Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. The surgical technique is described step-by-step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

Glaucoma is one of the primary causes of blindness worldwide. Canal opening surgery, a type of minimally invasive glaucoma surgery (MIGS) applied in cases of mild to moderate glaucoma, has gained increasing popularity in recent years due to its efficacy in reducing intraocular pressure, its safety profile, the simplicity of its technique, and the reduced likelihood of compromised vision. Nevertheless, the existing body of histopathological studies remains insufficient for a comprehensive understanding of post-surgical wound healing. Consequently, debates persist among researchers regarding the mechanism through which Schlemm’s canal opening surgery reduces intraocular pressure, as well as the surgical techniques that may impact the outcomes and the factors influencing surgical success. As the history of MIGS is relatively short and lacks sufficient systemic reviews or meta-analysis evaluating the influence of individual factors, this review was conducted to illuminate disparities in the researchers’ opinions at the current stage of research.

Event detection provides a crucial foundation for intelligent text analysis and supports numerous downstream applications. However, existing detection models often fail to meet the high accuracy requirements and typically require a human–machine collaborative detection mode involving “machine detection followed by manual audit and correction.” Analysis reveals that the recall rate of machine detection is a major factor limiting the efficiency of human–machine collaboration. To address this at its root and ensure high recall, an event trigger recommendation task is introduced, and a span-based recommendation model for Chinese, SpETR (Span-based Event Trigger Recommender), is developed. This model integrates confidence information from both trigger identification and event classification stages to recommend candidate triggers and their event types for each event. To enhance recall, a semantic boundary smoothing method is proposed, which assigns soft labels to spans around gold triggers based on semantic completeness and part-of-speech, combined with a modified focal loss function to make the model predictions smoother. Experiments on DuEE and a self-built dataset show that SpETR is most effective when the number of recommendations is set to 3, achieving recall rates of 97.76% and 98.70%, respectively, comprising improvements of 4.30% and 5.22% over the optimal baseline models. In terms of human–machine collaborative detection, SpETR saved 30.6% and 25.8% of time compared to traditional detection models on two datasets, and the average F1 score of the annotation results was also improved by 5.35% and 3.48%, respectively.

Gilbert's syndrome (GS) is a common hereditary condition characterized by mild increases in serum bilirubin levels due to inherited defects in bilirubin metabolism. This review, based on data from peer-reviewed articles and journals spanning from 1977 to January 2024, provides a comprehensive overview of over four decades of research on GS. Early studies primarily focused on defining the clinical and genetic characteristics of the syndrome, laying the foundation for subsequent investigations. More recent research has delved into the genetic mechanisms underlying the reduced expression of bilirubin UDP-glucuronosyltransferase, which has significantly enhanced our understanding of the pathogenesis of GS. Furthermore, recent studies have shed light on the clinical implications of GS, including its association with non-alcoholic fatty liver disease and mortality risk, highlighting the complex interplay between genetic factors, bilirubin metabolism, and clinical outcomes. Despite its generally benign nature, thorough research is essential to fully understand the impact of GS on patients' lives. This review emphasizes the importance of ongoing research to deepen our understanding of GS and its broader implications.

Surgical approaches for ovarian cancer have advanced significantly in recent years. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in gyneco-logical oncology, with limited reports of its use in ovarian cancer management. This study aimed to evaluate the feasibility and safety of vNOTES for the surgical staging of early-stage adnexal malignancies. Methods: We retrospectively reviewed all cases of borderline ovarian tumors (BOTs) and early-stage ovarian cancer surgically staged using vNOTES at our institution between October 2021 and August 2024. Results: Eleven patients were included, 7 with ear-ly-stage ovarian or tubal cancer and 4 with BOTs. The median age was 47 (27 – 81) years, and the median body mass index was 28.1 (22.4 – 39.2) Kg/m². Complete vNOTES staging was achieved in all cases, including peritoneal washing, unilateral/bilateral salpingo-oophorectomy, ab-dominal cavity inspection, peritoneal biopsies, infracolic omentectomy, and total hysterectomy when required. The median operating time was 70 (35 – 138) minutes, with a median blood loss of 50 (10 – 100) mL. No intraoperative complications occurred except for one case of minor ovar-ian spillage. No conversions to laparoscopy or laparotomy were needed. Postoperative compli-cations included one surgical site infection (9.1%) and two cases of postoperative cystitis (18.2%). No severe complications graded ≥3 on the Clavien-Dindo classification were observed. Conclu-sion: vNOTES appears to be a feasible and safe approach for the surgical staging of selected pa-tients with early stage adnexal malignancies. Further studies are needed to validate its long-term safety and oncological outcomes.

Ballastless track has high smoothness, but the laying requirements are strict. Therefore, the maximum span of cable-stayed bridges laying ballastless tracks is 392m. For laying ballastless track structures over larger spans, the deformation characteristics of long-span cable-stayed Bridges under complex loads are incomplete, and the interaction between long-span bridge-track structures is unclear. The influence of wavelength of cosine wave on the track- bridge mapping of different orbital structures was explored. The wavelength characteristics of vertical deformation under complex loads were investigated. The track-bridge integrated model for the cable-stayed bridge was establish to analyze the mapping relationship between rail and bridge and wavelength characteristics of deformation. Based on mapping relationships and wavelength characteristics of deformation, the Train-Track-Bridge dynamic simulation model was simplified. The results show that when the minimum wavelength of bridge deformation surpasses 6 m, 10 m, and 16 m, the rail deformation in the ballasted track, the longitudinal-connected track, and the unit slab-type ballastless track accurately mirrors the deformation of the bridge. For the span of bridge ranging from 200 m to 600 m, the wavelength of vertical deformation ranges from 21 to 1270 m under complex loads. During local loads, the vertical deformation below the 200 m wavelength constitutes a significant proportion near the pie. Considering the influence of the deformation on train vibration response, the Train-Bridge dynamic coupling model can be employed to treat the track structure as a load to reduce complexity of model and enhance the calculation efficiency.

A large body of evidence reports about the positive effects of physical activity in pathophysiological conditions associated with aging. Physical exercise, alone or in combination with other medical therapies, unquestionably causes reduction of symptoms in chronic non-transmissible diseases often leading to significant amelioration or complete healing. The molecular basis of this exciting outcome, however, remain largely obscure. Epigenetics, exploring at the interface between environmental signals and the remodelling of chromatin structure, promises to shed light on this intriguing matter possibly contributing to the identification of novel therapeutic targets. In this review, we shall focalize on the role of sirtuins (Sirts) a class III histone deacetylases (HDACs) which function has been frequently associated, often with a controversial role, to the pathogenesis of aging-associated pathophysiological conditions including cancer, cardiovascular, muscular, neurodegenerative, bones and respiratory diseases. Numerous studies, in fact, demonstrate that Sirt-dependent pathways are activated upon physical and cognitive exercises linking mitochondrial function, DNA structure remodelling and gene expression regulation to designed medical therapies leading to tangible beneficial outcomes. However, in similar conditions, other studies assign to sirtuins a negative pathophysiological role. In spite of this controversial effect, it is doubtless that studying sirtuins in chronic diseases might lead to an unprecedented improvement of life quality in the elderly.

This case report demonstrates the rare but potentially serious complication of pulmonary vein stenosis (PVS) diagnosed several years after radiofrequency ablation for atrial fibrillation. Pulmonary vein stenosis can remain asymptomatic until significant occlusion occurs, after which it can present with a variety of symptoms, mimicking numerous cardiovascular and pulmonary pathologies. Early diagnosis and treatment rely on consistent follow-up using appropriate diagnostic imaging modalities, which are paramount in preventing severe complications.

The document sets out three differentiated proposals for the transport of medicines through RPAS with their respective regulations, adapted to different operational categories: open category, special category and military scope. In the open category, an economical and efficient solution is prioritized for urban and rural areas, complying with weight and height regulations, in addition to guaranteeing the stability and quality of medications during transportation. The special category allows more complex operations and in more adverse conditions, such as densely populated areas and long routes, incorporating advanced security measures and training for personnel. In the military field, RPAS are used in conflict zones and hard-to-reach areas, ensuring the safe and rapid delivery of medical supplies under extreme conditions. Success stories in different countries are highlighted, demonstrating significant improvements in delivery times and risk reduction for health personnel.

We delve into the axion-dilaton model within the supergravity framework, with a specific focus on the intricacies of domain wall construction and stability. Employing holographic vitrification, we unravel the dynamics of domain wall formation in gauge theories featuring periodic vacuum structures. Our model, incorporating a QCD-like axion term and a stabilizing dilaton, undergoes scrutiny for conductivity variations under weak disorder. The investigation reveals the model's resilience, manifesting near-perfect conductivity under mild disorder conditions. However, the rigorous mathematical motivation for the holographic setup demands further elucidation. The scattered nature of our results prompts the necessity for a more systematic interpretation of QCD phenomena and conductivity transitions. This study contributes to the mathematical understanding of the axion-dilaton model's behavior, highlighting the imperative for a refined holographic framework and a more coherent interpretation of observed phenomena.

Conclusions: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.

As Chronic Non-Communicable Diseases (CNCD) increase, preventive approaches become more crucial. In this review, Calorie Restriction (CR) effects on human beings were evaluated, comparing benefits and risks of different CR diets: classic CR vs ketosis-inducing diets, including Intermittent Fasting (IF), Classic Ketogenic Diet (CKD), Fasting Mimicking Diet (FMD), Very-Low-Calorie Ketogenic Diet (VLCKD) and Spanish Ketogenic Mediterranean Diet (SKMD). Special emphasis on Insulin Resistance (IR) was placed, as it mediates Metabolic Syndrome (MS), a risk factor for CNCD, and predicts MS diagnosis. CR is the most robust intervention known to increase lifespan and health span, with high evidence and known biochemical mechanisms. CR improves cardiometabolic risk parameters, boosts exercise insulin sensitivity response, and there may be benefits of implementing moderate CR on healthy young and middle-aged individuals. However, there is insufficient evidence to support long-term CR. CKD is effective for weight and MS management, and may have additional benefits such as prevention of muscle loss and appetite control. SKMD has extreme significance benefits for all the metabolic parameters studied. Studies show inconsistent benefits of IF compared to classic CR. More studies are required to study biochemical parameters, reinforce evidence, identify risks, and seek effective and safe nutritional CR approaches.

Epoxy asphalt (EA) concrete is widely used in constructing long-span steel bridge pavements (SBDPs). This study aims to derive a fatigue damage evolution law, conducting an experimental investigation of SBDP. First, a general theoretical form of the fatigue damage evolution law of materials is established based on the thermal motion of atoms. Then, fatigue experiments demonstrate that this evolution law well represents the known damage–life relationships of SBDP. Taking into account the experimental relationships between damage and fatigue life under symmetrical cyclic loadings with different overload amplitudes and temperature variations, a detailed damage evolution law is deduced. Finally, the role of damage accumulation is discussed on the basis of the proposed damage evolution law for the extreme situation of heavy overload and severe environments. The results show that both heavy loading and falling temperatures increase the fatigue damage of SBDP considerably; therefore, SBDP should avoid heavy loading combined with winter temperatures. EA shows a fatigue life two to three times longer than that of modified matrix asphalt (SMA) or guss asphalt (GA). For the same thickness, EA pavement is demonstrated to be more suitable for an anti-fatigue design of large-span SBDP under high traffic flows and low temperatures.

This paper introduces an innovative theoretical framework for quantum-inspired data embeddings, grounded in foundational concepts of quantum mechanics such as superposition and entanglement. This approach aims to advance semi-supervised learning in contexts characterized by limited labeled data by enabling more intricate and expressive embeddings that capture the underlying structure of the data effectively. Grounded in foundational quantum mechanics concepts such as superposition and entanglement, this approach redefines data representation by enabling more intricate and expressive embeddings. Emulating quantum superposition encodes each data point as a probabilistic amalgamation of multiple feature states, facilitating a richer, multidimensional representation of underlying structures and patterns. Additionally, quantum-inspired entanglement mechanisms are harnessed to model intricate dependencies between labeled and unlabeled data, promoting enhanced knowledge transfer and structural inference within the learning paradigm. In contrast to conventional quantum machine learning methodologies that often rely on quantum hardware, this framework is fully realizable within classical computational architectures, thus bypassing the practical limitations of quantum hardware. The versatility of this model is illustrated through its application to critical domains such as medical diagnosis, resource-constrained natural language processing, and financial forecasting—areas where data scarcity impedes the efficacy of traditional models. Experimental evaluations reveal that quantum-inspired embeddings substantially outperform standard approaches, enhancing model resilience and generalization in high-dimensional, low-sample scenarios. This research marks a significant stride in integrating quantum theoretical principles with classical machine learning, broadening the scope of data representation and semi-supervised learning while circumventing the technological barriers of quantum computing infrastructure.

The survival analysis of the Cancer Genome Atlas (TCGA) dataset is a well-known method to discover the gene expression-based prognostic biomarkers of head and neck squamous cell carcinoma (HNSCC). A cutoff point is usually used in survival analysis for the patients' dichotomization in the continuous gene expression. There is some optimization software for cutoff determination. However, the software's predetermined cutoffs are usually set at the median or quantiles of gene expression value to perform the analyses. There are also few clinicopathological features available on their pre-processed data sets. We applied an in-house workflow, including data retrieving and pre-processing, feature selection, sliding-window cutoff selection, Kaplan-Meier survival analysis, and Cox proportional hazard modeling for biomarker discovery. In our approach for the TCGA HNSCC cohort, we scanned human protein-coding genes to find optimal cutoff values. After adjustment with confounders, the clinical tumor stage and the surgical margin involvement are independent risk factors for patients' prognosis. According to the resulting tables with Bonferroni-adjusted P value under the optimal cutoff and the hazard ratio, three biomarker candidates, CAMK2N1, CALML5, and FCGBP, are significantly associated with the patients' overall survival. We validated this discovery by using the other independent HNSCC dataset (GSE65858). Thus, we suggest the transcriptomic analysis could help for biomarker discovery.

The affinity constant, also known as the equilibrium constant, binding constant, equilibrium association constant, or the reciprocal value, the equilibrium dissociation constant (K_d), can be considered as one of the most important characteristics for any antibody-antigen pair. Many methods based on different technologies have been proposed and used to determine this value. However, since a very large number of publications and commercial datasheets do not include this information, significant obstacles in performing such measurements seem to exist. In other cases where such data are reported, the results have often proved to be unreliable. This situation may indicate that most of the technologies available today require a high level of expertise that does not seem to be available in many laboratories. In this paper, we present a simple approach based on standard immunoassay technology that is easy and quick to perform. It relies on the effect that the molar IC₅₀ approaches the K_d value in the case of infinitely small concentrations of the reagent concentrations. A two-dimensional dilution of the reagents leads to an asymptotic convergence to K_d. The approach has some similarity to the well-known checkerboard titration used for the optimization of immunoassays. A well-known antibody against the FLAG peptide, clone M2, was used as a model system and the results were compared with other methods. This approach could be used in any case where a competitive assay is available or can be developed. The determination of an affinity constant should belong to the crucial parameters in any quality control of antibody-related products and assays and should be mandatory in papers using immunochemical protocols.

Spinal Cord Stimulation (SCS) is an effective and validated treatment to address chronic refractory neuropathic pain in Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients. Surgical SCS lead placement is traditionally performed under general anesthesia due to its invasiveness. In parallel, recent works have suggested that Awake Anesthesia (AA), consisting in Target Controlled Intra-Veinous Anesthesia (TCIVA), could be an interesting tool to optimize lead anatomical placement using patient intra-operative feedback. We hypothesized that combining AA with Minimal Invasive Surgery (MIS) could improve SCS outcomes. The goal of this study was to evaluate SCS lead performance (defined by the area of pain adequately covered by paraesthesia generated via SCS), using an intraoperative objective quantitative mapping tool, and secondarily to assess pain relief, functional improvement and change in quality of life with a composite score. We analyzed data from a prospective multicenter study (ESTIMET) to compare the outcomes of 115 patients implanted with MIS under AA (MISAA group) or General Anesthesia (MISGA group), or by Laminectomy under General Anesthesia (LGA group). All in all, MISAA appears to show significantly better performance in terms of patient pain coverage, as well as improved secondary outcomes. One step further, our results suggest that MISAA combined with intra-operative hypnosis could potentialize patient intraoperative cooperation and could be proposed as a personalized package offered to PSPS-T2 patients eligible for SCS implantation in highly dedicated neuromodulation centers.

Research question/problem: This comprehensive review and comparative analysis aims to investigate the significance of enhancing oxygen provision in the context of COVID-19, focusing on the implications for healthcare policies and services.Background/context: The study addresses the shift in the oxygen dissociation curve of blood in COVID-19 patients, emphasizing the impact on oxygen delivery to tissues and the challenges it poses for clinical management. It also explores the disruption of healthcare systems due to the pandemic and the integration of social determinants of health in clinical environments.Methodology: The research incorporates a thorough literature review, comparative analysis of diverse approaches to oxygen delivery, and examination of successful interventions through case studies and best practices. Data collection techniques include the review of scholarly articles, case studies, and policy documents.Results/Key findings: The study highlights the imperative for augmented oxygen supply and the significance of maintaining appropriate oxygen saturation levels, especially in the context of respiratory illnesses like COVID-19. It also emphasizes the positive correlation between increased oxygen saturation levels and life expectancy, indicating potential health benefits of enhanced oxygen availability.Conclusions/Implications: The findings underscore the need for a structured approach to oxygen therapy and the importance of equitable distribution of oxygen to underserved regions. The implications of the research extend to enhancing healthcare policies and services regarding oxygen provision during the COVID-19 pandemic, especially in rural and remote areas.

Long-span steel structure trusses are widely used in factory buildings, but with the growth of service time and the increase of dynamic load fatigue, a considerable part of the long-span truss with dynamic load appears serious transverse cracks at the bottom of the middle span and oblique deformation of the abdomen in the operation process. The U-shaped cracks at the bottom and belly, as well as the mid-span down deflection of the main truss, reduced the functional function of the factory building truss structure, and had to limit the original crane load, which affected the normal safety and durability of the structure. Therefore, the application principle of the variable axial force cable system in the long-span factory building truss structure and 3D3S software modeling [1] were used. Analyzing and studying the reinforcement method of large-span powerhouse truss can provide practical experience for subsequent similar projects. In view of the above phenomenon, the large-span powerhouse trusses of Hongcheng Powerhouse 1 and No.2 located in Tonglu, Zhejiang Province are used as the research object, and the variable axial force cable method is proposed to strengthen and lift the load. Considering the span of large-span powerhouse truss, the cable system with 22m controlling force of 400kN is proposed to be selected for powerhouse 1, and the cable system with variable axial force of 24m is proposed to be selected for Powerhouse 2. The force model of large-span truss is established by using the finite element method commonly used to analyze the force of truss. Under two working conditions, The influence of reinforcement effect is analyzed and compared from three aspects: stiffness, bearing capacity and stability. And the phenomenon of uneven stress distribution is analyzed. The stress distribution characteristics of each node are understood by simulating the most disadvantageous node plates with the greatest internal force before and after reinforcement.

This study delves into the intricate interplay between cosmology and gravity in dilaton-based models, enhancing our understanding. Exploring boundary theories coupled to gravity, we derive a four-dimensional effective theory from the cosmological constant. Dilaton gravity is then scrutinized, revealing elegant solutions and insights into brane embedding. The analysis extends to probe scalar fields, employing the WKB approximation in both conformal and non-conformal cases. In summary, this work contributes to a nuanced understanding of the complex relationship between cosmology and gravity in dilaton-based frameworks.

We introduce the linear subgroup of volume-preserving diffeomorphism as the underlying symmetry to construct an action within the effective field theory framework and the Schwinger-Keldish formalism. The formulated action is posited to effectively incorporate dissipative effects into the Navier-Stokes equations.

Ramsey theory enables re-shaping of the basic ideas of the quantum mechanics. Quantum observables, represented by linear Hermitian operators are seen as the vertices of the graph. Relation of commutation define coloring of the edges linking the vertices: if the operators commute, they are connected with the red link; if they do not commute they are connected with the green link. Thus, a bi-colored, complete, Ramsey graph emerges. According to the Ramsey theorem, complete, bi-colored graph built of six vertices, will inevitably contain at least one monochromatic triangle; in other words, the Ramsey number R(3,3)=6. In our interpretation, this triangle represents the triad of observables, which could or, alternatively, could not be established simultaneously in a given quantum system. The Ramsey approach to the quantum mechanics is illustrated with the numerous examples, including the motion of a particle in a centrally symmetrical field.