Search Results (1,407)

Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., China), the smallest currently available ureteroscope Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard. Full article

This study uses the CREATE^TM-AV/Kestrel simulation software to model a towed jumper scenario using standard aircraft settings to quantify paratrooper stability and risk of contact during static line airborne operations. The focus areas of this study include a review of the technical build-up, which includes aircraft, paratrooper and static line modeling, plus preliminary functional checkouts executed to verify simulation performance. This research and simulation development effort is driven by the need to meet the analysis demands required to support the US Army Personnel Airdrop with static line length studies and the North Atlantic Treaty Organization (NATO) Joint Airdrop Capability Syndicate (JACS) with airdrop interoperability assessments. Each project requires the use of various aircraft types, static line lengths and exit procedures. To help meet this need and establish a baseline proof of concept (POC) simulation, simulation setups were developed for a towed jumper from both the C-130J and C-17 using a 20-ft static line to support US Army Personnel Airdrop efforts. Concurrently, the JACS is requesting analysis to support interoperability testing to help qualify the T-11 parachute from an Airbus A400M Atlas aircraft, operated by NATO nations. Due to the lack of an available A400M geometry, the C-17 was used to demonstrate the POC, and plans to substitute the geometry are in order when it becomes available. The results of a nominal Computational Fluid Dynamics (CFD) simulation run using a C-17 and C-130J will be reviewed with a sample of the output to help characterize performance differences for the aircraft settings selected. The US Army Combat Capabilities Development Command Soldier Center (DEVCOM-SC) Aerial Delivery Division (ADD) has partnered with the US Air Force Academy (USAFA) High Performance Computing Research Center (HPCRC) to enable Modeling and Simulation (M&S) capabilities that support the Warfighter and NATO airdrop interoperability efforts. Full article

Background and Objectives: Plantar fasciitis is one of the most common foot pathologies, and its diagnosis and clinical follow-up increasingly rely on the use of ultrasound. The aim of this study is to compare the reliability of ultrasound measurements of plantar fascia thickness between an expert technician, with more than 5 years of ultrasound experience, and a novice technician, with no prior ultrasound experience—both of whom are podiatrists. This allows us to assess whether operator experience significantly influences the results. Methods: An observational, descriptive, and cross-sectional study was designed with a sample of 60 healthy patients aged between 20 and 32 years. The thickness of the plantar fascia in both feet was measured using ultrasound. Each patient was evaluated by two observers (one expert and one novice) using a Vinno E35 ultrasound machine. Results: The results of the analysis indicated that there were no statistically significant differences in the measurements obtained either between the two technicians or between the left and right feet of the same individual, as the calculated p-value in both cases was greater than the conventional threshold of 0.05. This suggests that the measurements were consistent regardless of the operator or the side being evaluated. Nevertheless, when examining the differences in the time required to measure the plantar fascia between the two technicians, the situation was different. In this case, the data distribution did not meet the assumption of normality, as evidenced (p-value of less than 0.001). Furthermore, it was observed that the experienced technician not only completed the measurements in a shorter amount of time but also demonstrated less variability in those times, indicating a more efficient and standardized approach to the procedure. In contrast, the novice technician initially took longer and exhibited greater inconsistency; however, as the study progressed, a noticeable and progressive learning effect became apparent. Specifically, from approximately the midpoint of the study onward, the novice technician showed a significant improvement, achieving faster and more consistent measurement times compared to the earlier stages of the research. Conclusions: The study demonstrates that ultrasound measurements of the plantar fascia are consistent between technicians. However, the expert technician performs the measurements with greater speed and precision, and a learning effect is evident in the novice technician. Full article

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically significant complication of ERCP, with a multifactorial etiology involving patient- and procedure-related risk factors. Despite preventive measures such as NSAIDs and peri-procedural stenting, the incidence of PEP has not substantially declined. We aimed to assess clinical determinants of PEP in a large real-world cohort treated with standardized procedural protocols. Materials and Methods: This retrospective single-center study analyzed 806 patients who underwent ERCP between January 2019 and December 2021. All procedures were performed by a single operator under general anesthesia with standardized prophylaxis (diclofenac 100 mg per rectum and cefazolin 2 g intravenously). Patients with delayed ERCP (>48 h from admission) or active acute pancreatitis were excluded. Logistic regression was used to identify independent predictors of PEP, hospital stay, and in-hospital mortality. Results: PEP occurred in 60 patients (7.4%). Independent risk factors included stenosis of the papilla of Vater (OR = 2.45; p = 0.025), gallbladder stones (OR = 2.66; p = 0.001), prior acute pancreatitis (OR = 2.72; p = 0.005), and sphincterotomy (OR = 2.53; p = 0.016). PEP was associated with longer hospitalization (MD = 4.5 days; p < 0.001) and increased in-hospital mortality (6.7% vs. 1.7%; p = 0.032). Conclusion: Stenosis of the papilla, gallbladder stones, prior acute pancreatitis, and sphincterotomy independently increased the risk of PEP, whereas older age, previous ERCP, and pancreaticoduodenal tumors were associated with a reduced risk. Despite standardized prophylaxis, PEP remains a relevant clinical concern. Identification of high-risk patients and individualized procedural planning are essential to minimizing complications. Full article

Background/Objectives: Maxillofacial volumetric deficits are often treated using structural fat grafting with autologous free fat grafts. The buccal fat pad (BFP) is commonly used as a pedicled flap for limited oral cavity applications. This study explores its use as a free graft for reconstructing deformities in the upper and lower lips caused by trauma or tumor resections. Methods: Five patients underwent soft tissue defect reconstruction using a free fat graft from the BFP, following standard surgical procedures. Techniques for harvesting, transferring, and evaluating aesthetic and functional outcomes up to three months post-surgery are detailed, with long-term follow-up extending to an average of 20 months (range 12–24 months). Results: Initial post-operative assessments showed lip asymmetry due to edema and excessive graft volume. Partial necrosis was observed within 1–2 weeks, typical of tissue healing. By 4–5 weeks, mucosal revascularization occurred, with desired lip volume and functionality achieved between 8–12 weeks. Long-term follow-up averaging 20 months demonstrated excellent graft stability with no volume regression beyond the vermilion border in all patients. Conclusions: The BFP as a free graft offers advantages such as high survival rates and easy harvesting. It effectively restores lip function, volume, and aesthetics. Challenges include graft manipulation, retention, potential fibrosis, and volume unpredictability. Future refinements in technique and follow-up are necessary to overcome these issues, enhancing the reliability of BFP for lip reconstruction. Full article

Artificial intelligence (AI) enhances anesthesiology by introducing adaptive systems that improve clinical precision, safety, and responsiveness. This review examines the integration of AI in anesthetic practice, with a focus on closed-loop systems that exemplify autonomous control. These platforms integrate continuous physiologic inputs, such as BIS, EEG, heart rate, and blood pressure, to titrate anesthetic agents in real time, providing more consistent and responsive management than manual methods. Predictive algorithms reduce intraoperative hypotension by up to 40%, and systems such as McSleepy demonstrate greater accuracy in maintaining anesthetic depth and shortening recovery times. In critical care, AI supports sedation management, reduces clinician cognitive load, and standardizes care delivery during high-acuity procedures. The review also addresses the ethical, legal, and logistical challenges to widespread adoption of AI. Key concerns include algorithmic bias, explainability, and accountability for machine-generated decisions and disparities in access due to infrastructure demands. Regulatory frameworks, such as HIPAA and GDPR, are discussed in the context of securing patient data and ensuring its ethical deployment. Additionally, AI may play a transformative role in global health through remote anesthesia delivery and telemonitoring, helping address anesthesiologist shortages in resource-limited settings. Ultimately, AI-guided closed-loop systems do not replace clinicians; instead, they extend their capacity to deliver safe, responsive, and personalized anesthesia. These technologies signal a shift toward robotic anesthesia, where machine autonomy complements human oversight. Continued interdisciplinary development and rigorous clinical validation will determine how AI integrates into both operating rooms and intensive care units. Full article

Background and Aim: Food hygiene is fundamental to public health, ensuring safe and nutritious food free from contaminants, and is vital for economic development and sustainability. The Hazard Analysis and Critical Control Points (HACCP) system is a crucial tool for managing risks in food production. Despite global recognition of food safety’s importance, significant disparities exist, especially in Southern Italy, where diverse food production, tourism, and economic factors pose challenges to enforcing hygiene standards. This study evaluates non-compliance with food hygiene regulations within a Local Health Authority (LHA) in Calabria, Southern Italy, to inform effective public health strategies. Materials and Methods Authorized by the Food Hygiene and Nutrition Service (FHNS) of the LHA, the study covers January 2022 to December 2024, analyzing 579 enterprises with 1469 production activities. Inspections followed EC Regulation No. 852/2004, verifying the correct application of procedures based on the Hazard Analysis and Critical Control Points (HACCP) principles, including the operator’s monitoring of Critical Control Points (CCPs), and adherence to Good Hygiene Practices (GHPs). Non-compliances were classified by severity, and corrective and punitive actions were applied. Data were analyzed annually and across the full period using descriptive statistics and chi-squared tests to assess trends. Results: Inspection coverage increased markedly from 29.8% of production activities in 2022 to 62.5% in 2023, sustaining 62.0% in early 2024, exceeding the growth of new activities. Inspections were mainly triggered by RASFF alerts (22.4%), routine controls (20.0%), and verification of previous prescriptions (14.3%). The most frequent corrective measures were long-term prescriptions (28.6%), violation reports (22.9%), and short-term prescriptions (20.0%). Enterprises averaged 4.61 production activities, highlighting operational complexity. Conclusions: This study provides a granular analysis of food hygiene non-compliance within a Local Health Authority (LHA) in Southern Italy, to inform effective public health strategies. While official control data may be publicly available in some contexts, our research offers a unique, in-depth view of inspection triggers, non-compliance patterns, and corrective measures, which is crucial for understanding specific regional challenges. The analysis reveals that the prevalence of long-term prescriptions and reliance on RASFF alerts indicate systemic challenges requiring sustained interventions. Full article

Supply chain financing offers advantages over traditional channels such as bank loans and equity financing, including greater flexibility, lower transaction costs, and simplified approval procedures. However, when a firm’s sustainability faces uncertainty, access to supply chain financing may become constrained by multiple factors, including the risk tolerance of supply chain partners, market transparency, and corporate reputation. ESG, representing Environmental, Social, and Governance standards, is a critical framework for assessing corporate sustainability performance. Given that divergent ESG evaluations reflect disparate market assessments of a firm’s sustainable development capabilities, such divergence may affect supply chain financing by altering stakeholder trust dynamics. This research examines A-share listed firms in China (2016–2022) and reveals that divergence in ESG evaluations significantly inhibits firms’ access to supply chain financing. Mechanism validation suggests that divergent ESG evaluations amplify informational opacity, operational risks, and negative reputation, thereby influencing supply chain partners’ risk perceptions and trust levels. Heterogeneity analysis shows that corporate governance quality, regional trust levels, and ESG awareness modulate the negative impact of divergent ESG evaluations on supply chain financing. The asymmetric effects of divergent ESG evaluations on supply chain financing are further confirmed, with distinct manifestations between upstream suppliers and downstream customers. By bridging gaps in existing research on divergent ESG evaluations and supply chain finance, this work offers regulatory guidelines, operational recommendations for firms, and investment decision frameworks. Full article

In recent years, the construction sector has experienced a significant technological transition, driven by the introduction of innovative digital tools and the evolution of the legislative environment. This article presents a Systematic Scoping Review conducted in accordance with the PRISMA-ScR guidelines, aiming to examine the role of Public Administration (PA) regarding the adoption of innovative technologies, such as Building Information Modelling (BIM) and Digital Twin (DT), to improve the management of construction and public procurement processes. The review analyses the state of the art in the implementation of digitalised procedures for project management in the construction phase, according to PA organisational purposes and national and international standard requirements. The data obtained was used to structure the analysis in order to provide a useful framework for understanding the level of convergence between the academic world and public administration in the use of digital technologies and their combined applications. The review results are organised in a thematic matrix classifying contributions according to key topics, building process phases, and operational aims. This approach highlights adopted strategies and emerging best practices, aiming to support both PAs and professionals in overcoming digitalisation challenges. A specific focus has been dedicated to the need for continuous training and legislative adaptation, which are essential for integrating digital technologies into building processes. The analysis and verification of the results of the systematic scoping review on the digitalisation process in the construction sector, conducted between academia and the public administration, is supported by a comparison with an Italian case study from the Emilia-Romagna region, which illustrates the specific application of the strategies identified in the digital management of public construction processes. Full article

Language, a uniquely human cognitive faculty, is fundamentally characterized by its capacity for complex thoughts and structured expressions. This review examines two critical measures of linguistic performance: idea density (ID) and grammatical complexity (GC). ID quantifies the richness of information conveyed per unit of language, reflecting semantic efficiency and conceptual processing. GC, conversely, measures the structural sophistication of syntax, indicative of hierarchical organization and rule-based operations. We explore the neurobiological underpinnings of these measures, identifying key brain regions and white matter pathways involved in their generation and comprehension. This includes linking ID to a distributed network of semantic hubs, like the anterior temporal lobe and temporoparietal junction, and GC to a fronto-striatal procedural network encompassing Broca’s area and the basal ganglia. Moreover, a central theme is the integration of Chomsky’s theories of Universal Grammar (UG), which posits an innate human linguistic endowment, with their neurobiological correlates. This integration analysis bridges foundational models that first mapped syntax (Friederici’s work) to distinct neural pathways with contemporary network-based theories that view grammar as an emergent property of dynamic, inter-regional neural oscillations. Furthermore, we examine the genetic factors influencing ID and GC, including genes implicated in neurodevelopmental and neurodegenerative disorders. A comparative anatomical perspective across human and non-human primates illuminates the evolutionary trajectory of the language-ready brain. Also, we emphasize that, clinically, ID and GC serve as sensitive neurocognitive markers whose power lies in their often-dissociable profiles. For instance, the primary decline of ID in Alzheimer’s disease contrasts with the severe grammatical impairment in nonfluent aphasia, aiding in differential diagnosis. Importantly, as non-invasive and scalable metrics, ID and GC also provide a critical complement to gold-standard but costly biomarkers like CSF and PET. Finally, the review considers the emerging role of AI and Natural Language Processing (NLP) in automating these linguistic analyses, concluding with a necessary discussion of the critical challenges in validation, ethics, and implementation that must be addressed for these technologies to be responsibly integrated into clinical practice. Full article

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article

In free-running ship simulations, PID control gains for rudder and propeller revolution are often selected based on empirical experience without a standardized procedure, leading to inconsistent results under varying operational conditions. This study examined PID control gains by implementing a simulation framework using STAR-CCM+. The Ziegler–Nichols tuning method was applied to derive control gains, and their behavior was analyzed across different wave conditions (calm, short, medium, and long waves), PID period condition, ship speeds (low and design speeds), and scale ratios. The simulations showed that the PID gains derived under moderate wave conditions provided stable and reliable control performance across various sea states. Furthermore, the influence of scale ratio changes on the control performance was evaluated, and a non-dimensional scaling formula for PID coefficients was proposed to enhance applicability across different model sizes. Validation against experimental data confirmed the reliability of the simulation setup. These findings offer a systematic guideline for selecting the PID control gains for free-running simulations, promoting improved accuracy and stability under diverse environmental and operational conditions. This research contributes to developing standardized practices for maneuvering performance evaluations in realistic maritime environments. Full article

Background/Objectives: Calcified atherosclerotic disease of the common femoral artery (CFA) is a unique therapeutic challenge. Although endarterectomy has been the gold standard for CFA disease treatment, the evolution of endovascular techniques has led to increasing interest in minimally invasive alternatives to open surgery. Intravascular lithotripsy (IVL) offers calcium modification, facilitating vessel compliance and enhancing the effect of adjunctive therapies. Methods: A systematic review of current literature was conducted to summarize data on clinical outcomes and perioperative complications of IVL for the treatment of calcified CFA disease. Eligible studies up to July 2025 were included. Demographics, procedural and follow-up data were extracted and analyzed. Results: A total of 304 patients across 9 studies were included. The majority of the patients were males (68%) with hypertension (88%), dyslipidemia (75%) and smoking history (65%). Of the included patients, 56% had chronic limb-threatening ischemia (CLTI), with a previous intervention reported in about one-third of them. Additional calcium-modifying technology was used at the discretion of the operator in 11% of cases. The overall dissection rate was 2% (95% confidence interval (CI): 0–6%) with only five cases having flow-limiting dissections. Stenting rate was 3% (95% CI: 0–11%). No perforations or distal embolization events were reported by the rest of the studies apart from one study that had one such case. The overall periprocedural complication rate was 5% (95% CI: 0–13%). The 12-month target lesion revascularization (TLR) rate was 9% (95% CI: 3–18%). Conclusions: IVL could be a safe alternative endovascular option to open repair for treating calcified CFA disease with low rates of procedural complications. Further studies are needed to clarify IVL’s role in clinical practice, particularly for patients who are poor candidates for open surgery. Full article

Digital subtraction angiography (DSA) remains an important reference modality for evaluating chronic limb-threatening ischemia (CLTI), with left transradial access (TRA) increasingly favored for its lower complication rates and patient comfort. Radiation safety for operators is paramount, yet the impact of patient positioning on scatter radiation during lower limb diagnostic catheter angiography (CA) is understudied. This single-center randomized controlled trial evaluated whether head-first (HF) vs. feet-first (FF) supine patient orientation affects operator radiation exposure during lower extremity CA from left TRA. Between February and August 2024, 24 patients with CLTI were enrolled and randomized to HF or FF positions. Operator radiation exposure was measured using thermoluminescent dosimeters (TLDs) at the eye, chest, and left ring finger. Background radiation was subtracted. Procedures were standardized and performed by a single experienced interventional radiologist. Fluoroscopy time, dose area product (DAP), and contrast usage were recorded. No statistically significant differences were found between groups in patient BMI and procedural parameters. Patient positioning (HF vs. FF) did not significantly impact operator radiation exposure. A trend toward higher finger exposure in FF position suggests the need for optimized hand protection. These findings support flexible patient positioning without compromising operator safety, reinforcing adherence to ALARA principles. Full article

Cervical cancer remains the fourth most common malignancy among women worldwide, with over 600,000 new cases and approximately 350,000 deaths in 2022. Lymph node (LN) status is a critical prognostic factor, and in 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its staging system to include regional LN metastases, underscoring the importance of accurate nodal assessment. Sentinel lymph node biopsy (SLNB) has emerged as a minimally invasive alternative to systematic pelvic lymphadenectomy in early-stage disease, aiming to shorten operative time, reduce healthcare costs, and minimize treatment-related morbidity. This review synthesizes current evidence on SLNB in early-stage cervical cancer, including its diagnostic accuracy, optimal techniques, cost-effectiveness, and remaining clinical challenges. Data from prospective trials and meta-analyses demonstrate that SLNB provides high detection rates, especially with bilateral mapping and the use of advanced tracers such as indocyanine green. Ultrastaging further improves the detection of micrometastases and isolated tumor cells, refining adjuvant therapy decisions. Compared to full lymphadenectomy, SLNB significantly decreases intraoperative blood loss, operative time, and postoperative complications—most notably, lymphedema—while maintaining equivalent disease-free and overall survival. International guidelines now endorse SLNB for appropriately selected patients with early-stage cervical cancer (tumor size < 4 cm, negative preoperative imaging). However, variations persist between European and U.S. recommendations regarding its role as a standalone procedure. Future research must address protocol standardization, the prognostic relevance of low-volume metastases, and factors influencing mapping success. Overall, SLNB represents a paradigm shift toward more individualized, evidence-based surgical management of early-stage cervical cancer. Full article