multidimensional parameters that determine the clinical spectrum and prognosis. The two cohorts were systematically evaluated in terms of demographics and comorbidity burden, clinical presentation and limb involvement pattern, ulcer prevalence and localization, real-life treatment strategies (medical, endovascular, and surgical), and hard clinical endpoints (major/minor amputation, hospitalization, and all-cause mortality). DPVD was phenotyped according to the lesion level as isolated distal, isolated proximal, or multilevel. Within this framework, the isolated distal diabetic peripheral vascular disease (d-DPVD) subgroup was analyzed to determine how it differs from TAO in terms of clinical course, treatment patterns, and outcomes, despite the distal anatomical similarity. Methods: In this single-center retrospective cohort study, conducted between June 2019 and June 2025, 120 non-diabetic patients who met the angiographic TAO criteria were compared with 395 patients with DPVD with infrapopliteal/pedal atherosclerotic involvement. Clinical characteristics, ulcer topography, treatment strategies, and outcomes were recorded. The discriminatory value of the blood count and lipid-based inflammatory/atherogenic indices were evaluated using logistic regression and receiver operating characteristic (ROC) curve analyses. Additionally, a separate subgroup analysis was performed for the d-DPVD subgroup, which was considered the closest to the TAO phenotype in this study design. Results: Patients with DPVD were significantly older than those with TAO (61.1 ± 12.1 vs. 39.7 ± 7.9 years; p < 0.001), and male predominance was more pronounced in the TAO group (94.2% vs. 84.8%). Compared with TAO, DPVD was associated with a higher cardiometabolic comorbidity burden and increased inflammatory and atherogenic indices. Although the overall ulcer prevalence was comparable, DPVD more frequently presented with plantar or proximal ulcers confined to a single extremity, whereas TAO was characterized by bilateral or multi-extremity involvement and distal acral ulceration. Antiplatelet and statin therapy, revascularization, and rates of major amputation, all-cause mortality, and hospitalization were higher in patients with DPVD (all p < 0.05). On multivariate analysis, age, cumulative smoking exposure, SIRI, and CRI-I independently distinguished DPVD from TAO (all p < 0.05). In the isolated distal DPVD subgroup, despite similar distal anatomy, inflammatory/atherogenic burden, and overall clinical risk remained adverse. Conclusions: TAO and DPVD are two distinct phenotypes with different pathobiologies and prognoses, despite similar distal ischemia presentations. Simple inflammatory and atherogenic composite indices, evaluated in conjunction with clinical/ulcer patterns, may support the differential diagnosis and risk stratification of patients with peripheral arterial disease (PAD). However, prospective multicenter validation of these findings is required to confirm the results. Full article

Background: Advanced stages of peripheral arterial disease, particularly chronic limb-threatening ischemia, are characterized by unfavorable limb outcomes and a substantial risk of major amputation. Clinical evaluation traditionally focuses on arterial obstruction; however, venous dysfunction may coexist and contribute to local limb pathophysiology in advanced PAD, remaining insufficiently recognized in routine practice. Methods: We performed a retrospective cohort analysis of consecutive patients with advanced peripheral arterial disease managed at the First Surgical Clinic of the Emergency County Clinical Hospital of Craiova over a five-year period (January 2020 to December 2024). Venous disease was defined using a clinically oriented composite definition incorporating imaging-confirmed venous pathology, prior deep venous thrombosis, and persistent lower-limb edema attributable to venous dysfunction. Arterial disease severity was assessed using multimodal imaging. Analyses were performed at both patient and limb levels to evaluate associations between venous disease, arterial severity markers, and clinical outcomes. Results: Among 241 patients (482 limbs), concomitant venous disease was identified in 68.9% at the patient level and was predominantly unilateral. At the limb level, venous disease was significantly associated with markers of severe arterial involvement, including inflow disease, higher segment occlusion scores, impaired tibial runoff, and absence of a patent pedal arch. Despite greater arterial severity, patients with venous disease exhibited a lower unadjusted rate of major amputation compared with those without venous involvement. Conclusions: Concomitant venous disease is highly prevalent in patients with advanced PAD and is closely linked to arterial disease severity. These findings suggest that venous dysfunction represents an integral component of advanced limb-threatening ischemia rather than an isolated comorbidity. Incorporating clinically oriented venous assessment may improve understanding of limb pathophysiology and support a more integrated arterio-venous approach to advanced PAD management. Full article

Background/Objectives: Magnetic resonance imaging (MRI) can be used to assess muscle function while performing a motion task within the scanner. Quantitative measures such as contraction velocity and strain can be derived from the images. Cine phase contrast (PC) MRI for time-resolved imaging of muscle function relies on the consistently repeated execution of the motion task for several minutes until data acquisition is complete. This may be difficult for patients with neuromuscular dysfunctions. To date, this approach has been applied only in adults, but not pediatric populations. The aim of this pilot study was to investigate the feasibility of PC MRI for assessing calf muscle function during electrically evoked and voluntary motion in children with cerebral palsy (CP) using open-source hardware and software. Methods: Cine PC MRI was performed at 3T in ambulatory pediatric patients with CP and typically developing children under electrical muscle stimulation (EMS) (n = 14/13) and during voluntary plantarflexion (n = 4/4) using a home-built pedal with a force sensor. A visual feedback software was developed to enable synchronized imaging of voluntary muscle contractions. Muscle contraction velocity and strain were calculated from the MRI data. Data quality was rated by two readers. Results: During EMS, the velocity data quality was rated as sufficient in 21% of scans in patients compared with 82% of scans in controls. During the voluntary task, all patients demonstrated increased compliance and greater generated force output than during EMS. Voluntary motion imaging was successful in all controls but none of the patients, as motion periodicity in patients was worse during voluntary than during stimulated contraction. Conclusions: Cine phase-contrast MRI combined with EMS or voluntary motion proved challenging in pediatric patients with CP, particularly in those with more severe baseline muscle dysfunction or reduced tolerance to stimulation. In contrast, the approach was successfully implemented in typically developing children. Although the scope of the patient-based findings is limited by data heterogeneity, the method demonstrates considerable potential as a tool for monitoring treatment-related changes in muscle function, particularly in less severely affected patients. Further refinement of the EMS and voluntary motion protocols, together with a reduction in MRI acquisition time, is required to improve motion periodicity, tolerability, and consequently the overall success rate in the intended pediatric patient cohort. Full article

Background: Research to identify changes in driving behavior that occur with the onset of Pre-MCI and MCI is an emerging area with many gaps still to be addressed. These gaps include limited use of objective, continuous measurement of driver behavior in real-life traffic conditions and comprehensive, biomarker-validated, cognitive evaluation based upon both testing and clinical ratings. Using these strategies, the questions addressed in this exploratory study are whether or not differences in driving behavior are indicative of Pre-MCI/MCI and which behaviors are most predictive of Pre-MCI/MCI. Methods: As part of a naturalistic longitudinal study, older drivers with a Montreal Cognitive Assessment score ≥ 19 had telematic sensors installed in their vehicles and underwent comprehensive cognitive assessment quarterly for three years. Thirty-six participants were classified as Unimpaired (n = 23) or Pre-MCI/MCI (n = 10/3) based upon a neuropsychological battery and diagnostic algorithm. A penalized generalized linear mixed-effects model (GLMM) with a logistic link and LASSO regularization was used to model Pre-MCI/MCI group membership vs. unimpaired as a function of ten trip-level telematic features (trip distance, hard acceleration, hard braking, hard turns, speed average, maximum speed, RPM average, fuel level, throttle average, and throttle variability) at the end of their first 12 months in the study. Results: Higher RPM, shorter average trips, and greater throttle variability predicted higher odds of Pre-MCI/MCI, while more frequent hard braking, hard turns, higher mean speed, and lower average throttle (steadier pedal control) predicted lower odds of Pre-MCI/MCI. Conclusions: The model clearly distinguished unimpaired older drivers from those with MCI or Pre-MCI, suggesting that distinct patterns of driver behavior may be related to levels of cognitive function. Full article

Background: Foam rolling has become an increasingly popular self-myofascial release (SMR) technique among athletes to prevent injuries, improve recovery, and increase athletic performance. This study investigated how SMR improves mechanical and movement efficiency in recreational road cyclists. Methods: We conducted an exploratory randomized controlled trial (RCT) to investigate the effects of SMR using a foam roller on biomechanical and physiological performance parameters over a six-month period. A total of 32 male participants, aged 26–57 years, with a mean Body Mass Index (BMI) of 24.0 kg/m² (SD = 2.2), were randomly assigned to either an intervention group (n = 16), which incorporated a standardized SMR program into their post-exercise recovery, or a control group (n = 16), which followed the same cycling protocol without SMR. The training program included heart rate-controlled strength endurance intervals. As the primary target, the variables we investigated included torque effectiveness, leg force symmetry, and pedal smoothness. Secondary measurements included submaximal oxygen uptake (VO₂) as well as bioelectrical variables, which we analyzed using classic, repeated-measures ANOVA models and descriptive statistical methods. Results: The analysis revealed significant interaction effects in favor of the intervention group for torque effectiveness (η²_p = 0.434), leg strength symmetry (η²_p = 0.303), and pedal smoothness (η²_p = 0.993). No significant group × time interactions were found for submaximal VO₂ or bioelectrical parameters. Conclusions: Our findings indicate that foam rolling may serve as an effective adjunct to endurance training by enhancing functional neuromuscular performance in cyclists, particularly in torque control and pedal coordination. Its impact on aerobic efficiency and muscle composition appears to be minimal. The results support theoretical models that attribute SMR benefits to proprioceptive, circulatory, and neuromuscular mechanisms rather than structural tissue adaptations. Full article

Electric Vehicles (EVs) are still facing prejudices about limited range, making them unattractive for many customers. However, their locally emission-free operation and the ability to recover kinetic energy during braking manoeuvres are significant advances against conventional drivetrains. Especially the function of one-pedal driving (OPD) can further reduce the energy consumption of EVs if properly realized and tuned. In this research, the optimisation and evaluation of an adaptive OPD strategy for a battery electric vehicle (BEV) with the aim of improving energy efficiency and driving comfort, which was previously introduced by the authors, is presented. Therefore, an adaptive pedal curve was designed first and extended through the integration of a fuzzy controller that considers the trade-off between efficient operation and driver intention based on vehicle speed and the drive pedal position signals. The strategy was extended by the incorporation of another input to represent the traffic area. The efficiency was evaluated in a proband study using virtual driving tests in a static simulator, in which different configurations were analysed and rated. It was found that the optimised strategy achieved the best overall result. Compared to pure regenerative braking as the benchmark, energy consumption as well as the amount of pedal changes were reduced by 8.45% as well as 62.27%, respectively, and the rate of energy recovery was increased by 67.8%. Full article

To encourage the use of alternative fuels while limiting the use of fossil fuels, researchers have focused on using more environmentally friendly fuels. Furthermore, the goal is to improve engine performance to increase energy efficiency. A four-stroke, single-cylinder, diesel engine with a common rail fuel injection system runs with diesel, biodiesel, and biodiesel–alcohol fuel blends. The tests were performed using a constant engine speed of 2000 rpm and three different gas pedal positions (20%, 50% and 80%). It was found that maximum cylinder gas pressure increased in all test fuels with increased gas pedal position (GPP) and advanced injection start time. In general, the maximum heat release rate increased in blended fuels compared to diesel fuel. In addition, it was seen that advanced injection timings caused an increase in ignition delay in all fuel types. In the same test conditions, it was observed that biodiesel–alcohol fuel blends caused an increase in ignition delay by more than 10% compared to diesel fuel (D100), while shortening combustion duration (CD) by more than 10%. A decreasing trend in CO and HC emissions was observed in the use of biodiesel fuel compared to diesel fuel. With the use of biodiesel–alcohol fuel blends, CO₂ emissions tend to decrease. Advanced injection timings caused high NO emissions. Full article

Four entire male sugar gliders (Petaurus breviceps) belonging to the same colony were presented for elective orchiectomy. After clinical examination, dexmedetomidine (120 μg/kg) in combination with ketamine (5 mg/kg) were administered subcutaneously (SC). Once righting and pedal withdrawal reflexes were lost, ringer lactate solution, enrofloxacin and meloxicam were administered SC and a bilateral intratesticular block with lidocaine 0.25% was performed. Heart, respiratory rates and pulse oximetry values were recorded every minute. Onset of sedation, additional use of isoflurane, duration of anaesthesia, duration of surgery, time of recovery after atipamezole administration, quality of recovery and time of food intake were recorded. Postoperative assessment (posture, level of activity, vocalisation, response to manipulation, attention to the surgical wound) was performed hourly until discharge, five hours after surgery. Dexmedetomidine in combination with ketamine provided adequate short-lasting anaesthesia for castration in 3 out of 4 sugar gliders. One sugar glider needed additional isoflurane administration to perform orchiectomy. No perioperative additional analgesia was needed in any sugar glider. Full article

The objective of this study was to determine the effect of two aspiration pressures (75 vs. 150 mmHg), the follicle flushing method (injection pump controlled by a foot pedal vs. a plastic syringe) and the twisting of the OPU needle on oocyte recovery and in vitro embryo production. OPU data from a total of 104 warmblood sport mares belonging to a commercial OPU-ICSI program were collected as part of a prospective study split into three experiments. Each mare was used only once for OPU. In Experiment 1, the mares’ follicles were aspirated using either a high aspiration pressure (flow rate of 1.33 mL/s; n = 18) or low aspiration pressure (0.75 mL/s; n = 18); in Experiment 2, follicles were flushed using either a manual method (plastic syringe, n = 18) or an automatic method (injection pump controlled by a foot pedal, n = 18); and in Experiment 3, the follicles were aspirated by scraping the follicle wall with needle rotation (needle twisting, n = 16) or without needle rotation (control, n = 16). In all the experiments, the same OPU operator and technician searching oocytes were used, and the allocation of each mare to the different treatment groups was randomized. The overall mean oocyte recovery rate of the study was 54.2 ± 17.1%, and the mean number of embryos per OPU-ICSI session was 1.9 ± 1.6. The oocyte recovery rate was not influenced by any of the parameters investigated (p > 0.05). However, high aspiration pressure (150 mmHg) tended to yield oocytes with lower maturation (51.6%; p = 0.09) and blastocyst rates (20.6%; p = 0.08) following IVM and ICSI, respectively, compared with the low aspiration group (64.4% MII rate and 31.4% blastocyst rate). In conclusion, increasing aspiration pressure does not increase oocyte recovery. Furthermore, when a single operator performs the OPU (holding the ovary and handling the needle simultaneously), needle rotation to scrape the follicle wall does not improve oocyte recovery. Full article

Background: The incidence of neuropathic pedal ulceration is on the rise, especially as rates of type 2 diabetes continue to increase. Currently, there is limited research into the laterality for the development of lower-extremity neuropathic ulceration or a predominant side for amputation. However, identifying whether a predominant laterality exists could allow for better preventive measures to help mitigate risk and decrease the significant quality of life and health-care costs associated with lower-extremity ulceration and amputation. We sought to determine whether a predominant laterality exists for the development of lower-extremity neuropathic ulceration and amputation. Methods: Patient data from the authors’ primary health-care facility were retrospectively reviewed to determine the laterality of the initial presenting lower-extremity neuropathic ulcerations as well as the laterality of the initial lower-extremity amputations experienced during their care, if any. Results: A total of 136 patients were included in the study, with 61% of the initial ulcerations presenting on the right and 39% on the left, which was statistically significant. Of the 70 patients who went on to require amputation during their care, 67% experienced right-sided amputation and 33% experienced left-sided amputation, which was also statistically significant. Conclusions: The right lower extremity likely shows a predominance for the development of neuropathic ulceration and likewise is at a higher risk for advancing to lower-extremity amputation Full article

With the increasing emphasis on environmental sustainability, the electrification of urban public bus fleets has gained significant attention. Understanding the factors influencing the energy consumption of battery-electric buses (BEBs) is crucial for enhancing their energy efficiency. Therefore, it is crucial to identify the subsystems that contribute most to energy consumption and understand how operational factors influence them. This paper presents a comprehensive analysis of BEB energy consumption based on experimental measurements performed with a 12 m fully electric battery bus. The main limitations of this study stem from the use of a single vehicle over a total period of 18 days, during which 187 routes were completed. Additionally, sandbags were used as ballast in place of actual passengers. Various parameters, including the number of passengers, drivers, route characteristics, environmental conditions, and traffic, were analyzed to assess their impact on BEB energy consumption. Data related to the energy consumed by various bus utilities were collected through the vehicle’s CAN network, with a sampling rate of 1 measurement per second. These data were analyzed both daily and per route, revealing the breakdown of energy consumption among different utilities and highlighting those responsible for the highest energy use. The results correlate the total distance traveled, service duration, average speed, driver’s driving style, route characteristics, internal and external temperatures, and air-conditioning system’s reference temperature with the energy consumption of the traction motors and climate control system. In addition, the correlation between the driver, vehicle acceleration, and throttle pedal use, and the energy consumed by the electric traction motor is presented. Full article

Porphyromonas gingivalis is a key pathogen in periodontitis. Its outer membrane contains the RagAB transport complex, which has been implicated in protein uptake, essential for a proteolytic species. RagA is a 22-stranded β-barrel, and RagB is the corresponding 4-TPR lid, together forming a TonB-dependent system acting as a “pedal bin”. Four different alleles were observed, of which ragAB-1 is more virulent than the others. Our aim was to map ragAB in 129 strains of P. gingivalis and related species available in our collection, supported by a newly introduced universal PCR for amplification/sequencing of all four ragA variants and to find reasons for the differences in virulence and/or fitness. Regarding the PCR method, by pairing established Long-PCR primers with our newly designed sequencing primers (ragA-F0, -F1, -R2, -R2a, -R4), it was possible to amplify and sequence all four ragA variants. The same was not possible for ragB due to high heterogeneity. The mapping allowed us to type all strains into ragAB-1-4. For each type, some strains (of mainly animal origin such as Porphyromonas gulae) with slightly different amino acid sequences were identified (designated ragAB-1a to -4a). In terms of function, the transfer of recently discovered SusCD information to the similar RagAB complex provided new insights. Substrate specificity as well as length of pedal could be the route to differential virulence (survival rate, fitness) as Rag-1 (closer related to Rag-3/4) and Rag-2 were found to be massively different here. In general, substrate–ligand-binding sites seem to be quite variable with the exception of Rag-1, probably indicating nutritional preferences. In addition, an insertion (8 aa long) found in loop L7 throughout RagA-2 could not only affect the dynamics of lid opening/closing but might also alter the associated substrate throughput rate. Full article

Background: Medial arterial calcification (MAC), a distinct form of vascular pathology frequently coexisting with peripheral arterial disease (PAD), poses unique challenges in limb salvage among patients with diabetes, chronic kidney disease, and end-stage renal disease. This study examines the incidence of MAC and its impact on limb salvage outcomes over a decade of experience at a tertiary limb salvage center. Methods: A retrospective review of all complex lower extremity (LE) reconstructions using local flap (LF) or free tissue transfer (FTT), performed from July 2011 to September 2022, was conducted. Patients were classified into MAC and No MAC groups based on pedal radiography evaluations using the Ferraresi MAC scoring system. The primary outcomes were major lower extremity amputation (MLEA), the need for postoperative vascular intervention, major adverse limb events (MALE; defined as the composite of any unplanned reoperation, MLEA, or postoperative revascularization attempt), and mortality. Results: During the study period, a total of 430 LE reconstructions were performed with LF or FTT. A total of 323 cases (75.1%) demonstrated no MAC while the remaining 107 (24.9%) demonstrated MAC. The MAC group exhibited significantly higher rates of diabetes, PAD, and renal disease. With a follow-up duration of 17.0 (IQR: 33.9) months, the MAC group demonstrated a significantly higher rate of MLEA (24.3% vs. 13.0%, p = 0.006), postoperative vascular intervention (23.4% vs. 8.7%, p < 0.001), MALE (57.0% vs. 25.7%, p < 0.001), and mortality (28.0% vs. 9.9%, p < 0.001). Multivariate analysis identified MAC as independently predictive of MALE (OR: 1.8, CI: 1.1–3.0, p = 0.033). Conclusion: MAC is prevalent among surgical candidates for limb salvage. Patients with MAC represent a significant medical and reconstructive challenge. Radiographic screening for MAC should be considered in all limb salvage candidates with LE wounds, especially in those with diabetes and kidney disease. Assessing MAC is important for better evaluating risk factors and surgical options so as to optimize outcomes in this challenging population. Full article