Search Results (11,965)

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

Retinal vessel segmentation in fundus images is critical for diagnosing microvascular and ophthalmologic diseases. However, the task remains challenging due to significant vessel width variation and low vessel-to-background contrast. To address these limitations, we propose WDM-UNet, a novel spatial-wavelet dual-domain fusion architecture that integrates spatial and wavelet-domain representations to simultaneously enhance the local detail and global context. The encoder combines a Deformable Convolution Encoder (DCE), which adaptively models complex vascular structures through dynamic receptive fields, and a Wavelet Convolution Encoder (WCE), which captures the semantic and structural contexts through low-frequency components and hierarchical wavelet convolution. These features are further refined by a Gated Fusion Transformer (GFT), which employs gated attention to enhance multi-scale feature integration. In the decoder, depthwise separable convolutions are used to reduce the computational overhead without compromising the representational capacity. To preserve fine structural details and facilitate contextual information flow across layers, the model incorporates skip connections with a hierarchical fusion strategy, enabling the effective integration of shallow and deep features. We evaluated WDM-UNet in three public datasets: DRIVE, STARE, and CHASE_DB1. The quantitative evaluations demonstrate that WDM-UNet consistently outperforms state-of-the-art methods, achieving 96.92% accuracy, 83.61% sensitivity, and an 82.87% F1-score in the DRIVE dataset, with superior performance across all the benchmark datasets in both segmentation accuracy and robustness, particularly in complex vascular scenarios. Full article

Radar is one of the primary means of monitoring maritime targets. Compared to electro-optical systems, radar offers the advantage of all-weather, day-and-night operation. However, existing radar target detection algorithms predominantly achieve binary detection (i.e., determining the presence or absence of a target) and are unable to accurately classify target types. This limitation is particularly significant for coastal-deployed maritime surveillance radars, which must contend with not only maritime vessels but also various land-based and island targets within their monitoring range. This paper aims to enhance the informational breadth of existing binary detection methods by proposing a land–sea classification method of radar targets based on dynamic dense connections. The core idea behind this method is to merge the interlayer output features of the network and to augment and weigh them through dynamic convolutional combinations to improve the feature extraction capability of the network. The experimental results demonstrate that the proposed attribute recognition method outperforms current deep network architectures. Full article

Piping systems can be analogized to the “vascular systems” of vessels, but their transmission characteristics often result in loud noises and large vibrations. The integration of flexible inserts within these piping systems has been shown to isolate and/or mitigate such vibrations and noise. In this work, a novel sandwich flexible insert (NSFI) was presented specifically to reduce the vibrations and noise associated with piping systems on vessels. In contrast to conventional flexible inserts, the NSFI features a distinctive three-layer configuration, comprising elastic inner and outer layers, along with a honeycomb core exhibiting a zero Poisson’s ratio. The dynamic characteristics, specifically axial impedance, of the fluid-filled NSFI are examined utilizing a fluid–structure interaction (FSI) four-equation model. The validity of the theoretical predictions is corroborated through finite element analysis, experimental results, and comparisons with existing literature. Furthermore, the study provides a comprehensive evaluation of the effects of geometric and structural parameters on the dynamic characteristics of the NSFI. It is worth noting that axial impedance is significantly affected by these parameters, which suggests that the dynamic characteristics of the NSFI can be customized by parameter adjustments. Full article

Multiple sclerosis (MS), a chronic disease of the central nervous system, is known to cause structural and vascular changes in the retina. Although optical coherence tomography (OCT) and fundus photography can detect retinal thinning and circulatory abnormalities, these findings are not specific to MS. This study explores the potential of Infrared Scanning-Laser-Ophthalmoscopy (IR-SLO) imaging to uncover vascular morphological features that may serve as MS-specific biomarkers. Using an age-matched, subject-wise stratified k-fold cross-validation approach, a deep learning model originally designed for color fundus images was adapted to segment optic disc, optic cup, and retinal vessels in IR-SLO images, achieving Dice coefficients of 91%, 94.5%, and 97%, respectively. This process included tailored pre- and post-processing steps to optimize segmentation accuracy. Subsequently, clinically relevant features were extracted. Statistical analyses followed by SHapley Additive exPlanations (SHAP) identified vessel fractal dimension, vessel density in zones B and C (circular regions extending 0.5–1 and 0.5–2 optic disc diameters from the optic disc margin, respectively), along with vessel intensity and width, as key differentiators between MS patients and healthy controls. These findings suggest that IR-SLO can non-invasively detect retinal vascular biomarkers that may serve as additional or alternative diagnostic markers for MS diagnosis, complementing current invasive procedures. Full article

In the design of pressure vessels for hydrogen storage, the durability and robustness of the designs are tested by using experimental methods, numerical simulations, or both. However, in the initial design phase, it is widely known that using numerical simulation tools reduces the cost of performing experiments; therefore, models that provide accurate and reliable results must be developed. This work presents an axisymmetric finite element model to predict the mechanical response of reinforced wire pressure vessels of type II. The main contribution of the present model is the use of equivalent properties and a minor number of contact elements to simulate the behavior of the wire reinforcement, which reduces the computational effort compared to a model with a solid-based mesh. The accuracy of the proposed model is tested against solid elements with very good agreement and experimental results with reasonable agreement. A parametric study was conducted to test the influence of the number of layers of reinforcement, and it was concluded that there is a limit to increasing the number of layers, which does not increase the vessel’s strength considerably, but it does with its mass. Full article

The berth allocation and crane assignment problem (BACAP) is a key challenge in port logistics, particularly under dynamic and uncertain vessel arrival conditions. To address the limitations of existing methods in handling large-scale and high-disturbance scenarios, this paper proposes a novel optimization framework: Ternary Historical Memory-based Robust Clustered Particle Swarm Optimization (THM-RCPSO). In this method, the initial particle swarm is divided into multiple clusters, each conducting local searches to identify regional optima. These clusters then exchange information to iteratively refine the global best solution. A ternary historical memory mechanism further enhances the optimization by recording and comparing the best solutions from three different strategies, ensuring guidance from historical performance during exploration. Experimental evaluations on 25 dynamic BACAP benchmark instances show that THM-RCPSO achieves the lowest average vessel dwell time in 22 out of 25 cases, with the lowest overall average rank among five tested algorithms. Specifically, it demonstrates significant advantages on large-scale instances with 150 vessels, where it consistently outperforms competing methods such as HRBA, ACO, and GAMCS in both solution quality and robustness. These results confirm THM-RCPSO’s strong capability in solving dynamic and large-scale DBACAP scenarios with high disturbance levels. Full article

This study investigates the effect of Hull Vane^® on the total resistance and propulsion performance of a patrol vessel using computational fluid dynamics (CFD). Utilizing SHIPFLOW software, multiple simulations were conducted to evaluate how Hull Vane^® position and angle of attack influence hydrodynamic performance. A patrol vessel hull form the MAXSURF’s library was selected to investigate resistance and propulsive performance. Nine (9) configurations (named Cases A to I) of the Hull Vane^® were examined based on variations in longitudinal position and angle of attack. A grid independence study was conducted to determine the optimal mesh configuration. Validation was performed using the Holtrop–Mennen power prediction method and MAXSURF. According to this study, results indicate that Hull Vane^® configurations significantly reduce total resistance and delivered power at higher vessel speeds, with the best improvement in resistance occurring in Case C and in propulsion power in Case B. Propulsive efficiency was maximized in Case E. Furthermore, the study also demonstrates the potential of Hull Vane^® as a practical retrofit for enhancing naval vessel performance and reducing energy consumption. Full article

This study applies a deep neural network (DNN) to optimize the 22.5 m pontoon hull form of a small waterplane area twin hull (SWATH) vessel with fin stabilizers, aiming to reduce calm water resistance at a Froude number of 0.8 under even keel conditions. The vessel’s resistance is simplified into three components: pontoon, strut, and fin stabilizer. Four design parameters define the pontoon geometry: fore-body length, aft-body length, fore-body angle, and aft-body angle. Computational fluid dynamics (CFD) simulations using STAR-CCM+ 2302 provide 1400 resistance data points, including fin stabilizer lift and drag forces at varying angles of attack. These are used to train a DNN in MATLAB 2018a with five hidden layers containing six, eight, nine, eight, and seven neurons. K-fold cross-validation ensures model stability and aids in identifying optimal design parameters. The optimized hull has a 7.8 m fore-body, 6.8 m aft-body, 10$°$ fore-body angle, and 35$°$ aft-body angle. It achieves a 2.2% resistance reduction compared to the baseline. The improvement is mainly due to a reduced Munk moment, which lowers the angle of attack needed by the fin stabilizer, thereby reducing drag. The optimized design provides cost-efficient construction and enhanced payload capacity. This study demonstrates the effectiveness of combining CFD and deep learning for hull form optimization. Full article

Gastrointestinal (GI) cancers represent a significant global health burden, with high morbidity and mortality often linked to late-stage detection and metastatic disease. The progression of these malignancies is critically driven by angiogenesis, the formation of new blood vessels, and the surrounding dynamic tumor microenvironment (TME), a complex ecosystem comprising various cell types and non-cellular components. This comprehensive review, based on a systematic search of the PubMed database, synthesizes the existing literature to define the intertwined roles of angiogenesis and the TME in GI tumorigenesis. The TME’s influence creates conditions favorable for tumor growth, invasion, and metastasis, but sometimes induces resistance to current therapies. Available therapeutic strategies for inhibiting angiogenesis involve antibodies and oral tyrosine kinase inhibitors, while immune modulation within the tumor microenvironment is mainly achieved through checkpoint inhibitor antibodies and chemotherapy. Creative emerging strategies encompassing cellular therapies, bispecific antibodies, and new targets such as CD40, DLL4, and Ang2, amongst others, are focused on inhibiting proangiogenic pathways more profoundly, reversing resistance to prior drugs, and modulating the TME to enhance therapeutic efficacy. A deeper understanding of the complex interactions between components of the TME is crucial for addressing the unmet need for novel and effective therapeutic interventions against aggressive GI cancers. Full article

Multi-vessel formation shipping demonstrates significant potential for enhancing maritime transportation efficiency and economy. However, existing route planning systems inadequately address the unique challenges of formations, where traditional methods fail to integrate global optimality, local dynamic obstacle avoidance, and formation coordination into a cohesive system. Global planning often neglects multi-ship collaborative constraints, while local methods disregard vessel maneuvering characteristics and formation stability. This paper proposes GLFM, a three-layer hierarchical framework (global optimization–local adjustment-formation collaboration module) for intelligent route planning of transport ship formations. GLFM integrates an improved multi-objective A* algorithm for global path optimization under dynamic meteorological and oceanographic (METOC) conditions and International Maritime Organization (IMO) safety regulations, with an enhanced Artificial Potential Field (APF) method incorporating ship safety domains for dynamic local obstacle avoidance. Formation, structural stability, and coordination are achieved through an improved leader–follower approach. Simulation results demonstrate that GLFM-generated trajectories significantly outperform conventional routes, reducing average risk level by 38.46% and voyage duration by 12.15%, while maintaining zero speed and period violation rates. Effective obstacle avoidance is achieved, with the leader vessel navigating optimized global waypoints and followers maintaining formation structure. The GLFM framework successfully balances global optimality with local responsiveness, enhances formation transportation efficiency and safety, and provides a comprehensive solution for intelligent route optimization in multi-constrained marine convoy operations. Full article

Tuberculosis (TB) is an ancient and re-emerging granulomatous infectious disease that continues to challenge public health. Early diagnosis and prompt effective treatment are crucial for preventing disease progression and reducing both morbidity and mortality. These steps play a vital role in infection control and in lowering death rates at both individual and population levels. Although diagnostic methods have improved sufficiently in recent decades, TB can still present with ambiguous laboratory and imaging features. This ambiguity can lead to diagnostic pitfalls and potentially disastrous outcomes due to delayed diagnosis. In this article, we present a case of TB that was difficult to diagnose. The disease had invaded the mediastinum, right atrium, right coronary artery, and inferior vena cava (IVC), resulting in Budd–Chiari syndrome. This rare presentation created clinical, laboratory, and radiological confusion, resulting in a diagnostic dilemma that ultimately led to open cardiac surgery. The patient initially presented with progressive shortness of breath on exertion and fatigue, which suggested possible heart disease. This suspicion was reinforced by computed tomography (CT) imaging, which showed infiltrative mass lesions predominantly in the right side of the heart, invading the right coronary artery and IVC, with imaging features mimicking angiosarcoma. Although laboratory findings revealed an exudative effusion with lymphocyte predominance and elevated adenosine deaminase (ADA), the Gram stain was negative for bacteria, and an acid-fast bacilli (AFB) smear was also negative. These findings contributed to diagnostic uncertainty and delayed the confirmation of TB. Open surgery with excisional biopsy and histopathological analysis ultimately confirmed TB. We conclude that TB should not be ruled out solely based on negative Mycobacterium bacteria in pericardial effusion or AFB smear. TB can mimic aggressive tumors such as angiosarcoma or lymphoma with invasion of the surrounding tissues and blood vessels. Awareness of the clinical presentation, imaging findings, and potential diagnostic pitfalls of TB is essential, especially in endemic regions. Full article

The resilience concept is well established in engineering, but the quantitative studies of vessel impact resilience for bridge structures remain limited. This paper presents an integrated framework for assessing vessel impact resilience under combined rebar corrosion and vessel collision effects. First, a corroded reinforced concrete bridge is considered for nonlinear static analysis to quantify initial corrosion damage and for nonlinear dynamic analysis to evaluate post-impact function loss. Then, recovery for each damage state is modeled by using both negative exponential and triangular recovery functions to estimate restoration times and to obtain a vessel impact resilience index. The results show that increasing corrosion severity markedly reduces resilience capacity. Furthermore, resilience indices obtained from the negative exponential function generally exceed those from the triangular function, and this improvement becomes more significant at lower resilience levels. Resilience indices calculated by using negative exponential and triangular recovery functions show negligible differences when the concrete bridge is in the uncorroded initial state and the vessel impact velocity is below 1.5 m/s. However, as reinforcement corrosion increases, the maximum discrepancy between these two recovery functions also increases, reaching a value of 67% at a corrosion level of 15.0%. From the numerical results obtained from a case study, it is important to select an appropriate recovery model when assessing vessel impact resilience. For rapid initial restoration followed by slower long-term recovery, the negative exponential model yields greater resilience gains compared to the triangular model. The proposed method thus provides an effective tool for engineers and decision makers to evaluate and improve the vessel impact resilience of aging bridges under the combined corrosion and impact effects. This proposes a quantitative metric for resilience-based condition assessment and maintenance planning. Full article

Background/Objectives: Nowadays, intravascular lithotripsy (IVL) has emerged as a novel technique for treatment of vascular calcifications, first in coronary and then in peripheral arteries. In the current literature there is little evidence that describes IVL as an effective and safe solution in treating severe aortic and aorto-iliac calcifications. The aim of this study is to report current available data about the use of IVL in treating aortic and aorto-iliac calcified lesions and its application in facilitating other endovascular procedures. Methods: the present review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines. Preliminary searches were conducted on MEDLINE and Pubmed from January 2015 to February 2025. Studies were divided into 3 main categories depending on the location of calcifications and the type of treatment: IVL in visceral and infrarenal obstructive disease (group 1), IVL in aorto-iliac obstructive disease (group 2), IVL used to facilitate other endovascular procedures. Main primary outcomes in the perioperative period were technical and clinical successes and perioperative complications. Primary outcomes at 30 days and mid-term (2 years) were overall survival, limb salvage rate, primary patency, primary assisted patency, secondary patency, and residual stenosis. Results: Sixteen studies were identified for a total of 1674 patients. Technical and clinical successes were 100%, with low rates of perioperative complications. Dissection rate reaches up to 16.1% in some studies, without any differences compared to plain old balloon angioplasty (POBA) alone (22.8%; p = 0.47). At 30 days, limb salvage and survival rates were 100%. At 2 years, primary patency, assisted primary patency, and secondary patency were 95%, 98%, and 100%, respectively, with no difference compared to IVL + stenting. Conclusions: IVL has emerged as a novel approach to treat severe calcified lesions in visceral and aorto-iliac atherosclerotic disease and to facilitate other endovascular procedures. This technique seems to offer satisfactory early and mid-term outcomes in terms of primary, primary assisted patency, and secondary patency with low complication rates. Full article

The impact of Oedema Disease produced by Shiga toxigenic Escherichia coli (STEC) in swine is increasing in some production countries due to increasing limitations on treatment with antimicrobials and zinc oxide, either because of the increased prevalence of multi-resistant strains or because of legal restrictions. The main pathological effect of Shiga toxin 2e is represented by damage to the endothelial cells of the blood vessel walls, leading to liquid extravasation and oedema formation in multiple tissues. These oedemas are generally easily identifiable in acute clinical cases. However, disease caused by Shiga toxin can occur without any externally visible oedema in the pigs, as observed in the subclinical presentation of Oedema Disease. It also causes productive losses, so it is important to identify and/or diagnose cases to set up control measures in order to optimize production and health. This article includes a comprehensive review of lesions and signs caused by Shiga toxin toxicosis in pigs, as well as other insights about the aetiology and epidemiology of STEC in pigs, and the effect of Shiga toxin recombinant toxoid vaccines in reducing these clinical and subclinical signs under field conditions. Full article