The Effectiveness of Combining Botulinum Toxin Type A and Therapeutic Exercise in Treating Spasticity in a Patient with Complicated Stiff-Person Syndrome: A Case Report.

Stiff-person syndrome is rare and disabling autoimmune condition that most frequently affects women, with no real predisposition by race. Diagnosis is often arduous, which is why patients concomitantly suffer from anxiety and depression. To date, drug therapy is based on the use of benzodiazepines, barbiturates, and baclofen. Refractory cases are treated with intravenous immunoglobulin, plasmapheresis, B lymphocyte depletion with rituximab, and even the implantation of intrathecal baclofen devices. Botulinum toxin injection is frequently used, even if it still has an unclear role in the literature. Our case report aims to demonstrate the efficacy of a combined treatment of botulinum toxin and therapeutic exercise in a 65-year-old patient with biceps brachii muscle hypertonia and diffuse spasms of the axial musculature, using rating scales such as the Numeric Rating Scale (NRS) and Modified Ashworth Scale (MAS), joint range of motion (ROM) measurement, and muscle dynamic stiffness mensuration, which is performed by using the MyotonPro®. All the assessments were conducted at the first evaluation (T0), soon after the combined treatment with botulin toxin and therapeutic exercise (T1), three months (T2), six months (T3), and eight months after the botulinum toxin injection (T4). The patient demonstrated benefits for more than 6 months with no side effects. The combined therapy of botulinum toxin and therapeutic exercise had an excellent result in our patient.

Doctor, Indian nationalist and humanitarian: Mukhtar Ahmad Ansari (1880-1936).

Mukhtar Ahmad Ansari was a doctor and remarkable political figure in the late 19th century and the first half of 20th century. After studying medicine in Edinburgh, he returned to his country and became interested in political issues. Not unlike other educated Indian Muslims, Ansari first expressed his concerns about the situation in the Ottoman empire and went to Istanbul as the head of the medical mission. Ansari, who became more interested in politics after his days in Istanbul, came to the forefront as one of the leading figures of the Indian independence movement. Along with Mahatma Gandhi (1869-1948), Ansari did not engage in violence but supported the unity of Muslims and Hindus and opposed communalism. Despite his active political life, Ansari continued his medical studies with great seriousness and played an active role in establishing the Delhi Medical Association in 1914. During this period, his most important aim was to graft animal testicles onto human beings.

Global view of domain-specific O-linked mannose glycosylation in glycoengineered cells.

Protein O-linked mannose (O-Man) glycosylation is an evolutionary conserved post-translational modification (PTM) that fulfills important biological roles during embryonic development. Three non-redundant enzyme families, POMT1/POMT2, TMTC1-4 and TMEM260, selectively coordinate the initiation of protein O-Man glycosylation on distinct classes of transmembrane proteins, including α-dystroglycan, cadherins and plexin receptors. However, a systematic investigation of their substrate specificities is lacking, in part due to the ubiquitous expression of O-Man glycosyltransferases in cells, which precludes analysis of pathway-specific O-Man glycosylation on a proteome-wide scale. Here, we apply a targeted workflow for membrane glycoproteomics across five human cell lines to extensively map O-Man substrates and genetically deconstruct O-Man initiation by individual and combinatorial knock-out (KO) of O-Man glycosyltransferase genes. We established a human cell library for analysis of substrate specificities of individual O-Man initiation pathways by quantitative glycoproteomics. Our results identify 180 O-Man glycoproteins, demonstrate new protein targets for the POMT1/POMT2 pathway and show that TMTC1-4 and TMEM260 pathways widely target distinct Ig-like protein domains of plasma membrane proteins involved in cell-cell and cell-extracellular matrix interactions. The identification of O-Man on Ig-like folds adds further knowledge on the emerging concept of domain-specific O-Man glycosylation which opens for functional studies of O-Man glycosylated adhesion molecules and receptors.

Influence of floor inclination on handle push and pull forces production of the upper limb.

Floor inclination can alter hand force production, and lower limb kinetics, affecting control operations, and threatening operator safety in various domains, such as aviation, naval, construction industry, or agriculture. This study investigates the effects of different floor inclinations, on handle push or pull force production. Participants performed maximal isometric contraction tasks requiring to exert a maximal voluntary force either by pulling or pushing a handle, at different floor inclinations from -30° to +30° about the transverse and longitudinal axes. Maximal hand force and Ground Reaction Forces about both feet were recorded. The results revealed non-equivalent variations in hand and feet responses as a function of inclination angle. Specifically, there was a significant reduction in handle push-pull force production, up to 70% (p < 0.001) for extreme inclinations, around both axes. This study provides critical data for design engineers, highlighting the challenge of production forces at steep angles.

Factors associated with sexual dysfunction in patients with bipolar disorder.

OBJECTIVES: The aims of our study were to assess the sexual function in men with bipolar disorder type 1 in remission and to determine the various sociodemographic, clinical and therapeutic factors associated with sexual dysfunction. METHODS: We conducted a cross-sectional study over an 18-month period (January 2020-June 2021) in which we included men followed up for bipolar disorder type 1 in the euthymic phase strictly defined by a score <8 on the Young Mania Rating Scale and a score ≤7 on the Hamilton Depression Rating Scale. Sexual function was assessed using the Arizona Sexual Experiences Scale (Asex) in its Arabic-validated version. RESULTS: Sixty patients were included in the study. The mean age was 42.5 (SD=11.1) years. Among the patients, 68% had sexual dysfunction according to the total score of the Asex scale. According to univariate analysis, several factors were significantly associated with sexual dysfunction in patients with bipolar disorder type 1: age (P=0.001), total number of hospitalizations for thymic relapse (P=0.015), total number of depressive episodes (P=0.006) and depressive dominant polarity (P=0.046). The factors identified as modifying sexuality according to the total score of the Asex scale by multivariate analysis were age at first antipsychotic prescription: P=0.01; ORa=1.109; 95% CI [1.021-1.206] and number of hospitalizations for thymic relapse: P=0.015; ORa=1.259; 95% CI [1.046-1.546]. CONCLUSION: Studies assessing factors associated with sexual dysfunction in patients with bipolar disorder type 1 in euthymia were mostly concerned with the effects of psychotropic drugs on sexual function, with factors inherent in bipolar illness itself not widely addressed in the literature. According to the results of our study, sexual dysfunction in patients with bipolar disorder in the euthymic phase is frequent and significantly associated with clinical factors inherent in the bipolar illness itself and its course.

An Uncommon Coexistence of Ischemic Stroke in a Multiple Sclerosis Patient With Duplicated Superior Cerebellar Artery: A Case Report From Saudi Arabia.

The case describes a middle-aged man with well-managed multiple sclerosis who experienced an acute ischemic stroke attributed to a rare anatomical variant - a duplicated left superior cerebellar artery (SCA). Despite his prior lack of neurological issues, the patient presented with severe headaches and walking difficulties. Imaging confirmed the ischemic stroke in the left SCA territory and revealed the duplicated left SCA. This case highlights the importance of considering cerebrovascular anatomy in stroke risk assessment, especially in individuals with unique vascular features such as duplicated SCAs, which can predispose to vascular complications.

Upcycling of cellulosic textile waste with bacterial cellulose via Ioncell® technology.

Currently the textile industry relies strongly on synthetic fibres and cotton, which contribute to many environmental problems. Man-made cellulosic fibres (MMCF) can offer sustainable alternatives. Herein, the development of Lyocell-type MMCF using bacterial cellulose (BC) as alternative raw material in the Ioncell® spinning process was investigated. BC, known for its high degree of polymerization (DP), crystallinity and strength was successfully dissolved in the ionic liquid (IL) 1,5-diazabicyclo[4.3.0]non-5-enium acetate [DBNH][OAc] to produce solutions with excellent spinnability. BC staple fibres displayed good mechanical properties and crystallinity (CI) and were spun into a yarn which was knitted into garments, demonstrating the potential of BC as suitable cellulose source for textile production. BC is also a valuable additive when recycling waste cellulose textiles (viscose fibres). The high DP and Cl of BC enhanced the spinnability in a viscose/BC blend, consequently improving the mechanical performance of the resulting fibres, as compared to neat viscose fibres.

Unraveling Lymphatic Filariasis in an Old Man: A Case Report.

Lymphatic filariasis, caused by filarial worms such as Wuchereria bancrofti, Brugia malayi, and Brugia timori, represents a significant public health burden in endemic regions. The disease primarily affects the lymphatic system, leading to lymphatic dysfunction and chronic morbidity. This abstract provides a comprehensive overview of lymphatic filariasis, including its transmission dynamics, pathogenesis, clinical manifestations, diagnostic approaches, and treatment options. Special attention is given to the socioeconomic impact of the disease and the challenges associated with its control and elimination. The patient in this particular case is a 58-year-old man who had lower limb swelling and pain, characteristic of chronic lymphatic obstruction. Additionally, the swelling tends to worsen during the evening hours often resulting in difficulty in walking and discomfort. Lymphatic filariasis was diagnosed based on clinical presentation.

MAN-C: A masked autoencoder neural cryptography based encryption scheme for CT scan images.

Sharing medical images securely is very important towards keeping patients' data confidential. In this paper we propose MAN-C: a Masked Autoencoder Neural Cryptography based encryption scheme for sharing medical images. The proposed technique builds upon recently proposed masked autoencoders. In the original paper, the masked autoencoders are used as scalable self-supervised learners for computer vision which reconstruct portions of originally patched images. Here, the facility to obfuscate portions of input image and the ability to reconstruct original images is used an encryption-decryption scheme. In the final form, masked autoencoders are combined with neural cryptography consisting of a tree parity machine and Shamir Scheme for secret image sharing. The proposed technique MAN-C helps to recover the loss in image due to noise during secret sharing of image.•Uses recently proposed masked autoencoders, originally designed as scalable self-supervised learners for computer vision, in an encryption-decryption setup.•Combines autoencoders with neural cryptography - the advantage our proposed approach offers over existing technique is that (i) Neural cryptography is a new type of public key cryptography that is not based on number theory, requires less computing time and memory and is non-deterministic in nature, (ii) masked auto-encoders provide additional level of obfuscation through their deep learning architecture.•The proposed scheme was evaluated on dataset consisting of CT scans made public by The Cancer Imaging Archive (TCIA). The proposed method produces better RMSE values between the input the encrypted image and comparable correlation values between the input and the output image with respect to the existing techniques.

Ethnoprimatology reveals new extended distribution of critically endangered banded langur Presbytis femoralis (Martin, 1838) in Pahang, Malaysia: Insights from indigenous traditional knowledge and molecular analysis.

The banded langur (Presbytis femoralis) is a critically endangered primate, restricted to Johor, Malaysia, with an estimated population size of less than 500 individuals. Traditionally, distribution studies on this highly threatened primate have relied on conventional methods such as DNA identification, live counting, and camera trapping. However, ethnoprimatology offers an alternative approach to data collection, involving the active participation of indigenous and local communities possessing valuable knowledge and experience with local primate species. This study employed an integrated approach incorporating ethnoprimatology by utilizing pooled local expert opinion, local surveys, interviews, and fecal DNA analysis, resulting in a novel distribution range for the banded langur. The combination of expert opinions revealed this species' most optimistic distribution scenario across Johor and Pahang, inhabiting various ecosystems, including lowland forests, peat swamps, and human-modified landscapes. Further interviews and surveys conducted within the Orang Asli community in Tasik Chini and Tasek Bera have provided additional support for the revised distribution, documenting occurrences of banded langur utilization in indigenous practices, such as food consumption, cultural beliefs, medicinal applications, and craftsmanship. Phylogenetic analysis demonstrated genetic differentiation between populations in Johor and Pahang, with the populations in the southern part of Peninsular Malaysia likely serving as ancestral sources for other populations. Consequently, this study not only elucidated the updated distribution of banded langur through DNA records and direct observations but also established the efficacy of ethnoprimatology as a precursory tool for uncovering the present distribution patterns of other primate species in Malaysia.

Prenatal Diagnosis of c.437-1G>A Mutation in the MAN2B1 Gene in a Family With Alpha-Mannosidosis: Unraveling Clinical Presentation and Treatment Outcomes in a Novel Prenatal Case.

Alpha-mannosidosis is a rare lysosomal storage disorder with progressive impairments in motor functions, skeletal deformities, and immunodeficiency. Enzyme replacement therapy (ERT) should be initiated early to achieve optimal outcomes. This report describes how alpha-mannosidosis diagnosis in a seven-year-old girl led to a successful prenatal diagnosis in the subsequent pregnancy and pre-symptomatic treatment at the early disease stage. The index patient was a seven-year-old girl who was referred with a confirmed diagnosis of alpha-mannosidosis based on the presence of homozygous c.437-1G>A mutation in the MAN2B1 gene. A prenatal diagnosis was made in the subsequent pregnancy through molecular analysis, which revealed the same homozygous variant. The patient was treated at the fifth week of age and showed mild skeletal involvement and normal development at ERT initiation. At 11 months of age, the ERT level increased to 15.8 µmol/l/h. The motor assessment showed that the patient was developmentally normal and was able to maintain her sitting and walking for a few steps only. Prenatal molecular screening in affected families can allow for the early identification and implementation of appropriate management strategies for alpha-mannosidosis.

Slovakian glass fibre factory genotoxicity biomonitoring study - unsupported adverse outcome pathway (AOP) from the toxicology and human epidemiological experience of synthetic vitreous fibres (SVFs).

The article by Ceppi and colleagues, Genotoxic Effects of Occupational Exposure to, Glass Fibres - A Human Biomonitoring Study, published in Mutation Research -Genetic Toxicology and Environmental Mutagenesis in 2023 was reviewed with great interest. The authors undertook a novel approach to conducting a biomonitoring study of genotoxicity markers among a population of glass fibre manufacturing workers in Slovakia. On the surface, the Ceppi et al. (2023) study provides an interesting application of genotoxicity markers among a human population of workers to explore potential markers of effect (DNA strand breaks) and potential risk of susceptibility (e.g., genetic damage, disease, death). However, limited data for exposure reconstruction, uncertain influences from smoking history, and lack of consideration of decades of human epidemiology research showing no increased risk of malignant or non-malignant respiratory disease and mortality among glass fibre manufacturing workers, reveals that the conclusions of the authors are overreaching and inconsistent with the existing science. The limitations of this study preclude the ability to draw causal inferences or conclusions about DNA strand breaks as a marker of exposure, effect, or susceptibility within this population of Slovakian glass fibre workers. Further longitudinal research is required (e.g., more robust temporal assessment of occupational exposures - fibres and other compounds - and smoking history) to support the study conclusions.

Successful revascularization of inferior ST-segment elevation myocardial infarction with positive "Dead Man Sign": A case report.

This case report outlines the management of a 43-year-old male with no past medical history presenting with inferior ST-segment elevation myocardial infarction and a positive "Dead Man Sign." Prompt administration of antiplatelet therapy and emergent percutaneous coronary intervention led to successful revascularization of the occluded right coronary artery and left anterior descending artery. The patient remained asymptomatic throughout hospitalization and was discharged home with instructions for monthly follow-up for 1 year. Subsequent assessments demonstrated normal echocardiography and Electrocardiography (ECG) findings, indicating favorable cardiac recovery. This case emphasizes the critical importance of rapid recognition and intervention in ST-segment elevation myocardial infarction cases, as well as the significance of the Dead Man Sign as a predictor of the occluded culprit coronary vessels, demonstrating favorable outcomes achievable with timely revascularization strategies.

Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis.

BACKGROUND: In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. OBJECTIVE: We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. METHODS: In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. RESULTS: Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. CONCLUSIONS: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear.

Vortioxetine-induced syndrome of inappropriate secretion of antidiuretic hormone: A case report.

BACKGROUND: Vortioxetine, known for its efficacy in treating depression through its effects on various neurotransmitters, has not been previously reported to induce syndrome of inappropriate secretion of antidiuretic hormone (SIADH). CASE PRESENTATION: This case report describes a 74-year-old man with major depressive disorder who developed SIADH 1 week after starting treatment with vortioxetine. SIADH is characterized by symptoms such as headache, nausea, disorientation, and seizures, stemming from hyponatremia (123 mEq/L), without dehydration or edema. Vortioxetine was discontinued, and an alternative drug, mianserin, was initiated. The patient was restricted from drinking water due to hyponatremia. The serum Na concentration improved over time to within the normal range by the second week after admission. CONCLUSION: This is the first case report of vortioxetine-induced SIADH.

Long-term radiological assessment of a Mediterranean freshwater ecosystem surrounding a nuclear power plant.

The radionuclide concentration of man-made radionuclides on non-human biota in freshwater ecosystems has been extensively studied in environments affected by the Chernobyl and Fukushima accidents, in both humid continental and subtropical climates, respectively. However, there are very few studies that assess the long-term effects of operating nuclear facilities in Mediterranean environments. In the present study, a temporal analysis of the impact on carp, cattail, and bulrushes in the cooling pond of the currently operating Almaraz nuclear power plant was investigated for the period 2000-2020. The results do not show a general trend in man-made radionuclide concentrations. Instead, depending on their availability and the type of organism, trends decrease over time. This is also reflected in the effective half-lives obtained, which are lower than the physical half-life for some radionuclides. Transfer coefficients for the main man-made radionuclides detected were obtained, and it was found that these were significantly lower than the typical ranges found for benthic fish and vascular plants in freshwater ecosystems. Finally, the internal and external doses received by the carp have been evaluated using ERICA tool, and it has been observed that the main contribution to the total dose is due to the internal dose (0.65-7.04) × 10-4 µGy/h.

Clinical trainee performance on task-based AR/VR-guided surgical simulation is correlated with their 3D image spatial reasoning scores.

This paper describes a methodology for the assessment of training simulator-based computer-assisted intervention skills on an AR/VR-guided procedure making use of CT axial slice views for a neurosurgical procedure: external ventricular drain (EVD) placement. The task requires that trainees scroll through a stack of axial slices and form a mental representation of the anatomical structures in order to subsequently target the ventricles to insert an EVD. The process of observing the 2D CT image slices in order to build a mental representation of the 3D anatomical structures is the skill being taught, along with the cognitive control of the subsequent targeting, by planned motor actions, of the EVD tip to the ventricular system to drain cerebrospinal fluid (CSF). Convergence is established towards the validity of this assessment methodology by examining two objective measures of spatial reasoning, along with one subjective expert ranking methodology, and comparing these to AR/VR guidance. These measures have two components: the speed and accuracy of the targeting, which are used to derive the performance metric. Results of these correlations are presented for a population of PGY1 residents attending the Canadian Neurosurgical "Rookie Bootcamp" in 2019.

Congenital disorders of glycosylation with multiorgan disruption and immune dysregulation caused by compound heterozygous variants in MAN2B2.

BACKGROUND: Congenital disorders of glycosylation (CDG) are a type of inborn error of metabolism (IEM) resulting from defects in glycan synthesis or failed attachment of glycans to proteins or lipids. One rare type of CDG is caused by homozygous or compound heterozygous loss-of-function variants in mannosidase alpha class 2B member 2 (MAN2B2). To date, only two cases of MAN2B2-CDG have been reported worldwide. METHODS: Trio whole-exome sequencing (Trio-WES) was conducted to screen for candidate variants. N-glycan profiles were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). MAN2B2 expression was evaluated by western blotting. MX dynamin like GTPase 1 (MX1) function was estimated via Thogoto virus (THOV) minireplicon assay. RESULTS: Trio-WES identified compound heterozygous MAN2B2 (hg19, NM_015274.1) variants (c.384G>T; c.926T>A) in a CDG patient. This patient exhibited metabolic abnormalities, symptoms of digestive tract dysfunction, infection, dehydration, and seizures. Novel immune dysregulation characterized by abnormal lymphocytes and immunoglobulin was observed. The MAN2B2 protein level was not affected, while LC-MS/MS showed obvious disruption of N-glycans and N-linked glycoproteins. CONCLUSION: We described a CDG patient with novel phenotypes and disruptive N-glycan profiling caused by compound heterozygous MAN2B2 variants (c.384G>T; c.926T>A). Our findings broadened both the genetic and clinical spectra of CDG.

Establishment and application of a quadruplex real-time RT-qPCR assay for differentiation of TGEV, PEDV, PDCoV, and PoRVA.

Porcine viral diarrhea is a common ailment in clinical settings, causing significant economic losses to the swine industry. Notable culprits behind porcine viral diarrhea encompass transmissible gastroenteritis virus (TGEV), porcine epidemic diarrhea virus (PEDV), porcine deltacoronavirus (PDCoV), and porcine rotavirus-A (PoRVA). Co-infections involving the viruses are a common occurrence in clinical settings, thereby amplifying the complexities associated with differential diagnosis. As a consequence, it is therefore necessary to develop a method that can detect and differentiate all four porcine diarrhea viruses (TGEV, PEDV, PDCoV, and PoRVA) with a high sensitivity and specificity. Presently, polymerase chain reaction (PCR) is the go-to method for pathogen detection. In comparison to conventional PCR, TaqMan real-time PCR offers heightened sensitivity, superior specificity, and enhanced accuracy. This study aimed to develop a quadruplex real-time RT-qPCR assay, utilizing TaqMan probes, for the distinctive detection of TGEV, PEDV, PDCoV, and PoRVA. The quadruplex real-time RT-qPCR assay, as devised in this study, exhibited the capacity to avoid the detection of unrelated pathogens and demonstrated commendable specificity, sensitivity, repeatability, and reproducibility, boasting a limit of detection (LOD) of 27 copies/µL. In a comparative analysis involving 5483 clinical samples, the results from the commercial RT-qPCR kit and the quadruplex RT-qPCR for TGEV, PEDV, PDCoV, and PoRVA detection were entirely consistent. Following sample collection from October to March in Guangxi Zhuang Autonomous Region, we assessed the prevalence of TGEV, PEDV, PDCoV, and PoRVA in piglet diarrhea samples, revealing positive detection rates of 0.2 % (11/5483), 8.82 % (485/5483), 1.22 % (67/5483), and 4.94 % (271/5483), respectively. The co-infection rates of PEDV/PoRVA, PEDV/PDCoV, TGEV/PED/PoRVA, and PDCoV/PoRVA were 0.39 %, 0.11 %, 0.01 %, and 0.03 %, respectively, with no detection of other co-infections, as determined by the quadruplex real-time RT-qPCR. This research not only established a valuable tool for the simultaneous differentiation of TGEV, PEDV, PDCoV, and PoRVA in practical applications but also provided crucial insights into the prevalence of these viral pathogens causing diarrhea in Guangxi.

The factors affecting the performance of the tunnel wall drilling task and their priority.

Clarifying the relationship between the man-machine environment and its impact on the tunnel wall drilling task performance (TWDTP) is crucial for enhancing the task performance. Based on a questionnaire survey, indicators of the man-machine environment that affect the TWDTP were proposed in this study, and exploratory factor analysis and a structural equation model were employed to examine the potential factors influencing the task performance and their degrees of influence. By comparing the discrepancy between the perceived performance and importance, the satisfaction of potential factors was evaluated, and the priority order for optimizing these factors was determined by considering the degree of influence and dissatisfaction. The results of survey data analysis based on actual tunnel drilling operation scenarios indicated that tools had the greatest impact on the TWDTP, followed by the quality of the physical environment, while human factors had the least influence on the task performance. Convenient functional maintenance is the key to improving the TWDTP, along with enhancing the quality of the working environment. Once these main aspects are optimized, it is important to consider additional factors such as availability of spare tools, efficient personnel organization, man-tool matching, and safety and health assurance. This research approach provides significant guidance in understanding the relationships between the man-machine environmental factors affecting the performance of complex engineering tasks and identifying key influencing factors, thus providing essential insights for optimizing the TWDTP.