Introduction:Lumbar radiculopathy, frequently triggered by disc herniation, affects around one in 50 young adults (30-55 ages), leading to significant impacts on quality of life. When conservative treatments fail to alleviate symptoms, surgical intervention such as discectomy is often pursued. Technological advancements have led to various minimally invasive techniques, promising improved outcomes. Our aim was to compare clinical outcomes of different techniques.Methods:We conducted a systematic search in PubMed using "lumbar disc hernia" and the meta-analysis filter. Inclusion criteria comprised meta-analyses focusing on lumbar disc herniation treatments, published in English. A rigorous selection process adhering to PRISMA guidelines ensured high-quality evidence extraction.Results:From 28,171 initial records, 31 meta-analyses involving 87,852 patients were included. Heterogeneity across the literature presented challenges, notably in study populations, surgical techniques, and research designs. Among the techniques evaluated, full-endoscopic lumbar discectomy (FELD) emerged as superior in various perioperative parameters, including Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), operation time, and complications. Conversely, automated percutaneous discectomy (AUTD) consistently exhibited poorer outcomes, suggesting limited effectiveness compared to other techniques. Conclusion:Despite advancements, the heterogeneity observed in the literature underscores the need for standardized approaches in minimally invasive spinal surgery research. FELD stands out as a preferred technique, offering favorable outcomes across multiple parameters. Conversely, techniques like AUTD raise concerns regarding efficacy. Future research should aim for uniformity in methodologies to facilitate accurate comparisons and guide clinical decision-making.

Study design :Technical note. Objectives : To present a new unilateral biportal endoscopic technique for lumbar disc herniation without C-arm . Background : Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. Our study introduces the use of standard intraoperative navigation in unilateral biportal endoscopy (UBE) to reduce radiation exposure and increase surgical acuracy. Materials and Methods : A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had have conservative treatment for 12 months in another hospital before admission. However, the conservative treatment did not work for him. He had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle waekness of bilateral legs (Manual muscle testing ;MMT of extensor hullusis longs 4 4), and numbness of bilateral lower leg. Preoperative lumbar MRI showed L4/5 large central disc herniation. Results: He underwent C-arm free unilateral biportal endoscopic discectomy under the guidance of O-arm navigation. The patient was successfully treated surgically. Postoperative lumbar MRI showed good decompression of dural sac and bilateral L5 nerve roots. MMT and sensory function of both leg had recovered fully on final follow-up at one year. Conclusions/Level of Evidence: The new unilateral biportal endoscopic technique under navigation guidance is useful technique for lumbar disc herniation. This innovative technique proved to be safe, accurate, and minimized radiation exposure for surgeons for the treatment of lumbar intervertebral disc herniation. Level V.

The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients while reducing the medical risks of aggressive open surgery.

Objective To explore the endoscopic anatomical structures of lumbar surgery. Methods A total of 290 patients who underwent lumbar endoscopic surgery due to lumbar intervertebral disc (IVD) herniation from September 2020 to September 2022 were retrospectively reviewed in our hospital,179 patients had complete surgical video recordings, including 108 males and 71 females, aged from 19 to 65 years, with an average age of 41±16 years. The endoscopic structures through the intervertebral foramen and interlaminar space were independently identified by 3 doctors with more than 3 years of related surgery experience. When there were differences of opinions, the three doctors would discuss and come to a consensus. The probability, location, and neighboring structures of each specific structures were statistically analyzed. Results The anatomical structures observed through the lumbar foramen under endoscopy include muscles and ligaments attached to the superior articular process (SAP), main blood vessels inside the intervertebral foramen, blood vessels on the surface of IVD, and blood vessels on the surface of the dural sac and nerve root. The major anatomical structures observed through interlaminar space are multifidus, the conjugated ligament of ligament flavum and capsule ligament (capsule part of flavum ligaments), edges of the lamina, specific vessel bundle to facet with exit nerve root. Conclusion The anatomical structures under spinal endoscopy have certain characteristics, which are grossly different from those under open surgery. Familiarity with these anatomical structures has important clinical significance.

The aging of the population in developing and developed countries has lead to a significant increase in health burden of spinal diseases. These elderly patients often have a number of medical co-morbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits such as minimal muscle trauma, minimal bony resection, lesser post-operative pain, decreased infection rate and shorter hospital stay. Over the last 40 years, constant efforts are being made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS which has all the benefits of modern MISS. Endoscopic spine surgery initially was limited only to treatment of lumbar disc herniations. With improvement in optics, endoscopes, endoscopic drills and shavers, irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification thus allowing its application not only to lumbar spinal stenosis, but also to spinal fusion surgeries, cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. For the purpose of this review, we studied current available literature and outlined the historical evolution of endoscopic spine surgery, the various different endoscopic systems, and techniques available and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.

Advances in gastric cancer screening and endoscopic technology have made it possible to detect and treat gastric cancer at an early stage. As a result, about 40% of all gastric cancers have now been resected by endoscopic treatment in Japan. In endoscopic diagnosis, magnifying endoscopic observation using band-limited light such as narrow band imaging (NBI) has significantly improved the accuracy of gastric cancer diagnosis. At the same time, in endoscopic treatment, endoscopic submucosal dissection (ESD) has contributed to increase explosively the number of gastric cancers which could be resected endoscopically. In recent years, the construction of algorism for endoscopic diagnosis and treatment with a view to personalized medicine has been explored, and endoscopic use for gastric cancer managements is expected to develop further in the future. Keywords (5 words):

Abstract: Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percu-taneous drainage for this condition is controversial. This study compared the clinical and radio-logic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-center cohort study enrolled patients with symp-tomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n=22; combined modality approach, n=12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. After treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both the total hospital stay (55 days vs 71 days; p=0.071) and time to complete radiologic resolution were shorter (93 days vs 124 days; p=0.23) in the endoscopic approach group. Conclusion: The endoscopic step-up approach resulted in the clinical resolution of symptomatic walled-off pancreatic necrosis comparable to that of the combined modality drainage. However, the endoscopic approach alone allows higher clinical success, early clinical and radiologic resolution, and a shorter hospital stay.

Background: The two-stage technique combining the Endoscopic Retrograde CholangioPancreatography (ERCP) with common bile duct (CBD) clearance carried out before the laparoscopic cholecystectomy represents the most common approach for CBD stones. Over time, different techniques have been proposed to manage cholecysto- choledocholithiasis (CCL) advantageously in one stage. Among these, the laparoendoscopic rendez-vous (LERV) addresses the CCL issue with a laparoscopic cholecystectomy with insertion of a guide wire performed at initial stage of the procedure, followed by the clearance of the bile duct carried out by the endoscopists. The goal of this study was to evaluate the efficacy and safeness of LERV procedure recording results and complications, also making a comparison between our results and current literature. Methods: We reviewed our experience of all consecutive patients with cholecysto-choledocholithiasis managed with LERV between January 2018 and December 2023. LERV success rate, operative time, length of hospital stay, stone recurrence, incidence of endoscopic and surgical complications were analysed. Results: A total of 120 patients underwent LERV in our facilities. We reported a 97% LERV success rate, 1.6% conversion-to-open rate, a median intraoperative time of 122 (range 95-220) min. The median hospital stay was 4 (range 2-38) days. An overall morbidity of 15% was reported (18/120): 15 Clavien-Dindo type 1/2, 2 type 3a and one type 3b. In two cases a re-operation during the hospital stay was necessary. At a median follow-up of 14 months (3-59) five patients experienced stone recurrence requiring redo-ERCP in two cases. Conclusion: LERV offers the significant advantage of a single stage procedure and hospitalisation along with a lower risk of post-ERCP pancreatitis, failed CBD cannulation and complications. Our experience confirms safety and effectiveness of the technique for CCL management.

Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs), and a high success rate of stone removal has been reported. However, EST is associated with the risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow-up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years; including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted, and pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean, 96%). The incidence of pancreatitis was 0%–9.6% (mean, 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3%–5.4% (mean, 2.7%). According to the grade of bleeding, seven and four cases were mild (64%) and moderate (36%), respectively, Compared with adult cases who underwent EST, the frequency of pancreatitis and bleeding was almost similar in children.; however once bleeding occur, it has a higher risk of leading to blood transfusion in children. Stone removal by EPBD in children was 100% successful. All complications were pancreatitis, and its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2–3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal by EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation by EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered an effective method for CBDS removal in children.

Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly for the neurovascular structures which it contains, therefore a detailed knowledge of its anatomy is mandatory for the surgical unlocking. To compare the anatomy of this region from different endoscopic and microsurgical operative corridors, also focusing on the corresponding anatomic landmarks met along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors and provide indications regarding the optimal approach according to the lesion location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA) and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space have been described and compared from these surgical perspectives. Results: The SETOA allowed the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed to disclose in a minimally invasive fashion, also the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan’s triangle. Through the anterolateral triangle, the transorbital corridor allowed to expose the lateral 180 degrees of vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA, at its the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel’s cave. Conclusion: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of tumor and cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes in the exposure of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.

Differential diagnosis of solid pancreatic lesions (SPLs) using B-mode endoscopic ultrasonography (EUS) is challenging. Detective flow imaging (DFI) offers the potential for detecting low-flow vessels in the pancreas, thus enhancing diagnostic accuracy. This study aimed to investigate DFI-EUS findings of SPLs and analyze their differential diagnostic accuracy for pancreatic cancer. This retrospective study included patients with pathologically confirmed SPLs who underwent EUS between April 2021 and June 2023. Expert endosonographers, blinded to the patients’ clinical data, evaluated images obtained through B-mode, eFLOW, and DFI-EUS. Frame rate and vessel detection sensitivity between eFLOW and DFI were compared, and diagnostic criteria for pancreatic cancer were established. This study included 104 patients, most diagnosed with pancreatic cancer. DFI-EUS demonstrated a significantly higher vessel visualization rate (96%) in SPLs compared to eFLOW (27%). Additionally, DFI showed a superior frame rate, sensitivity (99%), and accuracy (88%) in detecting pancreatic cancer, although with a modest specificity (43%). On DFI-EUS, characteristics such as hypovascular, peritumoral, or spotty vessel findings were suggestive of pancreatic cancer. DFI-EUS significantly improved the visualization of vascular structures within the SPLs, highlighting its efficacy as a diagnostic modality for pancreatic cancer.

Dementia is a rising public health concern. Feeding and nutritional problems increase as the disease progresses, affecting clinical course and caregiver burden. While some guidelines advise against percutaneous endoscopic gastrostomy (PEG) and tube feeding in advanced dementia, conflicting evidence exists. This study aims evaluating nutritional status and the influence of PEG-feeding on outcome and evolution of nutritional/progonosis markers of patients with severe dementia (PWSD) who underwent gastrostomy for nutritional support. We conducted a 16-year rectrospective study on 100 PEG-fed PWSD with strong familiar support. We evaluated survival PEG-feeding period, safety, and objective nutritional/progonosis data at the gastrostomy day and after 3 months: Body Mass Index (BMI), Mid Upper Arm Circumference, Tricipital Skinfold, Mid-Arm Muscle Circumference, albumin, transferrin, total cholesterol and hemoglobin. Most patients presented low values in these nutritional/progonosis parameters. No major life-threatening PEG complications were reported. The mean survival time after gastrostomy was 27.9 months (median of 17 months). Female sex, BMI recovery at 3 months, and higher baseline hemoglobin levels were associated with a reduced risk of death and increased survival time. The study concluded that, in carefully selected PWSD with strong familiar support, PEG feeding can improve nutritional status and have a positive impact on survival.

Background: Endoscopic Ultrasound (EUS) is widely used for the diagnosis of bilio-pancreatic and gastrointestinal (GI) tract diseases, for the evaluation of subepithelial lesions, and for sampling of lymph nodes and solid masses lo-cated next to the GI tract. The role of Artificial Intelligence in healthcare in growing. This review aimed to provide an overview of the current state of AI in EUS from imaging to pathological diagnosis and training. Methods: AI algorithms can assist in lesion detection and characterization in EUS by analysing EUS images and identifying suspicious areas that may require further clinical evaluation or biopsy sampling. Deep learning tech-niques, such as convolutional neural networks (CNNs), have shown great potential for tumour identification and subepithelial lesion (SEL) evaluation by extracting important features from EUS images and using them to classify or segment the images. Results: AI models with new features can increase the accuracy of diagnoses, provide faster diagnoses, identify subtle differences in disease presentation that may be missed by human eyes, and provide more information and in-sights into disease pathology. Conclusions: The integration of AI in EUS images and biopsies has the potential to improve the diagnostic accura-cy, leading to better patient outcomes and to a reduction of repeated procedures in case of non-diagnostic biopsies.

Although pancreatic neuroendocrine neoplasms (PNENs) are relatively rare tumors, their number is increasing with advances in diagnostic imaging modalities. Even small lesions that are difficult to detect using computed tomography or magnetic resonance imaging can be detected with endoscopic ultrasound (EUS). Contrast-enhanced EUS is useful, and not only diagnosis but also malignancy detection have become possible by evaluating the vascularity of tumors. Pathological diagnosis using EUS with fine-needle aspiration (EUS-FNA) is useful when diagnostic imaging is difficult. EUS-FNA can also evaluate the grade of malignancy. Pooling the data of the studies which compared the PNENs grading between EUS-FNA samples and surgical specimen, the concordance rate was 77.5% (κ-statistic: 0.65, 95% confidence interval = 0.59 - 0.71, P< 0.01). EUS is a particularly important modality for the treatment of PNENs.

Background: Pro-golfers are increasingly trained scientifically, but swing technique characteristics have not yet been conclusively determined for golf performance. We investigated the relationship between the player's thorax, pelvis and club based on a wireless biofeedback system. We also determined whether thoracic and pelvic changes during different swing phases have different effects on ball striking. Methods: Eight male professionals performed 10 successful full-swing shots using a 5-iron and applied the K-vest wireless biofeedback system for analysis. Results: Peak angular velocities between the pelvis, torso, and clubs were all significantly different (p&lt;0.05) in the men's professional players. All players deviated more from the PGA players range metrics during the preparation stance. Excessive lateral pelvic bending angle, over-rotation, and hyperextension of the trunk were prevalent at the top of the backswing. Conclusions: Most players have an irrational sequence of pelvic, trunk and club rotation times, which is not conducive to improving club head speed and distance. Excessive pelvic rotation in the closed direction at the apex of the backswing is not conducive to maximizing the X-factor. At the moment of striking the ball, maintain a moderate forward trunk lean and full trunk rotation to avoid sports injuries.

Endoscopic retrograde cholangiopancreatography (ERCP) is a routinely used therapeutic procedure for the biliary and pancreatic diseases. Population aging may increase the typical indications of ERCP and come with more complexity and difficulties, especially in cannulation. This study aimed to evaluate the incidence, causes, and management of difficult biliary cannulation during ERCP in super-aged patients and the role of difficult cannulation as a risk factor for adverse events. A total of 614 patients, underwent ERCP, were prospectively studied as a cohort and divided into two groups based on their age. There were 146 patients aged 80 years or older in group A and 468 patients aged less than 80 years in group B. The primary outcome measures were the difficulty grade of papilla cannulation, clinical outcomes, and ERCP-related complications in the two groups. The adverse events were analyzed using logistic regression for patient age, co-morbidities, indications, and cannulation difficulty grade variables. There was no difference in the incidence of difficult cannulation between the two groups (32.9% vs. 34.4%, p=0.765) though, as expected, super-aged Group A had a higher prevalence of periampullary diverticulum (29.5% vs. 16.7%, p=0.001). The technical cannulation success rate was (96.6% vs. 96.8%, p= 0.54). All used cannulation techniques in the elderly group were efficient and safe. Logistic regression showed that age ≥80 was not associated with increased adverse events; however, difficult cannulation (adjusted odds ratio [AOR]=3.478; 95% confidence interval [CI]=1.877, 6.442; p<0.001) and CCI ≥2 (AOR=1.824; 95% CI=0.993, 3.349; p=0.045) were more likely to have adverse events. Age ≤65 (AOR=3.460; 95% CI=1.511, 7.922; p=0.003), female gender (AOR=2.362; 95% CI=1.089, 5.124; p=0.030), difficult cannulation (AOR=4.527; 95% CI=2.078, 9.860; p<0.001), and patients with cholangitis (AOR=3.261; 95% CI=1.204, 8.832; p=0.020) were strongly associated with increasing Post-ERCP Pancreatitis (PEP). Advanced age has not proved to be a risk factor of difficult cannulation, and secondary cannulation techniques can be safely and efficaciously utilized for this group. CCI ≥2 and difficult cannulation are associated with increased overall adverse events rate while age ≥80 factor is not.

Full Matrix Capture is a multi-channel data acquisition method which enables flexible, high resolution imaging using ultrasound arrays. However, the measurement time and data volume are increased considerably. Both of these costs can be circumvented via compressed sensing, which exploits prior knowledge of the underlying model and its sparsity to reduce the amount of data needed to produce a high resolution image. In order to design compression matrices that are physically realizable without sophisticated hardware constraints, structured subsampling patterns are designed and evaluated in this work. The design is based on the analysis of the Cramér-Rao Bound of a single scatterer in a homogeneous, isotropic medium. A numerical comparison of the point spread functions obtained with different compression matrices and the Fast Iterative Shrinkage/Thresholding Algorithm shows that the best performance is achieved when each transmit event can use a different subset of receiving elements and each receiving element uses a different section of the echo signal spectrum. Such a design has the advantage of outperforming other structured patterns to the extent that suboptimal selection matrices provide a good performance and can be efficiently computed with greedy approaches.

Endoscopic medical images can suffer from uneven illumination, low contrast, and lack of texture information due to the use of point directional light sources and the presence of narrow tissue structures, posing diagnostic difficulties for physicians. In this paper, a deep learning-based su-pervised illumination enhancement network is designed for low-light endoscopic images, aiming to improve both global illumination and local details. Initially, a global illumination enhancement module is formulated utilizing a higher-order curve function to improve global illumination. Sec-ondly, a local feature extraction module incorporating dual attention is designed to capture local detailed features. Considering the significance of color fidelity in biomedical scenarios, the designed loss function prioritizes introducing color loss to alleviate image color distortion. Compared with seven state-of-the-art enhancement algorithms on Endo4IE endoscopic datasets, experimental re-sults show that the proposed method can better enhance low-light endoscopic images and avoid image color distortion. It provides an efficient method to enhance images captured by endoscopes which can effectively assist clinical diagnosis and treatment.

Background and Objectives: A novel synthetic self-assembling peptide, PuraStat, has been introduced as a hemostatic agent. This case series aimed to evaluate the clinical efficacy of PuraStat for gastrointestinal bleeding during emergency endoscopy. Cases: Twenty-five patients with gastrointestinal bleeding who had undergone emergency endoscopy with PuraStat between August 2021 and December 2022 were retrospectively examined. Six patients were receiving antithrombotic agent, and ten patients with refractory gastrointestinal bleeding had undergone at least one endoscopic hemostatic procedure. The breakdown of bleeding was gastroduodenal ulcer/erosion in 12 cases, bleeding after gastroduodenal or colorectal endoscopic resection in 4 cases, rectal ulcer in 2 cases, postoperative anastomotic ulcer in 2 cases, and gastric cancer, diffuse antral vascular ectasia, small intestinal ulcer, colonic diverticular bleeding, and radiation proctitis in each case. The method of hemostasis was only PuraStat application in six cases, and hemostasis in combination with high-frequency hemostatic forceps, hemostatic clip, argon plasma coagulation, and hemostatic agents (i.e. thrombin) in the remaining cases. Rebleeding was observed in three cases. Hemostatic efficiency was observed in 23 cases (92%). Conclusions: PuraStat has the expected hemostatic effect on gastrointestinal bleeding during emergency endoscopy. The use of PuraStat should be considered in emergency endoscopic hemostasis of gastrointestinal bleeding.

Surgeries that take place in medicine and dentistry or during any form of childbirth results in a significant amount of blood loss. The prevalent measurement methods that surgeons and anesthesiologists utilize as the “gold - standard” has several drawbacks. There are numerous other methods to measure blood loss, which, however, due to their impracticality and limitations, are not ideal either. This paper focuses on minimally invasive neurosurgery in particular, by taking into account a surgical technique known as Endoscopic Endonasal Transphenoidal surgery (EETS), which is used to treat pituitary tumors and adenomas. Along with the review of the existing literature pertaining to blood loss management, this paper proposes a modified electrode probe method along with the concept of usage, computer interface, and the system of integration. The probe is intended to measure the hematocrit count from the collected blood under all circumstances, such that the medical practitioner is assisted to improve the blood loss management technique for better patient recovery.

Aim: This study aimed to investigate the association between periampullary diverticulum (PAD) and difficult biliary cannulation, as well as to evaluate the impact of different types of PAD on the cannulation success rate and adverse events. Methods: A total of 636 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during the study period were prospectively studied and divided into two groups based on the presence or absence of PAD. In group A, 126 patients had PAD compared with 510 patients in group B without PAD. The primary outcome measurements were ERCP procedures time, selective cannulation techniques, and cannulation difficulty in addition to cannulation success rate and ERCP-related adverse events. The difficult cannulation was analyzed using logistic regression considering age, co-morbidities, the presence of PAD types, and indications as independent factors. Results: The average cohort age was 65.30±16.67 years, and 52.7% were male. Significant higher rates of choledocholithiasis, cholangitis, and biliary pancreatitis were reported in the group of PAD (p<0.05). Successful selective cannulation was achieved in 97.6% in group A and 95.3% in group B (p>0.05). The cannulation time was significantly longer in the presence of PAD (5.1 min, vs. 4.09 min, p<0.05). There was no significant difference in the rate of overall adverse events and post ERCP pancreatic PEP. Conclusion: The presence of PAD did not affect the duration or success of the ERCP procedure. Furthermore, it was associated with longer cannulation time and increase in the cannulation difficulty, especially with PAD type 1.

In this paper a full state feedback control of a double inverted pendulum on a cart (DIPC) are designed and compared. Modeling is based on Euler-Lagrange equations derived by specifying a Lagrangian, difference between kinetic and potential energy of the DIPC system. A full state feedback control with H infinity and H 2 is addressed. Two approaches are tested: open loop impulse response and a double inverted pendulum on a cart with full state feedback H infinity and H 2 controllers. Simulations reveal superior performance of the double inverted pendulum on a cart with full state feedback H infinity controller.

Muscle fatigue caused by using staplers affects the surgical procedures of surgeons. Compared to manual staplers, electric staplers decrease the muscle fatigue by replacing repeated gripping and releasing with automatic model. Still powered by the battery, the electric staplers are confronted with new operation fatigue due to the extra weight of the battery. The weight and manual operation of the electric stapler can cause user's muscle fatigue. To tackle the unsettled fatigue issue, the study is to propose a new design method to offset the influence of extra weight of the battery attached to the electrical stapler by changing the opening and closing of the stapler end clamp to electric control. The purpose of this study is to verify whether the design of this electric stapler can offset the impact of weight. Experiments are set up to test the feasibility of the design on 12 male Chinese surgeons. The muscle fatigue is indicated by measuring the EMG (electromyography) signal, and the stapler's working effect is indicated by measuring the end movement of the stapler. The result shows the new-designed stapler reduce the operation fatigue, counteracting the impact of the battery weight.

(1) Background: Endoscopic submucosal dissection (ESD) has been widely accepted as the standard method for treating early-stage cancer or precancerous lesions in the upper gastrointestinal tract, however it may be difficult in patients with liver cirrhosis due to coagulation dysfunction or presence of gastroesophageal varices. We aimed to demonstrate the safety and efficacy of ESD in these population. (2) Methods: We retrospectively collected the clinical data and analyzed. Patients inclusion criteria: 1) patients with liver cirrhosis; 2) patients who underwent ESD; 3) patients diagnosed of early-stage cancer or precancerous lesions in the upper gastrointestinal tract. (3) Results: Eight patients were enrolled from April 2019 to April 2023, of whom 3 were male and 5 female, with age ranging from 43 to 70 years old. Seven lesions were located in the stomach, and the other one lesion in the esophagus. ESD was performed successfully in all patients, and the resected lesion size ranged from 2 to 6 cm. Only one patient encountered postoperative complication, chest pain and fever. No recurrence of noticed during a follow-up of 6 to 36 months. (4) Conclusions: ESD is safe and effective for treating upper gastrointestinal early-stage cancer or precancerous lesions in patients with liver cirrhosis.

Based on the high-precision quantitative measurement ability, the S-band subsystem of China's high- resolution aviation system carried out the agricultural application test for the first time in Jilin elm, China. The experiment is mainly carried out in combination with vegetation growth, soil moisture content inversion, wheat straw returning and ground feature classification. Through the design of quantitative measurement scheme, the results of different straw coverage and observation at different times are compared, which shows the prospect of S-band full polarization synthetic aperture radar system in the field of agricultural application.

Silver nanoparticles from Origanum vulgare (Oregano) have been synthesized in the past. However, no investigation has been performed on the combined effects of independent factors that affect the synthesis. Silver nitrate and Oregano concentrations, incubation temperature and time, as well as pH can play crucial roles in synthesis. In this regard Full Factorial Design was applied. A Voigt function was fitted on the measured UV – Vis spectra. The fitting parameters of the Voigt function (peak wavelength, area, and Full Width at Half Maximum) were used as the responses. A quadratic model was fitted for the peak wavelength and area, and the pH proved the dominant factor on nanoparticle synthesis.

Grill-specific footprints for common fuels/grill types in the USA are estimated from public information and data from a major grill manufacturer. These are a function of both 1) a fuel’s footprint and 2) a grill’s efficiency of cooking. In 2022, grill-specific footprints vary by 9:1. A typical gas grill is highest at 3.6 lb CO2e/grill session, nine times that of a wood-pellet grill, lowest at 0.4 lb. Charcoal briquettes, electricity and super-efficient gas grills come in-between. Pellets are lowest, because they are made from waste wood and their production burden is modest. Electricity has the highest fuel footprint, yet the second-lowest grill-specific footprint, thanks to its high efficiency. Briquettes come in fourth, because their production involves fossil gas, and they contain some fossil coal. Grill efficiency is key for gas (natural gas or propane): a typical gas grill has twice the footprint of a super-efficient one. In 2027, with bio substitution, the super-efficient gas grill would move ahead of pellets. Electricity and charcoal could improve but would still place fifth and sixth. The range of grill-specific footprints could fall to 4.5:1, within a much-lower range, the highest footprint in 2027 almost 60% lower than 2022’s highest.

The present paper investigates numerically the resistance at full-scale of a zero-emission, high-speed catamaran in both deep and shallow water, with the Froude number ranging from 0.2 to 0.8. The numerical methods are validated by two means: a) comparison with available model tests; b) a blind validation using two different flow solvers. The resistance, sinkage and trim of the catamaran, as well as the wave pattern, longitudinal wave cuts and cross-flow fields, are examined. The total resistance curve in deep water shows a continuous increase with the Froude number while in shallow water, a hump is witnessed near the critical speed. This difference is mainly caused by the pressure component of total resistance, which is significantly affected by the interaction between the wave systems created by the demihulls. The pressure resistance in deep water is maximised at a Froude number around 0.58, whereas the peak in shallow water is achieved near the critical speed (Froude number ≈ 0.3). Insight into the underlying physics is obtained by analysing the wave creation between the demihulls. Profoundly different wave patterns within the inner region are observed in deep and shallow water. Specifically, in deep water, both crests and troughs are generated and moved astern as the increase of the Froude number. The maximum pressure resistance is accomplished when the secondary trough is created at the stern, leading to the largest trim angle. In contrast, the catamaran generates a critical wave normal to the advance direction in shallow water, which significantly elevates the bow and creates the highest trim angle as well as pressure resistance. Moreover, significant wave elevations are observed between the demihulls at supercritical speeds in shallow water which may affect the decision for the location of the wet deck.

Plasma cell-free DNA (cfDNA) is frequently analyzed using liquid biopsy to investigate cancer markers. Accordingly, we hypothesized this concept could be applied to the field of exercise physiology. Here, we aimed to identify specific cfDNA (spcfDNA) sequences in the plasma of non-treated human participants using next generation sequencing (NGS) and to clearly define the dynamics regarding the amounts of spcfDNA-fragments upon extreme exercise, such as running a full marathon. NGS analysis was performed using cfDNA of pooled plasma collected from non-treated participants. We confirmed the TaqMan-qPCR assay had a high sensitivity and found the spcfDNA sequence abundance was 16,600-fold higher than a normal genomic region. We then used the TaqMan-qPCR assay to investigate the dynamics of the levels of spcfDNA-fragments upon running a full marathon. Quantities of the spcfDNA fragments were significantly increased post marathon. Furthermore, the amounts of spcfDNA fragments strongly correlated with the numbers of white blood cells and plasma myoglobin concentrations. These results suggest the spcfDNA fragments identified in this study were highly sensitive response markers to extreme physical stress. The findings of this study may provide new insights into exercise physiology and genome biology on the human.

Decoherence with recurrences appear in the dynamics of the one-body density matrix of an $F = 1$ spinor Bose-Einstein condensate, initially prepared in coherent states, in the presence of an external uniform magnetic field and within the single mode approximation. The phenomenon emerges as a many-body effect of the interplay of the quadratic Zeeman effect, that breaks the rotational symmetry, and the spin-spin interactions. By performing full quantum diagonalizations very accurate time evolution of large condensates are analyzed, leading to heuristic analytic expressions for the time dependence of the density matrix, in the weak and strong interacting regimes. We are able to find accurate analytical expressions for both the decoherence and the recurrence times, in terms of the number of atoms and strength parameters, that show remarkable differences depending on the strength of the spin-spin interactions. We discuss the nature of these limits in the light of the thermodynamic limit.

The skyrocketing growth in the number of Internet of Things (IoT) devices will certainly pose a huge traffic demand for fifth-generation (5G) wireless networks and beyond. In-band full-duplex (IBFD), which is theoretically expected to double the spectral efficiency of a half-duplex (HD) wireless channel and to connect more devices, has been considered as a promising technology to accelerate the development of IoT. To exploit the full potential of IBFD, the key challenge is how to handle network interference (including self-interference, co-channel interference and multiuser interference) more effectively. In this paper, we propose a simple yet efficient user grouping method, where a base station (BS) serves strong downlink users and weak uplink users and vice versa in different frequency bands, mitigating severe network interference. We aim to maximize a minimum rate among all users subject to bandwidth and power constraints, which is formulated as a highly nonconvex optimization problem. By leveraging inner approximation framework, we develop a very efficient iterative algorithm to solve this problem, which guarantees at least a local optimal solution. Numerical results are provided to show not only the benefit of using full-duplex raido at BS, but also the advantage of the proposed user grouping method.

Endoscopic ultrasound (EUS) and intraductal ultrasound (IDUS) play very important roles in the field of biliary tract disease. Because of their excellent spatial resolution, the detection of small lesions and T-staging of tumors have become possible. Additionally, contrast-enhanced EUS and the new imaging technique of detective flow imaging are reported to be useful for differential diagnosis. Furthermore, EUS-guided tissue acquisition is used not only for pathological diagnosis, but also to collect tissue samples for cancer genome profiling. Although percutaneous transhepatic biliary drainage (PTBD) was traditionally performed in cases where endoscopic retrograde cholangiopancreatography is not feasible, treatments using EUS have recently become increasingly common, and EUS-guided biliary drainage was recently suggested to be superior to PTBD in terms of a higher success rate, less adverse events, and lower reintervention rate. This review provides an overview of diagnosis and treatment utilizing the features and techniques of EUS and IDUS.

: Optical coherence tomography is a non-invasive imaging technique that provides three-dimensional visualization of subsurface tissue structures. OCT has been proposed and explored in literature as a tool to assess oral cancer status, select biopsy sites, or identify surgical margins. Our endoscopic OCT device can generate widefield (centimeters long) imaging of lesions at any location in the oral cavity – but it is challenging for raters to quantitatively assess and score large volumes of data. Leveraging a previously developed epithelial segmentation network, this work develops quantifiable biomarkers that provide direct measurements of tissue properties in three-dimensions. We hypothesize that features related to morphology, tissue attenuation, and contrast between tissue layers will be able to provide a quantitative assessment of disease status (dysplasia through carcinoma). This work retrospectively assesses seven biomarkers on a lesion-contralateral matched OCT dataset of lateral and ventral tongue (40 patients, 70 sites). Epithelial depth and loss of epithelial-stromal boundary visualization provide the strongest discrimination between disease states. The stroma optical attenuation coefficient provides distinction of benign lesions from dysplasia and carcinoma. The stratification biomarkers visualize subsurface changes which provides potential for future utility in biopsy site selection or treatment margin delineation.

Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to pro-longed hospitalization, serious tissue inflammation, even sepsis and the need for recurrent sur-gery. Current non-surgical treatments such as self-expanding metal stents (SEMS) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GITM, a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GITM applica-tion demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal prom-ising and most importantly equally good outcomes while maintaining the possibility for sus-tained enteral nutrition and reducing stent migration risk. The VacStent GITM presents a promis-ing alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and establish its role in leak management comprehensively. Fur-ther investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GITM in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma.

Endoscopic submucosal dissection (ESD) is almost always performed with a sedative because of the longer procedure times involved. The risk of post-ESD deep vein thrombosis (DVT) has been reported as relatively high, and D-dimer levels are sometimes elevated after ESD. This retrospective study evaluated factors affecting changes in D-dimer levels from before to after ESD to identify causes of elevated D-dimer levels after ESD. This retrospective analysis included 117 patients with gastrointestinal tumors resected using ESD. After excluding 8 patients with pre-ESD levels of D-dimer >1.5 μg/mL, factors correlating with changes in D-dimer from before to after ESD were analyzed using logistic regression analysis in 109 patients. Sedation was accomplished primarily using midazolam, but because the sedative effect of midazolam shows marked inter-individual variability, a “corrected midazolam dose” was determined by dividing the total midazolam dose by the initial dose to correct for inter-individual differences in the sedative effect of midazolam. This value was used as one potential explanatory variable in subgroup analysis of the 103 patients who received midazolam. In subgroup analysis using the corrected midazolam dose as an explanatory variable, only corrected midazolam dose correlated with a change in D-dimer ≥ 1.0 μg/mL in multivariate analysis (odds ratio [OR]=1.5, 95% confidence interval [CI] 0.43–0.95; P=0.030). Corrected midazolam dose correlated with increases in post-ESD D-dimer levels. This potential relationship indicates that patients undergoing ESD and requiring extended sedation may be at increased risk of DVT.

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an alternative to surgery for acute cholecystitis (AC) in poor operative candidates. However, the role of EUS-GBD in non-cholecystitis (NC) indications has not been well studied. We compared clinical outcomes of EUS-GBD for AC and NC indications. Consecutive patients undergoing EUS-GBD for all indications at a single center were retrospectively analyzed. Fifty-one patients underwent EUS-GBD during the study period. Thirty-nine (76%) patients had AC while 12 (24%) had NC indications. NC indications included malignant biliary obstruction (n = 8), symptomatic cholelithiasis (n = 1), gallstone pancreatitis (n = 1), choledocholithiasis (n = 1), and Mirizzi’s syndrome (n = 1). Technical success was noted in 92% (36/39) for AC and 92% (11/12) for NC (p &gt; 0.99). Clinical success rate was 94% and 100%, respectively (p &gt; 0.99). There were 4 adverse events in the AC group and 3 in the NC group (p = 0.62). Procedure duration (median 43 vs 45 minutes, p = 0.37), post-procedure length of stay (median 3 vs 3 days, p = 0.97), and total gallbladder related procedures (median 2 vs 2, p = 0.59) were similar. EUS-GBD for NC indications is similarly safe and effective as EUS-GBD in AC.

Purpose: To examine the effectiveness of patterned laser trabeculoplasty (PSLT) as an additional treatment for patients of open-angle glaucoma (OAG) receiving maximized ocular hypotensive medications (OHM). Methods: Forty eyes of 33 patients (average age 72.7±10.7 years) who had not previously undergone open glaucoma surgery or laser trabeculoplasty and were treated with maximized OHM between June 2018 and March 2022 were included. A 360-degree PSLT was conducted and postoperative intraocular pressure (IOP) and survival curves at 1, 3, 6, 9, and 12 months were evaluated. Results: According to the Kaplan-Meier survival analysis, the average survival time was 8.1 months with death defined as postoperative IOP reduction of less than 10% or requiring additional treatment. The average survival time was 4.9 months with death defined as postoperative IOP reduction of less than 20% or requiring additional treatment. In the 31 eyes which received no additional treatment after PSLT, the mean preoperative IOP was 18.5±3.9 mmHg, which reduced to 15.3±4.1 mmHg (p=1.62 x 10-6)), 15.5±3.4 mmHg (p=1.51 x 10-5), 15.7±4.0 mmHg (p=1.75 x 10-5), 14.7±4.38 (p=2.89 x 10-6), and 15.0±4.0 mmHg (p=5.74 x 10-9) at 1, 3, 6, 9 and 12 months after PSLT, respectively. The IOP reduction rate one year after PSLT was 18.7%. Thirteen of the 31 eyes (42%) achieved a 20% reduction in IOP compared to the baseline. Conclusion: Adjunctive treatment with PSLT in OAG patients receiving maximized OHM may be effective over 12-months of follow-up.

Cooperative Non-Orthogonal Multiple Access (NOMA) with Simultaneous Wireless Information and Power Transfer (SWIPT) communication can effectively improve the spectrum efficiency and energy efficiency of the wireless networks with extend coverage. An important design issue is to incentivize a relaying center user to participate in the cooperative process and achieve a win-win situation to both the BS and the center user. Some private information of the center users are hidden from the BS in the networks. We apply a contract theory-based incentive mechanism under such asymmetric information scenario to incentives center user to join the cooperative communication to maximize the BS profit utility and to guarantee the center user’s expect payoff. A match theory-based Gale-Shapley algorithm is proposed to obtain the optimal strategy with low computation complexity. Simulation results indicated the network performance of our proposed cooperative transmission is much better than the conventional NOMA transmission and the benefit utility of the BS with the stable match strategy is nearly close to the complete channel state information multi-users scenario while the center users get the satisfied expect payoffs.

The purpose of this study was to investigate the effect of chitosan (CS) and Alginate (Alg) polymers concentrations and CaCl2 concentration on metronidazole (MET) drug loading (LE), size particles and zeta potential. Nanocomposites were prepared by ionotropic pregelation method. A (21 *31 *21) *3= 36 full factorial design (FFD) was used to predict statistical equation and responses. The MET-CS-AlgNPs nanocomposites were characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, thermal gravimetric analysis, scanning electron microscope and in vitro drug release studies. All data indicated the presence of drug into MET-CS-AlgNPs nanocomposites. The release profile of MET-CS-AlgNPs nanocomposites was found to be sustained

In this paper, a new full-Newton step feasible interior point method for convex quadratic programming is presented and analyzed. The idea behind this method is to replace the complementarity condition with a non-negative variable weight vector and use the algebraic equivalent transformation for the obtained equation. Under the selection of appropriate parameters, the quadratic rate of convergence of the new algorithm is established. In addition, the iteration complexity of the algorithm is obtained. Finally, some numerical results are presented to demonstrate the practical performance of the proposed algorithm.

We studied Ni2FeSi, Co2FeSi and Co2MnSi -based full Heusler alloy glass-coated microwires with the same geometric aspect ratio ρ ≈ 0.50 ± 0.01 prepared using Taylor-Ulitovsky method. The fabrication of X2YZ; (X = Co &amp; Ni, Y = Fe &amp; Mn and Z = Si) based glass coated microwires with fixed aspect ratio is a quite challenging due to the different samples preparation conditions. The XRD analysis shows nanocrystalline microstructure for all the samples. Space group Fm3¯m (FCC) with disordered B2 and A2-types for Ni2FeSi and Co2FeSi and ordered L21-type for Co2MnSi are observed. The change in the positions of Ni, Co and Mn, Fe in X2YSi resulted in a variation in the lattice cell parameters and the average grain size of the sample. Room temperature magnetic behavior shows a dramatic change depending on the chemical composition, where Ni2FeSi-MWs shows the highest coercivity (Hc) compared to Co2FeSi-MWS and Co2MnSi-MWs. The Hc –value of Ni2FeSi-MWs is 16 times higher than that of Co2MnSi-MWs and 3 times higher than that of Co2FeSi-MWS. Meanwhile, the highest reduced remanence is reported for Co2FeSi-MWS (Mr =0.92), , being about 0.33 and 0.22 for Ni2FeSi-MWs and Co2MnSi-MWs, respectively. From the analysis of the temperature dependence of the magnetic properties (Hc and Mr) of X2YZ-MWs we deduced that Hc shows a stable tendency for Co2MnSi-MWs and Co2FeSi-MWs, meanwhile two flipped points are observed for Ni2FeSi-MWs where the behavior of Hc changes with temperature. For Mr monotonic increase by decreasing the temperature is observed for Co2FeSi-MWs and Ni2FeSi-MWs and roughly stable for Co2MnSi-MWs. The thermomagnetic curves at low magnetic field show irreversible magnetic behavior for Co2MnSi-MWs and Co2FeSi-MWs and regular ferromagnetic behavior for Ni2FeSi-MWs. The current result illustrates the ability to tailor the structure and magnetic behavior of X2YZ-MWs at a fixed internal stresses, i.e., with fixed aspect ratio. Additionally, a different behavior was revealed in X2YZ-MWs depending on the degree of ordering and elements distribution. The tunability of magnetic properties of X2YZ-MWs makes them suitable for sensing applications.

Alfalfa is an important forage crop around the world. LncRNAs are considered to be a class of functional biomacromolecules, while little is known about lncRNAs in alfalfa. In this study, RNAs from different tissues of alfalfa were sequenced and anlyzed with full-length transcriptome sequencing technology, yielding the full-length transcripts dataset of alfalfa. Based on sequencing and public RNA-seq data, lncRNAs of alfalfa were predicted genome-wide by CPC2 and PLEK. The results showed most lncRNAs shared low sequence conservation with those in other plant species, part of which seems originate from plastid genome. We also identified 88563 lncRNAs, approximately 99.8% of total lncRNAs, with possibility of coding small ORFs using two prediction tools. Our research generated the biggest sequence set of alfalfa lncRNAs, and revealed some plastid originated lncRNAs with high sequence conservation.

Background: This study aimed to evaluate survival rate, marginal bone levels, and full arch prosthetic success on short implants when placed in areas of severely resorbed and edentulous mandibles. Methods: This is a systematic review of all randomized controlled trials of at least 10 patients with a control group in which bone augmentations were performed that were published between January 2010 and February 2023. Only 3 relevant studies met the inclusion criteria. Results: It obtained demonstrate that short-term dental implant survival rates ranged from 94.2% to 97.4% with a 5-year follow-up and the prosthetic success rate varied by 62% during the same follow-up. The mean marginal bone level values ​​of the affected short implants ranged from 0.2 mm to 0.6 mm. Conclusions: The data obtained demonstrated that short dental implants positioned with criterion and precision as a full-arch fixed support are a valid therapeutic choice for the medium-long term rehabilitation of severe edentulous mandibular atrophy.

In this paper, sea surface wind speed (SSWS) retrieval from Gaofen-3 (GF-3) quad-polarization stripmap (QPS) data in vertical-vertical (VV), horizontal-horizontal (HH) and vertical-horizontal (VH) polarizations is investigated in detail based on 3,170 scenes acquired from October 2016 to May 2018. The radiometric calibration factor of the VV polarization data is examined first. This calibration factor generally meets the requirement of SSWS retrieval accuracy with an absolute bias of less than 0.5 m/s but shows highly dispersed characteristics. These results lead to SSWS retrievals with a small bias of 0.18 m/s but a rather high root mean square error (RMSE) of 2.36 m/s compared with the ERA-Interim reanalysis model data. Two refitted polarization ratio (PR) models for the QPS HH polarization data are presented. Based on a combination of the incidence angle- and azimuth angle-dependent PR model and CMOD5.N, the SSWS derived from the QPS HH data shows a bias of 0.07 m/s and an RMSE of 2.26 m/s relative to the ERA-Interim reanalysis model wind speed. A linear function relating SSWS and the normalized radar cross section (NRCS) of QPS VH data is derived. The SSWS data retrieved from the QPS VH data show good agreement with the WindSat SSWS data, with a bias of 0.1 m/s and an RMSE of 2.02 m/s. We also apply the linear function to the GF-3 Wide ScanSAR data acquired for the typhoon SOULIK, which surprisingly yields a very good agreement with the model results. A comparison of SSWS retrievals among three different polarization datasets is also presented. The current study and our previous work demonstrate that the general accuracy of the SSWS retrieval based on GF-3 QPS data has an absolute bias of less than 0.3 m/s and an RMSE of 2.0 ±0.2 m/s relative to various datasets. Further improvement will depend on dedicated radiometric calibration efforts.

Various renewable energy sources such as wind power and photovoltaic (PV) have been increasingly integrated into the power system through power electronic converters in recent years. However, power electronic converter-driven stability issues under specific circumstances, for instance, modal resonances might deteriorate the dynamic performance of the power systems or even threaten the overall stability. In this paper, the integration impact of a hybrid renewable energy source (HRES) system on modal interaction and converter-driven stability is investigated in an IEEE 16-machine 68-bus power system. Firstly, an HRES system is introduced, which consists of full converter-based wind power generation (FCWG) and full converter-based photovoltaic generation (FCPV). The equivalent dynamic models of FCWG and FCPV are then established, followed by the linearized state-space modeling. On this basis, converter-driven stability analyses are performed to reveal the modal resonance mechanisms of the interconnected power systems and the modal interaction phenomenon. Additionally, time-domain simulations are conducted to verify effectiveness of dynamic models and support the converter-driven stability analysis results. To avoid detrimental modal resonances, an optimization strategy is further proposed by retuning the controller parameters of the HRES system. The overall results demonstrate the modal interaction effect between external AC power system and the HRES system and its various impacts on converter-driven stability.

Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) is an alternative for revascularisation of isolated left anterior descending (LAD) or as multi-vessel (MV) procedure for diagonal branch (RD) or circumflex artery (RCX) region. Methods: From 2021 to 2022 91 patients underwent MIDCAB procedure in our heartcenter. 80% were male. Eighty percent of the patients had two or three vessel coronary artery disease. Mean age was 65±10 years. The left internal mammary artery (LIMA) was anastomosed to the left anterior descending via left minithoracotomy approach in all patients. Fourteen patients received multi-vessel MIDCAB (15%) with two or three anastomoses a saphenous vein graft (as T-graft to LIMA) was anastomosed to RD or RCX. Results: Mean operation time was 2.6±0.8 hours. The 30-day mortality was 0. Mean required packed red blood cells (pRBC) was 0.4±1.2 unit. The intensive care unit stay (ICU) was 1.5±1.6 days mean. We observed two patients (2%) with wound infections postoperatively. Four patients underwent rethoracotomy because of bleeding. Mean follow-up time was 1.5±0.5 years. Seventy-eight patients (86%) were in New York Heart Association (NYHA) class 1, 11 patients (12%) were in NYHA class 2. One patient received percutaneous coronary intervention due to de novo stenosis of the RCA. Late mortality was 2%. The Kaplan-Meier survival rate was 98.8% at 1 and 2 years. Conclusion: MIDCAB is technically demanding. Our postoperative and short-term clinical results demonstrate that this procedure is safe and feasible. Optimal patient selection and an experienced surgical team are mandatory.

Background and aims. Clinically significant delayed bleeding (CSDB) may complicate endoscopic colorectal submucosal dissection (ESD). Methods. We assessed the results of a prospective registry of colorectal ESD. We evaluated the effect of clip closure and PuraStat application for prevention of CSDB. Results. 40 patients with 41 colorectal ESD were included. ESD was successful in 38 lesions (92.7%), 35 with R0 resection (92.1%) and 33 with curative resection (86.8%). CSDB occurred in 3 out 38 lesions (7.9%, 95% CI [1.7 – 21.4%]), exclusively after rectal ESD (3 of 22 rectal lesions vs. 0 of 16 colonic lesions, p = 0.249). Clip closure was more frequently used after colonic ESD (12 of 16 colonic lesions vs. 2 of 22 rectal lesions, p < 0.001) and was not protective for CSDB in univariate analysis, even though no events occurred after clip closure (0 of 14 lesions with clip closure vs. 3 of 27 lesions without, p = 0.283). PuraStat was more frequently applied after ESD for rectal lesions (16 of 22 rectal lesions vs. 2 of 16 colonic le-sions, p < 0.001) and was not protective for CSDB, all three events occurring after PuraStat application (3 of 21 lesions with PuraStat application vs. 0 of 20 lesions without, p = 0.097). Conclusions. CSDB occurred exclusively after rectal ESD, and no predictive factors were identified in uni-variate analysis. Clip closure and PuraStat application were not protective for CSDB.

Background: Recently, minimally invasive access via right-anterolateral mini-thoracotomy (RAMT) has been gaining popularity in cardiac surgery. This approach is also an option for sur-geons performing aortic surgery. Aim of the study is to present our surgical method highlighting the total endoscopic minimally invasive approach via RAMT for replacement of the ascending aorta (AAR) with or without involvement of the aortic root and the aortic valve. Methods: Clini-cal data of 44 patients from three participating institutions with AAR with or without involving the aortic valve or aortic root via RAMT between April 2017 and February 2024 were retrospec-tively analyzed. According to surgical procedure patients were divided in group A with only AAR and group B with concomitant valve or root replacement. Operative time, length of ventila-tion, perioperative outcome, length of intensive care unit (ICU) as well as postoperative hospital stay, and mid- and long-term results were retrospectively analyzed. Results: Mean age was 61.4 ± 10.7 years old with a frequency of male gender (63.6%). Mean cardiopulmonary bypass (CBP) time and aortic cross-clamping time was 94.9 ± 32.5 min. and 63.8 ± 25.9 min., respectively. CPB and aortic clamp time were significantly lower in group A. In the first 24 hours the mean drain-age volume was 790.3 ± 423.6 ml. Re-thoracotomy due to bleeding was zero. Sternotomy could be avoided in all patients. Patients stayed 35.9 ± 23.5 hrs at ICU and were discharged 7.8 ± 3.0 days following surgery from hospital. Mean ventilation time was 5.8 ± 7.6 hrs. All patients survived and 30-day mortality was 0.0%. At a median follow-up time of 18.2 months, all patients were alive. The results were similar in both groups. Conclusions: The full endoscopic RAMT approach with 3D visualization is a safe and feasible technique which can be transferred in the field of aor-tic surgery without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.

Endoscopy has made a significant and noteworthy contribution to the field of medical science and technology. Nevertheless, its potential remains constrained due to the limited availability of rigid or flexible endoscopes. This paper introduces a novel hydraulic actuator based on electrorheological fluid (ERF) as a pivotal advancement in bridging the existing gap within the realm of endoscopy. Following a comprehensive introduction that briefly outlines the electrorheological effect, the subsequent section is dedicated to the elucidation of the actuator’s development process. Challenges arise, particularly in terms of miniaturization and the realization of a hydraulically sealed system with integrated valve electrodes. An internal electrorheological valve system consisting of four valves that are controlled using a pulse-width modulated high voltage was suitable for position control of the antagonistic hydraulic actuators. High-precision stereolithography (SLA) printing has proven practical for manufacturing the actuator components. For functional testing, a test bench was set up in which the actuator follows a setpoint through a PI control loop. The control deviation ranged from 0.6 to 1 degree, with a response time between 6 and 8 seconds. The experiments have demonstrated that, through the use of ERF and integrated valve electrodes, a miniaturized functional actuator can be constructed.

Gastric outlet obstruction (GOO) poses a common and challenging clinical scenario, characterized by mechanical blockage in the pylorus, distal stomach, or duodenum, resulting in symptoms such as nausea, vomiting, abdominal pain, and early satiety. Its diverse etiology encompasses both benign and malignant disorders. The spectrum of current treatment modalities extends from conservative approaches to more invasive interventions, incorporating procedures like surgical gastroenterostomy (SGE), self-expandable metallic stents (SEMS) placement, and the advanced technique of endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While surgery is favored for longer life expectancy, stents are preferred in malignant gastric outlet stenosis. The novel EUS-GE technique, employing a lumen-apposing self-expandable metal stent (LAMS), combines the immediate efficacy of stents with the enduring benefits of gastroenterostomy. Despite its promising outcomes, EUS-GE is a technically demanding procedure requiring specialized expertise and facilities.

In the diagnosis of olfactory neuroblastoma (ONB), the presence of S-100–positive sustentacular cells surrounding the tumor is important; however, these are also present in normal nasal sinus epithelium. Although ONB often has a different final diagnosis, complete resection of the tumor has a good prognosis and minimally affects the patient's treatment plan. When the tumor extends around the internal carotid artery (ICA), complete resection is difficult due to the high risk of vascular injury; revascularization using a high-flow bypass can avoid this complication. In the present case, the tumor was located in the left sphenoid sinus and extended around the ICA. Preoperative biopsy tissue was positive for neuroendocrine markers and slightly positive for S-100 protein, leading to a diagnosis of ectopic ONB. High-flow bypass revascularization with trapping of the ICA allowed complete tumor resection. The postoperative histopathological diagnosis was neuroendocrine carcinoma, showing no S-100 protein–positive cells. There was no sign of recurrence two and a half years after surgery without additional treatment. This case demonstrates that the presence of S-100 protein–positive cells in ONB may be misleading. Although misdiagnosis of ectopic ONB should be anticipated, a complete resection of the tumor is an effective treatment strategy.

This paper presents design and optimization of a small-size electromagnetic induction heating control system powered by a 3.7V-900mAh lithium battery and featuring an LC series resonant full bridge inverter circuit, which can be used in small size materials heating applications, such as micro medical devices. The effects of resonant capacitance, inductor wire diameter, heating tube material and wall thickness are studied to maximize the heating rate of the workpiece and meantime reduce the temperature rise of the NMOS transistor. The optimal circuit configuration meeting the design requirements was finally identified via comparing the operational parameters and NMOS transistor loss under different circuit conditions. The validation experiments were conducted on a designed electromagnetic induction smoking devices. The results indicate that under an output current of 4.6A, the heating tube can reach up to the temperature target of 250℃ within 11 seconds, and all NMOS transistors stay below 50°C in a 5 minutes heating process.

The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 109/l; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England Canada, and Australia. Patients aged 40 years and over with a full blood count were included and stratified by age (in 10-year bands), sex, (male/female), and platelet count group. Cancer incidence within one year of test date was estimated from linked registry data. In all three countries there was a clear upwards trend in cancer incidence with increasing platelet count, for both sexes and at all age groups. Lung and colorectal were the most common sites. These results have important implications for the international application of this work; analysis of local health datasets will be crucial to determine appropriate thresholds. Appropriate upper thresholds will depend on local populations, healthcare needs, and priorities. Further research is needed to assess the likely impact of new recommendations on the healthcare system, on cancer outcomes, and patient benefit.

Dynamic optical structural color is always desired in various display applications and usually involves active materials. Full-color generation, especially bi-directional full-color generation in both reflective and transmissive modes, without any active materials included has been rarely investigated. Herein, we demonstrate a scheme of bi-directional full-color generation based on a plasmonic metasurface modulated by rotation of the polarization angle of the incident light without varying the geometry and the optical properties of the materials and the environment where the metasurface resides. The metasurface unit cell consists of plasmonic modules aligning in three directions and is patterned in a square array. The metasurface structural color device generates full colors in both reflection and transmission. Based on the proposed polarization-dependent structural color, information encoding of three multiplexed animal images and quick-responsive (QR) codes is demonstrated to verify the efficient information encoding and decoding of the proposed scheme. The animals can be seen under different polarization incidence and the QR codes can be successfully decoded by the polarization rotation in transmission. The proposed bi-directional full-color generation metasurface has great potential in applications such as kaleidoscope generation, anti-counterfeiting, dynamic color display, and optical information encoding.

When describing the tribological behaviour of technical surfaces, the need for full length scale microtopographic characterization often arises. The self-affine of surfaces and the characterization of self-affine by a fractal dimension and its implantation into tribological models are commonly used. The goal of our present work was to determine the frequency range of fractal behaviour of surfaces by analysing the microtopographic measurements of a brake plunger. We also wanted to know if the bifractal and multifractal behaviour can be detected in real machine parts. As a result, we developed a new methodology for determining the fractal range boundaries to separate the nano- and micro-roughness. In order to reach our goals, we used atomic force microscope (AFM) and stylus instrument to provide measurements in wide frequency range (19 nm - 3 mm). As a result of the power spectral density (PSD) based fractal evaluation, it was found that the examined surface could not be characterized by a single fractal dimension and that we developed a methodology for stopping the margin of validity of each fractal dimension, and we also developed a methodology for determining the limits of validity of certain fractal dimensions.

This study updates previous research showing that 22 all-cause mortality in 31 European countries increased over time the higher the 21 COVID-19 full vaccination uptake. The update illuminates that a one percentage point increase in 21 full vaccination uptake initially decreased all-cause mortality from Jan to Mar 22 by –0.423 percent (95% CI –0.577, –0.270), but the following 14 months, a one percentage point increase in 21 booster vaccination uptake oppositely increased mortality by 0.366 percent (95% CI 0.250, 0.482). The findings indicate that full vaccination initially prevented mortality, but subsequently, booster vaccination, in particular, detrimentally and consistently induced higher mortality. The effects remained robust when controlling for alternative explanations. Studies have argued that heat waves caused mortality in the 22 summer and energy prices caused mortality in the 22-23 winter. However, the update shows that booster vaccination consistently induced higher mortality when neither heat waves nor energy prices were likely explanations.

Background - Mandibular flexion (MF) is a complex biomechanical phenomenon, which involves a deformation of the mandible, due mainly to the contraction of the masticatory muscles, and can have numerous clinical effects. The main aim of the current systematic review is to highlight the different factors that can increase MF, to help clinicians, identify patients to whom they should pay more attention. As a secondary outcome, we wanted to analyze the preventive measures and suitable techniques to be adopted to minimize the negative effects of this phenomenon on oral fixed rehabilitations. Methods - The review, which was carried out in accordance with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) flowchart, was recorded in the “International Prospective Register of Systematic Reviews” (PROSPERO). As research questions, “Patient/Population, Intervention, Comparison and Outcomes” (PICO) questions were employed. Using the ROBINS-I technique, the risk of bias in non-randomized clinical studies was evaluated. Results - The initial electronic search identified over 1300 potential articles, of which 54 studies were included in this systematic review. Information regarding the relationship between MF and individual factors, mandibular movements, impression-taking and fixed rehabilitations were obtained. Conclusions – The studies included in this systematic review showed that MF is greater during protrusive movements, in the posterior areas of the lower jaw, and in patients with brachial facial type, greater jaw length, small gonial angle and less density, length and bone surface of the symphysis. The biomechanical effects of mandibular flexion on fixed restorations are debated. Prospective clinical and radiological observational studies should be conducted to evaluate the potential short-, medium- and long-term consequences of MF.

This paper summaries the main findings from the full-scale CFD analyses conducted at SINTEF Ocean on the case of MV REGAL, which is one of the benchmark vessels studied in the ongoing joint industry project JoRes. The numerical approach is described in detail, and comparative results are presented regarding the propeller open water characteristics, ship towing resistance, and ship self-propulsion performance. The focus of numerical investigations is on the assessment of the existing simulation best practices applied to a ship scale case in a blind simulation exercise, and performance of thereof with different turbulence modelling methods. The results are compared directly with full-scale performance predictions based on model tests conducted at SINTEF Ocean and sea trails data obtained in the JoRes project.

In this paper, a metal cutting machine position control have been designed and simulated using Matlab/Simulink Toolbox successfully. The open loop response of the system analysis shows that the system needs performance improvement. Static output feedback and full state feedback H₂ controllers have been used to increase the performance of the system. Comparison of the metal cutting machine position using static output feedback and full state feedback H₂ controllers have been done to track a set point position using step and sine wave input signals and a promising results have been analyzed.

Background: This prospective study assesses the use of Rapid Remote Online Cytological Evaluation analysis for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. Methods: The study was conducted between April 2021 and September 2022 and involved a total of 314 Rapid Remote Online Cytological Evaluations (17 brush, 143 fine needle aspirations and 154 imprint cytologies) analyses performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was determined and the findings were compared with the cyto-/histological and final diagnoses. Results: By means of Rapid Remote Online Evaluation, 86 cytological benign and 190 malignant and 38 findings of unclear diagnosis were recorded (Ø assessment time 100 sec., range 11 - 370sec.). In 27 of the 38 cases with unclear diagnosis, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another five of these 38 cases remained unclear. Excluding these 38 findings, the Rapid Remote online cytology achieved a sensitivity of 78.6% with a specificity of 99.5% and a correct classification rate of 93.1% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. Conclusions: Rapid remote online analysis allows fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived.

Pancreatic neuroendocrine tumor (P-NET) is a rare neoplasm originating in the neuroendocrine system. Carcinoid syndrome occurs in approximately 19% of patients with functional P-NETs, typically when liver metastases occur. NETs diagnosis is frequently late, along with symptoms related to hormone hypersecretion. We described the case of a patient with a low-grade non-functional P-NET, but with a typical clinical presentation of a carcinoid syndrome; moreover, we reviewed the literature regarding this topic. An 81-year-old male was admitted to our Department of Internal Medicine at Cannizzaro Hospital (Catania, Italy) because of the onset of abdominal pain with nausea, loose stools and episodic flushing. Firstly, an abdominal contrast-enhanced CT scan showed a small pancreatic hypervascular mass; then a gallium-68 DOTATOC integrated PET/CT revealed an elevated expression of SSTR receptors. Serum Chromogranin A and urinary 5-HIAA measurements resulted negative. Given the small size of the lesion (8 mm), we preferred to perform an endoscopic ultrasonography (EUS) with fine-needle biopsy (EUS-FNB), allowing the diagnosis of low-grade (G1) non-functional P-NET (NF-P-NET). Surgery was waived, while a follow-up strategy was chosen. Early recognition of P-NETs, although rare, is necessary to improve patient’s survival. EUS-FNB should be the protocol of choice for an early characterization of these tumors.

Digital Image Correlation (DIC) is an optical technique used to measure surface displacements and strains in materials and structures. This technique has demonstrated significant utility in structural examination and monitoring. This manuscript offers a comprehensive review of contemporary research and applications that have leveraged the DIC technique in laboratory-based structural tests. The reviewed works encompass a broad spectrum of structural components, such as concrete beams, columns, pillars, masonry walls, infills, composite materials, structural joints, steel beams, slabs, and other structural elements. These investigations have underscored the efficacy of DIC as a metrological instrument for precise quantification of surface deformation and strain in these structural components. Moreover, the constraints of the DIC technique have been highlighted, especially in scenarios involving extensive or complex test configurations. Notwithstanding these constraints, the DIC methodology has validated its effectiveness as a strain measurement instrument, offering numerous benefits such as non-invasive operation, full-field measurement capability, high precision, real-time surveillance, and compatibility with integration into other measurement instruments and methodologies.

Quantum cell automata (QCA) is a nanotechnology that uses a transistor-free structure to design digital circuits and overcome the limitations listed for CMOS circuits. The computing circuits that make up the bulk of computers can be designed and using this technology. Subtractors are a big part of computational circuits. This research deals with the design of a subtractor that due to the innovation in the design of this circuit and the novel arrangement of quantum cells of its kind has caused the number of cells used in the design of the circuit to reach its lowest value compared to previously designed circuits. The size of the circuit as well as the loss power are minimized compared to the circuits designed by the subtractors. Another trait clears of this circuit compared to many previous designs is its single-layer design, which reduces latency and noise in the output waveform. The circuit designed by the QCADesigner simulator is tested and simulated inadition the results are displayed in the simulated waveform. Also, the results of calculations for power dissipation in each QCA cell were evaluated by QCAPro software, which is a powerful tool for estimating power loss simulation. It has less implementation and level (single layer) than Previous designs.

Globally 390 millions of people are at risk of dengue infection; over the past 50 years the virus incidence increased thirty-fold. In Senegal, an unprecedented occurrence of outbreaks and sporadic cases was noticed since 2017. In October 2018 an outbreak of DENV-2 was reported in Rosso area in the north of Senegal at the border with Mauritania. Out of the 187 blood specimen samples collected, 27 were positives by qRT-PCR and 8 were serologically positive for DENV IgM. Serotyping using qRT-PCR reveals that isolates were positive for DENV-2. A subset of DENV-2 positives samples was selected and subjected to full genome sequencing followed by phylogenetic analysis. Analysis of 06 nearly completed genome sequences (n= 6) revealed that isolates belong to the cosmopolitan genotype and are closely related to the Mauritanian strains detected between 2017 and 2018 and those detected in many West African countries such as Burkina Faso or Cote d’Ivoire. Our results suggest a transboundary circulation of the DENV-2 cosmopolitan genotype between Senegal and Mauritania and call for a need of coordinated surveillance of arboviruses between these two countries. Interestingly, high level of homology between West African isolates highlights endemicity and call for a set-up of sub-regional viral genomic surveillance which will lead to a better understanding of viral dynamic, transmission and spread across Africa.

The process of full-thickness skin regeneration is complex and has many parameters involved, which makes it difficult to use a single dressing to meet the various requirements of the complete regeneration at the same time. Therefore, developing hydrogel dressings with multifunction, including tunable rheological properties and aperture, hemostatic, antibacterial and super cytocompatibility, is a desirable candidate in wound healing. In this study, a series of complex hydrogels were developed via the hydrogen bond and covalent bond between chitosan (CS) and alginate (SA). These hydrogels exhibited suitable pore size and tunable rheological properties for cell adhesion. Chitosan endowed hemostatic, antibacterial properties and great cytocompatibility and thus solved two primary problems in the early stage of the wound healing process. Moreover, the sustained cytocompatibility of the hydrogels was further investigated after adding FGF and VE-cadherin via the co-culture of L929 and EC for 12 days. The confocal 3D fluorescent images showed that the cells were spherical and tended to form multicellular spheroids, which distributed in about 40-60μm thick hydrogels. Furthermore, the hydrogel dressings significantly accelerate defected skin turn to normal skin with proper epithelial thickness and new blood vessels and hair follicles through the histological analysis of in vivo wound healing. The findings mentioned above demonstrated that the CS/SA hydrogels with growth factors have tremendous potential as multifunctional hydrogel dressings for full-thickness skin regeneration incorporated with hemostatic, antibacterial, sustained cytocompatibility for 3D cell culture and normal skin repairing.

In addition to the risk of vaccine failure caused by strain mismatch, the production of inactivated FMD vaccines is dangerous if adequate biosafety cannot be maintained. Using a high-throughput sequencing protocol optimized for short nucleic acid fragments, the composition of a local inactivated vaccine was analyzed in depth. The serotype O strain identified in the vaccine was genetically identical to viruses found in recent FMD outbreaks in Egypt.

Microfluidics is facing critical challenges in the quest of miniaturizing, integrating, and automating in vitro diagnostics, including the increasing complexity of assays, the gap between the macroscale world and the microscale devices, and the diverse throughput demands in various clinical settings. Here a “3D extensible” microfluidic design paradigm that consists of a set of basic structures and unit operations was developed for constructing any application-specific assay. Four basic structures- check valve (in), check valve (out), double-check valve (in and out), and on-off valve, were designed to mimic basic acts in biochemical assays. By combining these structures linearly, a series of unit operations can be readily formed. We then proposed a “3D extensible” architecture to fulfill the needs of the function integration, the adaptive “world-to-chip” interface, and the adjustable throughput in the X, Y, and Z directions, respectively. To verify this design paradigm, we developed a fully integrated loop-mediated isothermal amplification microsystem that can directly accept swab samples and detect Chlamydia trachomatis automatically with a sensitivity one order higher than that of the conventional kit. This demonstration validated the feasibility of using this paradigm to develop integrated and automated microsystems in a less risky and more consistent manner.

This paper presents the design of a high frequency zero voltage switching (ZVS) full-bridge converter with a phase-shifted driving signal for photovoltaic applications. The resonant power converter can provide high-power capacity under high-frequency operation. The proposed power converter can also reduce the size of the transformer under the same power rating. The high-frequency transformer was developed by using the resonant and switching frequencies of the power converter to reduce the switching loss and to improve the system efficiency. Phase-shifted modulation was selected to drive the switches of a full-bridge power converter based on the switching loss minimization method. The desired output voltage was controlled using a closed-loop controller under a loop gain stability margin. The simulation results showed that the output voltage can be controlled to the desired constant when the input voltage changes from 30 VDC to 60 VDC. The desired output voltage of power converter is constant at 400 VDC. The power converter can transfer the DC supply to a 220 VAC household via grid-connected inverter. Therefore, the proposed study showed the effectiveness of the phase-shift ZVS full-bridge power converter with high-frequency transformer. This power converter can control the operation of the desired voltage system and has a small sizing of power converter system, low switching loss, and high system efficiency.

Efficient member revocation and strong security against attacks are prominent requirements in group signature schemes. Among the revocation approaches Verifier-local revocation is the most flexible and efficient method since it requires to inform only the verifiers regarding the revoked members. The verifier-local revocation technique uses a token system to manage members’ status. However, the existing group signature schemes with verifier-local revocability rely on weaker security. On the other hand, existing static group signature schemes rely on a stronger security notion called, full-anonymity. Achieving the full-anonymity for group signature schemes with verifier-local revocation is a quite challenging task. This paper aims to obtain stronger security for the lattice-based group signature schemes with verifier-local revocability, which is closer to the full-anonymity. Moreover, this paper delivers a new key-generation method which outputs revocation tokens without deriving from the users’ signing keys. By applying the tracing algorithm given in group signature schemes for static groups, this paper also outputs an efficient tracing mechanism. Thus, we deliver a new group signature scheme with verifier-local revocation that satisfies a stronger security from lattices.

Global teacher shortage is a serious concern with grave implications for the future of education. This calls for novel ways of addressing teacher roles. The economic benefits of tireless labour inspires the need for teachers who are unlimited by natural human demands, highlighting consideration for the affordances of robotics and Artificial Intelligence in Education (AIED) as currently obtainable in other areas of human life. This however demands designing robotic personalities that can take on independent teacher roles despite strong opinions that robots will not be able to fully replace humans in the classroom of the future. In this paper, we argue for a future classroom with independent robot teachers, highlighting the minimum capabilities required of such personalities in terms of personality, instructional delivery, social interaction and affect. We describe our project on the design of a robot teacher based on these. Possible directions for future system development and studies are highlighted.

Video quality assessment (VQA) plays an important role in video applications for quality evaluation and resource allocation. It aims to evaluate the video quality consistent with the human perception. In this letter, a hierarchical gradient similarity based VQA metric is proposed inspired by the structure of the primate visual cortex, in which visual information is processed through sequential visual areas. These areas are modeled with the corresponding measures to evaluate the overall perceptual quality. Experimental results on the LIVE database show that the proposed VQA metric significantly outperforms the state-of-the-art VQA metrics.

EUS–TA in unresectable pancreatic cancer requires not only a tissue diagnosis but also tissue collection in anticipation of comprehensive genomic profiling. However, the optimal puncture target remains controversial. Therefore, the Primary and Metastatic Lesions in Pancreatic Cancer (PRIMATE) study was designed to clarify the optimal target by comparing the success rates for meeting OncoGuide NCC Oncopanel (NOP) analysis criteria on pre-check primary and metastatic lesion specimens obtained during the same EUS–TA session in patients with invasive pancreatic ductal adenocarcinoma. In this ongoing prospective study, two specimens, each from primary and metastatic lesions, are obtained by EUS–TA (typically using a 19G fine-needle biopsy needle) in patients with invasive pancreatic ductal adenocarcinoma. The primary endpoint is the proportion of EUS–TA specimens that meet NOP analysis criteria during pre-check (i.e., tumor cellularity ≥ 20% and tissue area ≥ 4 mm2), which are then compared between primary and metastatic lesions. This study has been approved by the National Cancer Center Institutional Review Board (Research No. 2022-168). The results of this study will be reported at an international conference and published in an international peer-reviewed journal. The trial registration number is UMIN 000048966.

Chronic rhinosinusitis (CRS) is a complex inflammatory condition affecting the nasal and paranasal sinus mucosa. Gastroesophageal reflux disease (GERD) has been implicated as a potential exacerbating factor in CRS, but the specific endoscopic features of nasopharyngeal pathology in this context remain poorly understood. Background and Objectives: CRS is a multifactorial disease with various underlying etiologies, including inflammation, anatomical factors, and environmental triggers. While GERD has been suggested as a potential contributor to CRS, the specific endoscopic features indicative of nasopharyngeal pathology in CRS patients with GERD symptoms have not been clearly elucidated. Our aim is to identify specific endoscopic features of nasopharyngeal pathology in patients with CRS associated with GERD symptoms, and to propose a method for assessing the influence of GERD on the mucosal layer of the nose and nasopharynx. Materials and Methods: We conducted a cross-sectional observational study involving 521 adult patients presenting with symptoms suggestive of CRS. From this cohort, 95 patients with the highest scores on the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) questionnaires were selected as the main group. Endoscopic examinations were performed to assess the nasal and nasopharyngeal mucosa. Results: Our study revealed significant alterations in the nasopharyngeal mucosa of patients with CRS associated with GERD symptoms. Increased vascularity of the nasopharyngeal mucosa was observed in 91 patients (95.7%), while hypertrophy was noted in 83 patients (87.4%). Mucus was present in the nasopharynx of 77 patients (81.1%), exhibiting varying characteristics of color and consistency. Asymmetric hypertrophy of the oropharyngeal mucosa was noted in 62 patients (65.3%). Conclusions: We propose a method for assessing the influence of GERD on the mucosal layer of the nose and nasopharynx, which may aid in diagnostic and management decisions. Further research is warranted to explore the potential impact of GERD symptoms on the course and severity of CRS exacerbations.

This mini-review explores the comparative efficacy, safety, and clinical outcomes of high-dose proton pump inhibitor (PPI) intravenous infusion versus oral acid pump inhibitor therapy following endoscopic treatment for bleeding peptic ulcers. Recent evidence suggests that intravenous PPIs can significantly reduce the rebleeding rates within the critical first 72 hours post-intervention, with a noted rebleeding rate of 6% compared to 14% in patients receiving oral Vonoprazan (VPZ) therapy. Additionally, the rapid onset of action associated with intravenous administration leads to faster stabilization of vital signs and a reduced need for subsequent blood transfusions. Safety profiles for both intravenous and oral VPZ were favourable, with minimal adverse effects, the most common being transient headaches.However, the findings from our single-centre study with a moderate sample size prompt consideration of more extensive, multicentre trials to enhance the generalizability of the results. Current limitations include potential biases, short-term focus, missing data issues, and a need for long-term outcome data, necessitating further research. Future studies should also explore the cost-effectiveness of intravenous versus oral VPZ and the impact on patient quality of life and long-term mortality rates.This review underscores the importance of tailored PPI therapy in managing bleeding peptic ulcers post-endoscopy. It suggests a potentially pivotal role for intravenous PPIs in high-risk patient groups, advocating for a shift towards more aggressive and immediate care protocols in specific clinical settings.

Introduction: Gastric cancer (GC) is one of the most common cancers in the world. It is a very aggressive and heterogeneous tumor. GC does not cause symptoms, so it is often diagnosed in an advanced stage and associated with poor prognosis. Despite new treatment options, it still remains a therapeutic problem. An important element determining the method of treatment of locally advanced gastric cancer (LAGC) is the assessment of lymph node metastases in preoperative and postoperative imaging and/or histopathological examination.Aim: The assessment of lymphovascular invasion (LVI) in histopathological examination in patients with LAGC after gastrectomy. The groups of patients were divided into patients who received preoperative chemotherapy, patients without preoperative chemotherapy, and all patients. Additionally, we assessed the correlation between the presence of LVI and the number of lymph nodes collected during gastrectomy.Material and method: We collected patients with histologically confirmed GC after gastrectomy. The collected samples were divided into three subgroups: patients with neoadjuvant chemotherapy (NAC), patients without NAC, and all patients. Histopathological examination assessed the presence of LVI infiltration. We then assessed the correlation between the presence of LVI and the presence of lymph node metastasis in GC. Additionally, we assessed the correlation between LVI and the number of lymph nodes evaluated in patients in each group. The statistical analyses were performed using Statistica v13.3 and Microsoft Excel 2021. The significance limit was set at p<0.05.Results:The presence of LVI strongly correlated with node involvement, and the result was statistically significant in all patients and the group of patients treated with NAC. The difference was not statistically significant in the group not treated by NAC. Additionally, we did not observe a correlation between the presence of LVI and the number of metastatic lymph nodes in GC.Summary and Conclusions: The presence of LVI in a patient with GC indicates a high probability of lymph node metastasis, which should translate into therapeutic procedures. Assessment of LVI may help identify potential patients with lymph node metastases, particularly in patients undergoing endoscopic resection without planned lymphadenectomy. It is advisable to expand research on a larger scale in order to establish clear standards in this area.

This study aimed to introduce a novel machine learning (ML) model designed to predict the need of interventions during endoscopy in patients with upper gastrointestinal bleeding (UGIB). The risk stratification tools in current use, such as the Glasgow Blatchford Score (GBS) and pre-endoscopic Rockall score, have limitations in accurately predicting the need for endoscopic interventions. All patients diagnosed with UGIB from January 2013 to October 2023 who underwent endoscopy were included in the study. Variables extracted included demographics, social history ,clinical history, clinical presentation and symptoms, drug history, management prior to endoscopy, findings during endoscopy, laboratory variables and vitals, and post-endoscopic results. Three machine learning models including Random Forest Classifier (RFC), Gradient Boosting Classifier (GBC), and AdaBoost Classifier were used to evaluate the need for intervention during endoscopy in our study. A total of 1372 patients were included from three major hospitals in Jordan, of whom 242 underwent endoscopic intervention. The GBC outperformed all other models and pre-endoscopic scores in predicting the need for endoscopic intervention with an area under the curve of 0.861. Findings during endoscopy, platelet count, pulse rate and systolic blood pressure during admission were the most contributing features in predicting the need for the need of endoscopic intervention. This study highlights the potential of machine learning models in enhancing decision making for UGIB management.

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evalua-tion. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP, as-sessing its accuracy, timing, safety, and future technological improvement. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a cru-cial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visu-alization of the pancreas, biliary system, and adjacent structures. High accuracy of EUS is evident in detecting the actual causes of IAP such as microlithiasis, small bile duct stones, pancreas divisum, and small pancreatic tumors. Optimal timing for EUS is post-resolution of the acute phase of the disease. EUS, when conducted by experienced endoscopists, it boasts minimal safety concerns, and is crucial to prevent complications. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in cytological analy-sis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicenter prospective studies. This review underscores EUS as a transformative tool in unraveling IAP's enigma and advancing diagnostic and therapeutic strategies.

In this study, the team employed full-scale crash tests to investigate the impact of post-densification technology on the safety performance of separated central median W-beam barriers under low compaction conditions. By precisely simulating the design and construction environment of the central median, the study comprehensively evaluated the barrier's containment, redirection, buffering, and anti-intrusion performances, as well as the deformation of both the barrier and vehicles under various collision scenarios. The results indicate that under low compaction soil conditions, the A-level separated central median barriers reinforced with post-densification technology effectively meet the specified protection requirements. By comparing the influence of soil strength variations on barrier performance under simulated rainfall conditions, it was confirmed that enhancing soil compaction significantly improves soil stability, effectively increases the overall strength and stability of the barriers, reduces deformation, and significantly enhances safety performance. This study not only validates the effectiveness of the reinforcement scheme but also provides new perspectives for the scientific research of safety barriers and offers crucial technical support for the optimal design of road safety protection facilities.

We introduce a full binary directed tree structure to represent the set of natural numbers, further categorizing them into three distinct subsets: pure odd numbers, pure even numbers, and mixed numbers. We adopt a binary string representation for natural numbers and elaborate on the composite methodology encompassing odd- and even-number functions. Our analysis focuses on examining the iteration sequence (or composition) of the Collatz function and its reduced variant, which serves as an analog to the inverse function, to scrutinize the validity of the Collatz conjecture. To substantiate this conjecture, we incorporate binary strings into an algebraic formula that captures the essence of the Collatz sequence. By this means, we transform discrete powers of 2 into continuous counterparts, ultimately culminating in the smallest natural number, 1. Consequently, the sequence generated through infinite iterations of the Collatz function emerges as an eventually periodic sequence, thereby validating an enduring 87-year-old conjecture.

We use binary string to represent a natural number and show the composite procedure of odd-number and even-number functions, thus we propose full binary directed tree to represent the set of natural numbers and give another partition the natural number set to three sets: pure odd, pure even and mixed number. For the Collatz conjecture we make use of the parity of a natural number to analyse the sequence of iteration (or composite) of Collatz function and reduced Collatz function analog to the inverse function. We give tabular and binary strings to the algebra expression to state the sequence of Collatz, this is the key topic to proof the conjecture: the discrete powers of 2 can be changed to ultimately continuous powers of 2, finally get to pure even number and to the smallest number 1. The sequence created by the infinite iterations of the Collatz function becomes the ultimately periodic sequence if any natural number is the beginning value, proving the conjecture that has been held for 87 years.

This experimental study probes the dynamic behaviour of a 3mm ABS sheet during positive mould vacuum-assisted thermoforming. In this process, the sheet undergoes large and fast deformations, caused by the applied vacuum and mechanical stretching by the mould. The objective is to elucidate the complexities of these large, rapid and non-isothermal deformations. The non-isothermal conditions are caused by the radiative heating of the sheet, convective heat loss to the surrounding air and conductive heat transfer from the sheet to the mould. Utilizing stereo Digital Image Correlation (DIC) in tandem with thermal imaging, the present study accurately maps the occurring displacement, strain and strain rate field in relation to real-time temperature variation of the material. The study progresses to observe the ABS material from the moment it contacts the mould until it conforms to a positive 250mm diameter semi-sphere cast aluminium mould. The DIC methods are validated by comparing thickness values derived from DIC’s principal strain directions to ultrasonic thickness gauge readings. This knowledge not only broadens the understanding of the thermo-mechanical behaviour of the material but also aids in optimizing process parameters for improved thickness uniformity in thermoformed products.

Combinations of Dilwet, an organosilicone surfactant, and ethephon, a hormonal compound often applied to fruit trees to thin the crop, were applied at full bloom to prevent fruit development in two young vineyards differing in elevation by 600 m. Each vineyard was planted with the same 19 red and 10 white grape cultivars from a range of countries of origin. Vineyard elevation did not affect response to treatment. A combined spray of 0.5% Dilwet with 0.04% ethephon reduced cluster number by an average of 85%, while weight of the remaining clusters was reduced by 63%, compared to unsprayed controls. Increasing the concentration of Dilwet to 1% reduced cluster number by 93% and cluster weight by 76%. There were significant differences in the response of cultivars to the treatments, depending on country of origin, with grapes originating in France responding better to higher concentrations of Dilwet. White grapes were more responsive than red grapes. These results highlight the need to test different cultivars and genetic origins of crops when examining the effects of new agricultural chemicals.

Background: Functional restoration of abdominal wall defects represent one of the fundamental challenges of reconstructive surgery. Synthetic grafts or crosslinked animal-derived biological grafts are characterized by significant adverse reactions, which are mostly observed after their implantation. The aim of this study was to evaluate the efficacy of the decellularization protocol to produce a completely acellular full-thickness abdominal wall scaffold. Methods: Full-thickness abdominal wall samples were harvested from Wistar rats and submitted to a 3 cylce decellularization process. Histological, biochemical and DNA quantification analyses were applied to evaluate the effect of the decellularization protocol. Mechanical testing and immunogenicity assessment were also performed. Results: Histological, biochemical and DNA analysis results showed the efficient decellularization abdominal wall samples after the 3rd cycle. Decellularized abdominal wall scaffolds were characterized by good biochemical and mechanical properties Conclusion: The data presented herein confirm the effective production of rat-derived full-thickness abdominal wall scaffold. Expanding this approach will allow the exploitation of the capacity of the proposed decellularization protocol in producing acellular abdominal wall scaffolds from larger animal models or human cadaveric donors. In this way, the utility of biological scaffolds with preserved in vivo remodelling properties may be one step closer to its application in clinical studies.

In this paper, the stability control of the inverted pendulum on a cart with a disturbance forces has been done using observer based and full state feedback H2 controllers. The Lagrangian equation has been used to model the system equation of motions and linearized the system to the unstable upward position. Comparison of the system stability has been simulated by comparing the proposed controllers using Matlab/Scripts and a promising results has been analyzed successfully.

In this paper, the design of a low cost portable ventilator with performance analysis have been done to solve the scarcity of respiratory ventilators for COVID-19 patients. The materials used to build the system are: DC motor, rotating disc and pneumatic piston. The system input is the patient heart beat and the output is volume of air to the patient lung with adjusted breathing rate. This ventilator adjusts the breathing rate to the patient depending on his heart beat rate. The performance analysis of this system have been done using Proportional Integral Derivative (PID) and Full State Feedback H2 controllers. Comparison of the system with the proposed controllers have been done using a step change and a random change of the patient heart beat and a promising result have been analyzed successfully.

Accurate prediction of the self-propulsion performance is one of the most important factors for energy-efficient design of a ship. In general, the hydrodynamic performance of a full-scale ship could be achieved by model-scale simulation or towing tank test with extrapolations. With the development of CFD methods and computing power, directly predict ship performance with full-scale CFD is an important approach. In this article, a numerical study on the full-scale self-propulsion performance with propeller operating behind ship at model- and full-scale is presented. The study includes numerical simulations using RANS method with double-model and VOF model respectively and scale effect analysis based on overall performance, local flow fields and detailed vortex identification. Verification study on grid convergence is also performed for full-scale simulation with global and local mesh refinements. And a series of sea trail tests were performed to collect reliable data for the validation of CFD predictions. The analysis of scale effect on hull-propeller interaction shows that the difference on hull boundary layer and flow separation is the main source of scale effect on ship wake. And the results of the fluctuations of propeller thrust and torque along with circulation distribution and local flow field show that propeller’s loading is significantly higher for model-scale ship. It is suggested that the difference on vortex evolution and interaction is more pronounced and have larger effects on ship’s powering performance at model-scale than full-scale according to the simulation results. From the study on self-propulsion prediction, it could be concluded that the simplification on free surface treatment does not only affect the wave-making resistance for bare hull but also the propeller performance and propeller induced ship resistance which can produced up to 5% uncertainty to the power prediction. Roughness is another important factor in full-scale simulation because it has up to approximately 7% effect on the delivery power. As a result of validation study, the numerical simulations of full-scale ship self-propulsion shows good agreement with the sea trail data especially for cases that have considered both roughness and free surface effects. This result will largely enhance our confidence to apply full-scale simulation in the prediction of ship’s self-propulsion performance in the future ship designs.

Academic entrepreneurship focuses on commercialization of research. Even though it is practiced worldwide for decades, Bangladesh is a newcomer in this segment. In Bangladesh only 2 Universities have Technology Transfer Offices or TTOs which are established with the sole focus of commercialization of researches of the students and the faculty members of the Universities. This article focuses on worldwide practices of technology transfer and academic entrepreneurial activities and also explores the opportunities and challenges of such entrepreneurs through detail investigation of the existing body of knowledge. Apart from exploring the problems and prospect of academic entrepreneurship in Bangladesh, this article also introduces the concept of Full-Service Knowledge Transfer Office (KTO), which existing literatures do not offer. The authors believe that by establishing such KTOs as a self-sustaining body, it is possible for an academic entrepreneur to stimulate, support and sustain their activities in Bangladesh. The concept of full service KTOs can also become models for other nations, specially the developing ones, to establish and nurture a culture of academic entrepreneurship.

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. government in deciding the fate of the ACA.

Nowadays, all the stakeholders, policy makers, regulators, aircraft designers, producers, operators, etc.) are intensively working on development of the aircraft with full electric and hybrid propulsion systems. However, the technical, technological constrains (like limit on accumulator energy density) require introducing a new approach to conceptual design of such aircraft. The new methods is based on energy and mass balance evaluation. This paper analyses the identified constrains; integrates the energy and mass balance equations into the preliminary definition and calculations of the aircraft performance. By this way, the technological constrains might be transferred into the limitation on the aircraft energy and mass breakdown, that initiates a new approach to aircraft conceptual design uses the knowledge based multidisciplinary optimization. The paper describes the developed methodology for conceptual design of aircraft. It show results of implementing this new development philosophy to conceptual design of a four-seat small electric/hybrid aircraft and a special hybrid cargo UAV. The discussion of the results including got by using the emerging and enabling new technologies and new methods and solutions (including for example distributed propulsion system, unconventional forms, morphing, biomimics, etc.), demonstrates the possible implementation of the new development philosophy, new approach to aircraft conceptual design.

Ambiguity exists over treatment and surveillance strategies after endoscopic submucosal dissec-tion (ESD) for esophageal squamous cell neoplasia (ESCN) with unfavorable histologic features. This study investigated the long-term outcomes of ESD in high-risk ESCN patients. We retro-spectively included early ESCN patients treated with ESD at two medical centers in Taiwan be-tween August 2010 and December 2023. Demographic, endoscopic, and pathological data were collected. Among 146 patients (mean age 59.17 years) with 183 lesions, 73 (50%) had a history of head and neck cancer (HNC). En bloc and R0 resection were achieved in 100% and 95.6% of the lesions, respectively. The 5-year overall survival (OS), disease-specific survival (DSS) and local recurrence rates were 42.7%, 94.7% and 11%. R0 resection was significantly associated with re-currence in univariate analysis (adjusted OR: 0.23, 95% CI: 0.05-0.99, P=0.05). Alcohol abstinence was independently associated with lower recurrence (adjusted OR: 0.20, 95% CI: 0.08-0.48, P

After an introductory reminder of safety concerns pertaining to early rechargeable battery technologies, this review discusses current understandings and challenges of sodium-ion batteries. Sodium-ion technology is now being marketed by industrial promoters who are advocating its workable capacity, use of readily accessible and cheaper key cell components. Often claimed to be safer than lithium-ion cells, currently only limited scientific-sound safety assessment of sodium-ion cells has been performed. However, the predicted sodium-ion development roadmap reveals that significant variants of sodium-ion batteries will potentially enter the market in the near future. With recent experiences of lithium-ion battery failures, sodium-ion battery safety management will constitute a key aspect of successful market penetration. As such this review discusses the safety issues of sodium-ion batteries presenting a twofold innovative perspective: i) in terms of comparison with the parent lithium-ion technology making use of the same working principle and similar flammable non-aqueous solvent basis and ii) anticipating the arrival of innovative sub-chemistries at least partially inspired from successive generations of lithium-ion cells. The authors do hope that the analysis provided will assist the concerned stakeholders in the quest for safe marketing of sodium-ion batteries.

A maxillary totally edentulism was rehabilitated with one-piece implants starting from pre-existing totally removable denture. A 3D digital scan of the removable denture and upper and lower arches was performed. On this basis, a prototype with optimal esthetic and functional outcomes was re-alized and turned into a custom-made radiological stent with markers. The superimposition of STL and DICOM files allowed the virtual planning of one-piece implants ideal position. The stackable templates composed of a fixed component, namely base template, and removable components, were realized. The fixed component, once secured with anchor pins to the bone, was no longer removed. The removable components, screwed to the fixed component, were used to perform the implant surgery and the immediate prosthetic loading. A base template allowed for maintaining a fixed reference during the entire workflow, improving the transition between the digital project, the surgical procedure, and the prosthetic rehabilitation.

We aimed to investigate whether the sequence length of HIV-1 increases over time. A longitudinal analysis of full-length coding region sequences (FLs) during an HIV-1 outbreak among pa-tients with hemophilia and local controls infected with the Korean subclade B of HIV-1 (KSB) was performed. Genes were amplified by overlapping RT-PCR or nested PCR and subjected to direct sequencing. Overall, 141 FLs were sequentially determined over 30 years in 62 KSB-infected patients. Phylogenetic analysis indicated that within KSB, two FLs from plasma donors O and P comprised two clusters together with 8 and 12 patients with hemophilia, respectively. Signature pattern analysis for the KSB of HIV-1 revealed 91 signature nucleotide residues (1.05%). In total, 48 and 43 signature nucleotides originated from clusters O and P, respectively. Only six positions contained 100% specific nucleotide(s) in clusters O and P. Additionally, in-depth FL analysis over 30 years indicates that the KSB FL significantly increased over time before combined antiretroviral therapy (cART) and decreased with cART. The increase occurred due to a significant increase in env and nef genes, originating in the variable regions of both genes. The increase in the sequence length of HIV-1 over time suggests that it has an evolutionary direction.

The objective of this study is to investigate whether the sequence length of HIV-1 increases over time. A longitudinal analysis of full-length coding region sequences (FLs) in an outbreak of HIV-1 infection among patients with hemophilia and local controls identified as infected with the Korean subclade B of HIV-1 (KSB). Genes amplified by overlapping RT-PCR or nested PCR were subjected to direct sequencing. In total, 141 FLs were sequentially determined over 30 years in 62 KSB-infected patients. Non-KSB sequences were retrieved from the Los Alamos National Laboratory HIV Database. Phylogenetic analysis indicated that within KSB, 2 FLs from plasma donors O and P comprised two clusters together with 8 and 12 patients with hemophilia, respectively. Signature pattern analysis for the KSB of HIV-1 revealed signature nucleotide residues at 1.05%, compared with local controls. Additionally, in-depth FLs sequence analysis over 30 years in KSB indicates that the KSB FL significantly increases over time before combined antiretroviral therapy (cART) and decreases on cART. Furthermore, the increase in FLs over time significantly occurred in the subtypes B, C and G, but, there was no increase in the subtypes D, A, and F1. Consequently, subtypes F1 and D had the shortest sequence length. Our analysis was extended to compare HIV-1 with HIV-2 and SIVs. Essentially, the longer the sequence length (SIVsm > HIV-2 > SIVcpz > HIV-1), the longer the survival period. The increase in the length of the HIV-1 sequence over time suggests that it might be an evolutionary direction toward attenuated pathogenicity.

Optimizing the nitrogen (N) timings and rate can improve nutrient uptake, and nutrient-efficiencies, especially of N in wheat under the changing climate scenario. Climatic stress in the form of high temperature and drought resulted in the decreased crop physiology and, ultimately, grain yield. Taking the example of rainfed wheat, we quantified the impact of N application rates as full and split-dose at three variable sites of rainfed Pothwar, Pakistan by conducting field experiments for two years (2013-14 and 201-15). Treatments include, T1 = Control (No fertilizer applied), full dose of N applied at the time of crop sowing, i.e. T2 = 50 kg N ha^-1, T3 = 100 kg N ha^-1 and T4 = 150 kg N ha^-1 and split application of N at different timings during different stages of the crop called as split application of N, i.e. T5: Application of 50 kg N ha^-1 (15 kg N ha^-1 (Sowing) : 20 kg N ha^-1 (Tillering) :15 kg N ha^-1 (Anthesis), T6: Application of 100 kg N ha^-1 (30 kg N ha^-1 (Sowing): 40 kg N ha^-1 (Tillering) : 30 kg N ha^-1 (Anthesis) and T7: Application of 150 kg N ha^-1(45 kg N ha^-1 (Sowing) : 60 kg N ha^-1 (Tillering) : 45 kg N ha^-1 (Anthesis). Three study sites include viz. Islamabad (High rainfall with optimum temperature), University Research Farm (URF)-Koont (Medium rainfall with moderate temperature), and Talagang (low rainfall with high temperature). Results showed that the highest stomatal conductance (0.80 mole m^-2 sec^-1), net photosynthetic rate (20.07 μmole m^-2s^-1), transpiration rate (9.58 mmole m^-2s^-1), intercellular CO2 concentration (329.25 μmole CO₂ mol^-1 air), SPAD values (58.86 %) and proline contents (35.42 μg g^-1) were obtained for split application of N (T6 = Split N100) compared to control and full dose of N treatments. Among sites, these physiological traits remained highest at Islamabad and lowest at Talagang, while among years, maximum values of the measured parameters were obtained in 2013-14. A similar trend was observed for crop total N, N efficiencies, and agronomic traits of the crop. Our results suggest that optimum N application rate and its suitable timings can help to harvest real benefits of N as in our findings, split dose resulted in the maximum performance of the crop from physiological parameters to the agronomic traits of the rainfed wheat crop.

Optimizing the nitrogen (N) timings and rate can improve nutrient uptake, and nutrient-efficiencies, especially of N in wheat under the changing climate scenario. Climatic stress in the form of high temperature and drought resulted in the decreased crop physiology and, ultimately, grain yield. Taking the example of rainfed wheat, we quantified the impact of N application rates as full and split-dose at three variable sites of rainfed Pothwar, Pakistan by conducting field experiments for two years (2013-14 and 201-15). Treatments include, T₁ = Control (No fertilizer applied), full dose of N applied at the time of crop sowing, i.e. T₂ = 50 kg N ha^-1, T₃ = 100 kg N ha^-1 and T₄ = 150 kg N ha^-1 and split application of N at different timings during different stages of the crop called as split application of N, i.e. T₅: Application of 50 kg N ha^-1 (15 kg N ha^-1 (Sowing) : 20 kg N ha^-1 (Tillering) :15 kg N ha^-1 (Anthesis), T₆: Application of 100 kg N ha^-1 (30 kg N ha^-1 (Sowing): 40 kg N ha^-1 (Tillering) : 30 kg N ha^-1 (Anthesis) and T₇: Application of 150 kg N ha^-1(45 kg N ha^-1 (Sowing) : 60 kg N ha^-1 (Tillering) : 45 kg N ha^-1 (Anthesis). Three study sites include viz. Islamabad (High rainfall with optimum temperature), University Research Farm (URF)-Koont (Medium rainfall with moderate temperature), and Talagang (low rainfall with high temperature). Results showed that the highest stomatal conductance (0.80 mole m^-2 sec^-1), net photosynthetic rate (20.07 μmole m^-2s^-1), transpiration rate (9.58 mmole m^-2s^-1), intercellular CO₂ concentration (329.25 μmole CO₂ mol^-1 air), SPAD values (58.86 %) and proline contents (35.42 μg g^-1) were obtained for split application of N (T₆ = Split N₁₀₀) compared to control and full dose of N treatments. Among sites, these physiological traits remained highest at Islamabad and lowest at Talagang, while among years, maximum values of the measured parameters were obtained in 2013-14. A similar trend was observed for crop total N, N efficiencies, and agronomic traits of the crop. Our results suggest that optimum N application rate and its suitable timings can help to harvest real benefits of N as in our findings, split dose resulted in the maximum performance of the crop from physiological parameters to the agronomic traits of the rainfed wheat crop.

(1) Background: Sentinel lymph node (SLN) mapping represents an accurate and feasible technique for the surgical staging of endometrial and cervical cancer. This is commonly performed by conventional laparoscopy or robotic-assisted laparoscopy, but in recent years, a new retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach has been described. This technique provides easy visualization of lymphatic afferent vessels and pelvic lymph nodes, early SLNs assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial. However, only a few publications have reported it. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, research concerning this technique is at stage 2a, with only small case series as evidence of its feasibility. Its standardized description appears necessary to provide the surgical homogeneity required to move further. (2) Methods: description of a standardized approach for retroperitoneal pelvic SLN mapping by vNOTES. (3) Results: we described a 10-step approach to successfully perform retroperitoneal vNOTES SLN mapping, including pre-, intra-, and postoperative management. (4) Conclusions: This IDEAL stage 2a study could help other surgeons approach this new technique, and it proposes a common methodology necessary to evolve through future IDEAL stage 2b (multi-center studies) and stage 3 (randomized controlled trials) studies.

Solid asperity interactions are common and inevitable under severe loading conditions for any lubricated contact. Heavy-duty machine components (gear, bearings etc.) generally operate under Mixed Lubrication, where uneven surface features contact each other when generated fluid pressure is not enough to support the external load. The Reynolds equation is commonly used to simulate smooth lubricated contacts numerically. In rough lubricated interfaces where opposite surface asperities make contact, the Reynolds equation alone cannot accurately predict pressure using the traditional numerical simulation method. In this paper, Lubrication-Contact interface conditions (LCICs) have been implemented and extended to solve the multiple asperity contact problem using the full-multigrid approach. The developed novel algorithm has significantly accelerated the solution process and improved the accuracy and efficiency of pressure calculation for fluid-solid sub-interactions that can occur under ML regions. The Finite Difference Method (FDM) results have been compared with Computational Fluid Dynamics (CFD) simulation to validate the newly developed model. Hence, the proposed optimized solution method will provide valuable insight to researchers and industry engineers interested in simulating the ML problem where the effect of the fluid-solid interface can be captured effectively to improve reliability in the calculation of the life expectancy of the lubricated parts.

We reveal the significance of plasmonic nanoparticle’s (NP) shape and its surface morphology en route to an efficient self-assembled plasmonic nanoparticle cluster. A simplified model is simulated in the form of free-space dimer and trimer nanostructures (NPs in shape of sphere, cube, and disk). A ~ 200 % to ~ 125% raise in near field strength (gap mode enhancement) is observed for spherical NPs in comparison with cubical NPs (from 2 nm to 8 nm gap sizes). Full-width three-quarter maximum reveals better broad-spectral optical performance in a range of ~ 100 nm (dimer) and ~ 170 nm (trimer) from spherical NPs as compared to a cube (~ 60 nm for dimer and trimer). These excellent properties for sphere-based nanostructures are merited from its dipole mode characteristics.

Traditional discrimination techniques for Euler deconvolution use only the color spectrums of structural indexes, without considering the spatial distribution characteristics and inherent relationships among the Euler solutions to separate adjacent causative sources. In the present study, a new approach was developed for discriminating uncorrelated Euler solutions from coherent solutions based on the focusing levels indicated by the probability density distributions generated using multivariate kernel density estimations (KDE). A novel multiple coverage technique was proposed by using a series of different sized moving windows over gridded gravity data, which formed tight clusters of Euler solutions for different sized causative sources. The results of the probability density distributions were obtained using a 3-D KDE method for the Euler solution subsets {x, y, z} of synthetical models, and real data from a survey conducted in British Columbia (Canada) which had successfully established more credible and meaningful geological models when compared with three other subsets.