Search Results (1,177)

The objective of this retrospective study was to compare outcomes after desmoplasty with fasciotomy (DF) against deep branch of the lateral plantar neurectomy with fasciotomy (NF) for lameness due to proximal suspensory desmopathy in the hindlimb. Medical records from 141 horses with proximal suspensory desmopathy treated by either desmoplasty with fasciotomy or deep branch of the lateral plantar neurectomy with fasciotomy were reviewed. Follow-up after surgery to determine resolution of the lameness and return to use was obtained from medical records, as well as referring veterinarians, owners and trainers by telephone conversations and/or email. Long-term outcomes were obtained for 109 horses. There was no significant difference in resolution of lameness between the two techniques (79% DF vs. 88% NF), or in the percentage of horses returning to work 1–3 years post-operatively (83% DF vs. 93% NF). Horses treated with DF had higher ultrasonography scores compared with horses treated with neurectomy/fasciotomy. Horses treated with DF took longer to return to work compared to NF and received more non-surgical treatments in the recovery period. Post-operative complications were minimal with either technique. Use of either surgical technique for hindlimb proximal suspensory desmopathy can result resolution of lameness and return to athletic use. Full article

The increasing complexity of managing maintenance activities across geographically dispersed hospitality facilities necessitates advanced digital solutions capable of effectively balancing operational costs and service quality. This study addresses this challenge by designing and validating an intelligent Prescriptive Maintenance module, leveraging advanced Reinforcement Learning (RL) techniques within a Digital Twin (DT) infrastructure, specifically tailored for luxury hospitality networks characterized by high standards and demanding operational constraints. The proposed framework is based on an RL agent trained through Proximal Policy Optimization (PPO), which allows the system to dynamically prescribe preventive and corrective maintenance interventions. By adopting such an AI-driven approach, platforms are the enablers to minimize service disruptions, optimize operational efficiency, and proactively manage resources in dynamic and extended operational contexts. Experimental validation highlights the potential of the developed solution to significantly enhance resource allocation strategies and operational planning compared to traditional preventive approaches, particularly under varying resource availability conditions. By providing a comprehensive and generalizable representation model of maintenance management, this study delivers valuable insights for both researchers and industry practitioners aiming to leverage digital transformation and AI for sustainable and resilient hospitality operations. Full article

Background: Splenic artery embolization (SAE) has emerged as a key adjunct to non-operative management (NOM) in hemodynamically stable patients with blunt splenic trauma, yet variability in its application persists across centers. Objectives: The aim was to evaluate real-life clinical practices, techniques, and outcomes of SAE in blunt splenic trauma across multiple Italian trauma centers. Materials and Methods: This retrospective multicenter study analyzed data from 281 patients undergoing emergency SAE for blunt splenic trauma between January 2019 and December 2021. Demographics, imaging findings, embolization techniques, complications, and outcomes were collected and analyzed. Multivariate logistic regression was used to assess predictors of splenectomy. Results: The technical success rate was 100%, with a 9.6% rate of post-embolization splenectomy and a complication rate of 24.9% (including 5.7% splenic infarction and 3.2% rebleeding). Embolization was performed proximally (46.6%), distally (28.8%), or with a combined approach (24.6%). No significant correlation was found between embolization technique and splenectomy rate. Patients with AAST grade III injuries benefited from SAE with high technical success and low failure rates. Notably, 14.2% of patients underwent angiography despite negative CT, with a splenectomy rate of 10% in this subgroup. Multivariate analysis identified no independent predictors of splenectomy. Conclusions: SAE is a reliable and effective tool in the management of blunt splenic trauma, achieving high splenic salvage rates even in selected grade III injuries and CT-negative patients. In an era of precision medicine, interventional radiology should be regarded as a distinct and specific treatment modality, comparable to surgery, rather than being merely included within non-operative management (NOM). Full article

In this work, we propose the use of a reinforcement learning (RL) agent for the control of a cascade hydropower plant system. Generally, this job is handled by power plant dispatchers who manually adjust power plant electricity production to meet the changing demand set by energy traders. This work explores the more fundamental problem with the cascade hydropower plant operation of flow control for power production in a highly nonlinear setting on a data-based digital twin. Using deep deterministic policy gradient (DDPG), twin delayed DDPG (TD3), soft actor-critic (SAC), and proximal policy optimization (PPO) algorithms, we can generalize the characteristics of the system and determine the human dispatcher level of control of the entire system of eight hydropower plants on the river Drava in Slovenia. The creation of an RL agent that makes decisions similar to a human dispatcher is not only interesting in terms of control but also in terms of long-term decision-making analysis in an ever-changing energy portfolio. The specific novelty of this work is in training an RL agent on an accurate testing environment of eight real-world cascade hydropower plants on the river Drava in Slovenia and comparing the agent’s performance to human dispatchers. The results show that the RL agent’s absolute mean error of 7.64 MW is comparable to the general human dispatcher’s absolute mean error of 5.8 MW at a peak installed power of 591.95 MW. Full article

The Economic Dispatch Problem (EDP) plays a critical role in power system operations by trying to allocate power generation across multiple units at minimal cost while satisfying complex operational constraints. Traditional optimization techniques struggle with the non-convexities introduced by factors such as valve-point effects, prohibited operating zones, and spinning reserve requirements. While metaheuristics methods have shown promise, they often suffer from convergence issues and constraint-handling limitations. In this study, we introduce a novel application of Group Relative Policy Optimization (GRPO), a reinforcement learning framework that extends Proximal Policy Optimization by integrating group-based learning and relative performance assessments. The proposed GRPO approach incorporates smart initialization, adaptive exploration, and elite-guided updates tailored to the EDP’s structure. Our method consistently produces high-quality, feasible solutions with faster convergence compared to state-of-the-art metaheuristics and learning-based methods. For instance, in the case of the 15-unit system, GRPO achieved the best cost of USD 32,421.67/h with full constraint satisfaction in just 4.24 s, surpassing many previous solutions. The algorithm also demonstrates excellent scalability, generalizability, and stability across larger-scale systems without requiring parameter retuning. These results highlight GRPO’s potential as a robust and efficient tool for real-time energy scheduling in smart grid environments. Full article

Accurate and feasible target assignment in an urban environment without road networks remains challenging. Existing methods exhibit critical limitations: computational inefficiency preventing real-time decision-making requirements and poor cross-scenario generalization, yielding task-specific policies that lack adaptability. To achieve efficient target assignment in urban adversarial scenarios, we propose an efficient traversable path generation method requiring only binarized images, along with four key constraint models serving as optimization objectives. Moreover, we model this optimization problem as a Markov decision process (MDP) and introduce the generalization sequential proximal policy optimization (GSPPO) algorithm within the reinforcement learning (RL) framework. Specifically, GSPPO integrates an exploration history representation module (EHR) and a neuron-specific plasticity enhancement module (NPE). EHR incorporates exploration history into the policy learning loop, which significantly improves learning efficiency. To mitigate the plasticity loss in neural networks, we propose an NPE module, which boosts the model’s representational capability and generalization across diverse tasks. Experiments demonstrate that our approach reduces planning time by four orders of magnitude compared to the online planning method. Against the benchmark algorithm, it achieves 94.16% higher convergence performance, 33.54% shorter assignment path length, 51.96% lower threat value, and 40.71% faster total time. Our approach supports real-time military reconnaissance and will also facilitate rescue operations in complex cities. Full article

Background/Objectives: Fibromyalgia syndrome is commonly associated with reduced intraepidermal nerve fiber density (IENFD), as assessed by skin biopsy, a finding referred to as small fiber pathology (SFP-FMG). The clinical significance of this abnormality, and how it relates to symptoms in fibromyalgia, remains uncertain. Reduced IENFD also represents the defining feature of small fiber neuropathy (SFN). While previous observations suggest that IENFD reduction is generally less severe in SFP-FMG than in SFN, no study has directly confirmed this finding in a large cohort. This retrospective study aimed to compare the severity of IENFD reduction in patients with SFP-FMG and those with SFN. Methods: To account for age and sex differences, we used the age-and sex-adjusted axonal loss density (ALD), defined as the percentage reduction from normative IENFD values. We retrospectively analyzed skin biopsy data from 73 patients with SFP-FMG and 134 patients diagnosed with SFN. Results: We found that the reduction in IENFD was significantly milder in patients with SFP-FMG than in those with SFN both at distal and proximal sites. Receiver operating characteristic analysis indicated that an ALD threshold of 37.6% provided good specificity for distinguishing SFN from SFP-FMG. Conclusions: These findings indicate that small fiber damage in fibromyalgia syndrome is quantitatively mild compared to patients with SFN. This may explain the absence of detectable sensory deficits on clinical examination and suggests a limited contribution of peripheral nerve damage to the pathophysiology of fibromyalgia syndrome. Full article

In the present paper we use the proximal point method in order to find an approximate common zero of an infinite collection of maximal monotone maps in a real Hilbert space under the presence of computational errors. We prove that the inexact proximal point method generates an approximate solution if these errors are sufficiently small. Full article

Background/Objectives: Femoral neck and proximal femur fractures in the elderly can result from low-energy trauma due to osteoporotic changes and contribute significantly to increased morbidity and mortality. Despite various treatment options, closed reduction and internal fixation (CRIF) with intramedullary nails has become the predominant approach. While a minimally invasive approach reduces complications and speeds recovery, this outcome is not always feasible in practice. The primary surgical goal remains achieving a stable and precise fracture reduction, favoring CRIF when possible. Our study aims to evaluate the clinical, radiological, and functional outcomes of patients operated on using the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique. Methods: Patients who underwent surgery for intertrochanteric femur fractures between June 2019 and June 2021 were analyzed. Patients who were between 75 and 90 years old and had undergone surgery with a proximal femoral nail (PFN) were included in the study. Patients were excluded if they required general anesthesia, if an acceptable reduction could not be achieved with the PFN, if they did not attend the last follow-up examination, or if the follow-up period was <4 years. Patients were functionally assessed using the Harris hip score at the 6th month and at the last follow-up and using the visual analog scale at the surgery, at the 4th hour after surgery, and at the time of discharge. For radiological assessment, the classification of reduction quality and the measurement of the tip–apex distance were used. Results: Forty patients (22F/18M) were included in the study. Their mean age was 83.0 ± 2.9 years. The mean time from trauma to surgery was 6.8 ± 2.3 h. Patients were mobilized on average 1.53 ± 0.8 h after surgery, and the mean hospitalization time was 27.4 ± 8.1 h. No statistically significant decrease in hemoglobin value was observed before or after surgery (p = 0.476). The Harris hip score was 73.3 ± 3.2 at the 6th month postoperatively and 74.9 ± 2.5 at the last follow-up (p = 0.296). The reduction quality was found to be poor in only two patients. Conclusions: The WALANT technique’s promising results in terms of pain management, blood loss control, and early mobilization show that it is a viable alternative to conventional anesthesia methods in geriatric hip fractures. Full article

Background: The perfusion of viscera, kidney, and spinal cord represents one of the main concerns during open repair (OR) of Thoraco-Abdominal Aortic Aneurisms (TAAAs). Passive shunting (PS) has been historically used for intraoperative distal aortic perfusion but has been progressively replaced almost entirely by partial left-sided heart or total cardiopulmonary bypass with extra-corporeal circulation (ECC). Despite several advantages of these methods, PS still has potential in mitigating some drawbacks of long extracorporeal circuits connected with centrifugal or roller pumps, such as the need for cardiac and great vessels cannulation, priming and large intravascular fluid volume shifts, high heparin dose, immunosuppressive effects, and systemic inflammatory response syndrome. Methods: This study prospectively analyzed data of a cohort of patients who underwent TAAA OR using a PS in a single institution. Outcomes of interest were mortality, rate of mesenteric, renal and spinal cord ischemia, cardiac complications, and intraoperative hemodynamic stability achieved in this setting. Our institutional bundle and a comprehensive literature review about the different configurations and applicability of PS for TAAA OR is also reported. The search was performed based on three databases (PubMed, EMBASE, and Cochrane Library) by two independent reviewers (LS and AA) from inception to 31 December 2023, and the reported clinical results (visceral, renal, and spinal cord complications and mortality) using PS during TAAAs OR were analyzed. Results: Between March 2021 and December 2023, 51 TAAA repairs were performed and eleven patients (n = 8, 73% male; mean age 67 years, range 63–79) were operated using a PS for a total of one (9%) type I, one (9%) type II, two (18%) type III, five (45%) type IV, and two (18%) type V TAAA. In our early experience, PS was indicated for limited staff resources during the COVID-19 pandemic to treat five non-deferable cases. The sixth and seventh patients were selected for PS as they already had a functioning axillo-bifemoral bypass that was used for this purpose. For the most recent cases, PS was chosen as the primary perfusion method according to a score based on clinical and anatomical factors with ECC as a bailout strategy. Selective renal perfusion with cold (4 °C) Custodiol solution was the method of choice for renal protection in all cases while antegrade perfusion of the coeliac trunk and the superior mesenteric artery was assured by PS through a loop graft (8–10mm) proximally anastomosed to the axillary artery (10 patients, 90.9%) or the descending thoracic aorta (one patient, 9%) and distally anastomosed to the infrarenal aorta (3), common iliac (3), or femoral vessels (5). In-hospital mortality was 9% as one patient died on the 10th postoperative day from mesenteric ischemia following hemodynamic instability; permanent spinal cord ischemia rate was 0% and the rate of AKI stage 3 was 9% (one patient). Bailout shifting to ECC was never required. No cardiac complications, nor a significant increase in serum CK-MB were reported in any patient. No prolonged severe intraoperative hypotension episodes (Mean Arterial Pressure < 50 mmHg) were assessed using the Software Acumen Analytics (Edwards LifeSciences, Irvine CA, USA). No peri-operative coagulopathy nor major bleeding was reported. Conclusions: Our experience showed satisfactory outcomes with the use of PS in specifically selected cases. Current data indicate that PS may represent an alternative to ECC techniques during TAAAs OR in high volume centers where assisted extracorporeal circulation could eventually be applied as a bailout strategy. However, due to the small sample size of this and previously published series, more data are needed to clearly define the potential role of such approach during TAAA OR. Full article

Cities play a central role in territorial development, acting as engines of economic growth, innovation, and social well-being. However, contemporary urban challenges, such as socio-spatial segregation, environmental degradation, and mobility constraints, necessitate innovative planning approaches. The “15-minute city” model, conceptualised by Moreno, seeks to reorganise urban spaces to enhance proximity, sustainability, and quality of life by ensuring that essential services are accessible within a short walk or bike ride. This study examines the applicability of this model in Portugal, analysing its presence in national scientific research and its integration into recent Sustainable Urban Mobility Action Plans. Additionally, a spatial analysis using pedestrian-based isochrone mapping assesses accessibility to education and health services, identifying areas with potential for implementation. The results indicate a selective adoption of the model’s operational dimensions, with an emphasis on fare integration and soft mobility infrastructure. However, there is a noticeable deficiency in regulatory instruments designed to promote multifunctionality and social–spatial inclusion. The spatial pattern in northern Portugal reveals disparities in pedestrian accessibility. This study highlights the stronger need for context-sensitive urban strategies, emphasising that while the 15-minute city offers a promising framework, its success depends on local adaptations and governance models. Full article

Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression hip screw [CHS] or intramedullary nail [IMN]) with or without bone grafting. This study aims to validate our treatment strategy through a retrospective analysis and a review of previous surgical outcomes. Methods: We sought to validate this strategy through a retrospective analysis of 16 patients (6 males and 10 females, mean age at surgery 37.4 years [range, 16–64 years]) with primary benign bone tumors or tumor-like conditions of the proximal femur, including the femoral head and neck. Curettage and synthetic or autologous bone graft was performed according to our treatment flowchart, utilizing either CHS or IMN for internal fixation. We compared the blood loss, operative time, time to full weight bearing, and perioperative complications between the CHS and IMN groups. Results: Blood loss did not significantly differ between the CHS and IMN groups (p = 0.11), but the operative time was significantly longer in the CHS group (p < 0.01). Two CHS cases experienced local recurrence, while no postoperative fractures were observed in either group. The median time to full weight bearing was 5 weeks, consistent with previous reports. No perioperative complications were noted. Conclusions: Our strategy achieved favorable clinical outcomes. IMN was selectively used in patients with non-aggressive benign tumors not involving the femoral head and neck, yielding good results with reduced surgical invasiveness, while in those patients with aggressive disease involving the head and neck, CHS was more appropriate. This approach may serve as a practical guide for surgical decision-making in benign proximal femoral bone tumors. Full article

Mission-critical services (MCX) comprise a standardized suite of capabilities including Mission-Critical Push-to-Talk (MCPTT), MCVideo, and MCData, designed to meet stringent requirements for availability, reliability, latency, security, and Quality of Service (QoS). These services are essential for public safety, emergency response, and other critical infrastructure domains, where communication performance directly affects operational effectiveness. Integration into 4G and 5G mobile networks, supported by targeted standardization efforts, has extended broadband capabilities to mission-critical environments. 5G networks provide the technical foundations for MCX through ultra-low latency (below 1 ms), high availability (99.999%), broadband throughput over 100 Mbps per user, deterministic QoS via network slicing, massive device connectivity (over one million devices per square kilometer), and seamless Non-Terrestrial Network (NTN) integration. Technical enablers such as Proximity Services (ProSe), network slicing, and Ultra-Reliable Low-Latency Communications (URLLC) are fundamental to delivering these capabilities. This paper reviews MCX architectures, service frameworks, and protocols, relating MCPTT, MCData, and MCVideo to the key performance requirements defined in ITU-T M.2377-2. It also examines the frozen features of 3GPP Release 19, including enhancements to MC services, NTN integration, Reduced Capability device support, sub-meter positioning, extended network slicing for Public Protection and Disaster Relief (PPDR), and strengthened security mechanisms. Finally, the study addresses challenges such as standard maturity, interoperability, and deterministic QoS, identifying research priorities toward 6G readiness. By consolidating advances from standards bodies, research initiatives, and deployments, this work serves as a technical reference for scalable, secure, and standards-compliant MCX solutions in current and future networks. Full article

Distributed acoustic sensing (DAS), which can provide dense spatial and temporal measurements using optical fibers, is quickly becoming critical for large-scale infrastructure monitoring. However, anomaly detection in DAS data is still challenging owing to the spatial correlations between sensing channels and nonlinear temporal dynamics. Recent approaches often disregard the explicit sensor layout and instead handle DAS data as two-dimensional images or flattened sequences, eliminating the spatial topology. This work proposes GraphDiffusion, a novel generative anomaly-detection model that combines a conditional denoising diffusion probabilistic model (DDPM) and a graph neural network (GNN) to overcome these limitations. By treating each channel as a graph node and building edges based on Euclidean proximity, the GNN explicitly models the spatial arrangement of DAS sensors, allowing the network to capture local interchannel dependencies. The conditional DDPM uses iterative denoising to model the temporal dynamics of standard signals, enabling the system to detect deviations without the need for anomalies. The performance evaluations based on real-world DAS datasets reveal that GraphDiffusion achieves 98.2% and 98.0% based on the area under the curve (AUC) of the F1-score at K different levels (F1_K-AUC), an AUC of receiver operating characteristic (ROC) at K different levels (ROC_K-AUC), outperforming other comparative models. Full article

With the growing integration of digital technologies on modern vessels, ranging from satellite links and mobile networks to onboard Wi-Fi, the exposure of maritime systems to cyber threats has become a pressing concern. Wireless networks on ships, although essential for operations and crew welfare, often lack sufficient protection and are frequently overlooked in broader cybersecurity strategies. This article explores vulnerabilities linked to Man-in-the-Middle attacks and rogue access points, particularly in port areas where attackers may exploit signal range and proximity. A simulation carried out in a public setting near the Port of Rijeka demonstrated how standard crew devices could be lured into connecting to a counterfeit Wi-Fi network, resulting in traffic interception and potential data leaks. Although practical limitations, such as signal attenuation and distance, reduce the feasibility of such intrusions at sea, the risk remains significant while in port. Insecure configurations and common user behaviors were identified as key enablers. The article outlines a series of countermeasures aligned with international guidelines ranging from segmentation and encryption to crew training and intrusion detection. Addressing these wireless vulnerabilities is essential for building resilience and ensuring that digital transformation efforts in the maritime sector do not come at the expense of security. Full article