搜索结果：Applied

Low back pain is a common pathology in the general population. In people over 60 years of age, it is associated with degenerative changes that cause narrowing of the vertebral canal. Its treatment includes conservative measures and even surgery with decompression and fusion. In those patients with moderate symptoms, the use of interspinous spacers emerged as a minimally invasive therapeutic option. This scoping review seeks to map the existing literature on the use of interspinous spacers and identify knowledge gaps to clarify their real position in the stepwise approach to low back pain. This study as a scoping review, conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. The type of synthesis chosen was descriptive and mapping-based, allowing for the inclusion of diverse study designs (randomized controlled trials, observational studies, case series, clinical guidelines, and relevant reviews) to capture a comprehensive overview of the field. This approach was selected because the existing literature is heterogeneous in terms of intervention protocols, clinical outcomes, and follow-up duration, and the effectiveness and indications for interspinous spacers (ISD) remain controversial. The search was extended from the inception of the databases until November 2025. The program "Rayyan" was used to collect the information and facilitate the analysis process. Each of the authors independently reviewed the summary of all the articles found and applied the following inclusion criteria: systematic review, clinical trials, observational studies, and case series. articles in cadavers or made in the laboratory. A total of 522 articles were found in the databases consulted, of which 95 duplicate articles were eliminated. The criteria (Inclusion/Exclusion) were applied to the 427 identified articles based on the independent reading of the abstracts by each of the authors in the Rayyan platform, and 110 articles were excluded. The 317 selected articles were reviewed completely by each of the authors to finally obtain 101 articles included in the review. The use of ISD in the treatment of moderate LSS may be controversial. Although the clinical results seem conclusive about the usefulness in controlling symptoms, more studies are needed to compare these technologies with new surgical procedures and especially new biomechanical concepts. The efforts made to treat patients with moderate LSS appropriately should continue to be channeled into optimizing techniques.

Multi-criteria optimization (MCO) is an advanced optimization technique that can be applied to any problem with multiple objectives that may be conflicting. MCO has been available in commercial treatment planning systems (TPS) for several years now and has been applied to treatment planning of many anatomical locations in a variety of ways. The MCO optimization method is based on the Pareto plans generation and is very powerful, but there are significant hurdles in terms of clinical implementation due to long computing times, lack of dosimetrists training and plan degradation after the optimized fluence is converted to deliverable. While some authors have studied the use of MCO in automation, no clinical implementation of an MCO-based auto-planning technique has been reported. This study aims to develop and clinically deploy an automated planning tool based on MCO for prostate and whole-pelvis radiotherapy. A Python script based on a commercial treatment planning system was developed to automate MCO, including Pareto plan generation, fluence plan selection, dose conversion, and post-processing. The tool underwent retrospective validation on 10 prostate patients with the input of four dosimetrists and a 10-month prospective pilot involving another three senior dosimetrists across different community sites. Dosimetrists evaluated plan quality and provided quantitative and qualitative feedback for iterative improvements of the tool. The study reports on the plan comparisons between the clinical and the MCO generated plans for retrospective patients. The study also reports the prospective use cases and the qualitative and quantitative evaluations from dosimetrists. Retrospective evaluations showed 82.5% of MCO prostate plans were clinically acceptable. The tool generated prostate plans in approximately 10.1 min and whole pelvis plans in 27.2 min. Dosimetric analysis revealed comparable plan quality to clinical plans, with MCO plans achieving lower organ-at-risk doses. In the pilot phase, the MCO tool was used for 41 prospective patients, producing plans that dosimetrists could refine to achieve clinical acceptability within a median of 10 min. This study demonstrates the successful development and clinical implementation of an MCO-based automated planning tool for generating acceptable VMAT plans for prostate and whole pelvis radiotherapy. The extensive pilot phase showcases an effective strategy for integrating automated planning solutions into routine clinical practice.

Effective pest management requires accurate and continuous monitoring. This monitoring helps assess population dynamics and guides the development of integrated pest management strategies. Traps used to capture insects are an alternative applied to various crops. However, the identification and manual counting of specimens are time-consuming, require taxonomic knowledge, and depend on the expertise of specialists. Automation could reduce costs, increase accuracy, and enable scalable analyses. Current computer vision and artificial intelligence techniques can quickly and accurately identify objects in digital images. This study presents a systematic review of literature retrieved from multidisciplinary and specialized databases (Scopus, ACM, Web of Science, IET, DBLP, Springer, and ScienceDirect), focusing on the intersections of agriculture, ecology, and computer science. We found 284 studies published between 2020 and 2025. Among them, 57 fulfilled the eligibility criteria, considering applied computing solutions for insect identification and counting using digital images of specimens collected via traps or photographed in situ on plants, in both field and laboratory settings. The findings highlight the use of electronic traps for real-time data collection and improvements in convolutional neural networks, with visual transformers and attention mechanisms for multi-species and fine-grained recognition. They also indicate opportunities to leverage microscopy resources, overcome limitations in the large-scale deployment and integration of electronic trap networks, and integrate real-time monitoring data with forecasting models using weather predictions to promote early warning systems for integrated pest management.

We aimed to compare the effectiveness of methadone and sublingual buprenorphine/naloxone and their association with treatment discontinuation using real-world data from Ontario, Canada. We conducted a longitudinal retrospective cohort study utilizing linked, population-level administrative databases in Ontario. We included data on all Ontario residents with an indication of opioid use disorder (OUD) between January 1, 2014, and a maximum follow-up of December 31, 2022 (n = 45,230). We defined exposure groups as methadone and buprenorphine, and the primary outcome was treatment discontinuation. We applied propensity score matching was applied to compare treatment discontinuation outcomes between patients initiating methadone or buprenorphine/naloxone, controlling for demographics and clinical measures. We incorporated various databases, including the Narcotics Monitoring System, Discharge Abstract Database, and the National Ambulatory Care Reporting System, and analyzed repeated treatment windows to evaluate healthcare utilization and treatment patterns across Ontario's diverse geographic regions. From 2014 to 2022, 45,230 people with OUD contributed case or control windows. During the first 30 days of treatment, buprenorphine was associated with lower discontinuation compared with matched methadone controls (61% vs. 57.7% retained at day 30). However, beyond 60 days, methadone demonstrated lower discontinuation, with Cox proportional hazards model indicating a lower risk of treatment discontinuation. We also observed lower discontinuation time among individuals in rural and remote Northern areas. Cox proportional hazards models confirm time-varying effects, with unadjusted HR 0.95 [0.94-0.96] and fully adjusted HRs ranging from 1.03 [1.02-1.04] to 1.09 [1.05-1.12], and rural/remote Northern areas show longer time to discontinuation. Our study highlights the importance of considering both medication type and geographic location when developing strategies to improve treatment retention for individuals with opioid use disorder.

This study aims to develop and validate the VOUSH (value orientation for users and society in healthcare) measurement scale, with a view to measuring how healthcare organizations offer value in an integrated way to both users and society. The theoretical framework combined approaches from experiential marketing and health - the foundations of VOUSH - taking into consideration business management, care management, value co-creation, digital technologies, user experience, corporate social responsibility (CSR) and value in healthcare. The methodology included two quantitative studies. The first, which was exploratory in nature, involved 213 users and health professionals, with a questionnaire and exploratory factor analysis being applied to identify dimensions of VOUSH. The second, confirmatory study included 169 managers (decision-makers) and used structural equation modeling for validation. The scale revealed three dimensions of VOUSH, namely user experience in healthcare, CSR in healthcare, and digital healthcare, with the results reinforcing the importance of these dimensions in aligning organizational practices with social and individual demands in healthcare. The scale is useful for assessing the degree of strategic maturity of healthcare organizations in offering shared value, which is a construct with high practical potential for the strategic marketing management of healthcare organizations.

Multidimensional information (e.g., composition, location, size, and particle concentration) of nanoparticles (NPs) in plants is critical for elucidating their uptake, translocation, and transformation. However, accurate acquisition of this information in complex plant samples remains a great challenge. Laser ablation-single particle inductively coupled plasma-mass spectrometry (LA-spICP-MS) holds promise for in situ NPs analysis, but its reliability is hindered by determination of NPs transport efficiency (η) and discriminating NPs signals from ionic/aggregation-induced varying backgrounds. To address this challenge, we proposed a new LA-spICP-MS strategy with dual-calibration and dynamic baseline correction to realize rapid multidimensional analysis of AuNPs in real plants. First, a dual-calibration approach using standards containing AuNPs/AuCl4- was developed. It enables simultaneous determination of η and concentration response factor of Au, thereby achieving quantification of the size and particle number of AuNPs. Second, a dynamic baseline-corrected data processing workflow was established. Specifically, a baseline composed of continuous minimum points was constructed, and AuNPs signals were further discriminated using the peak width and maximum-to-minimum intensity ratio. Under optimal conditions, AuNPs larger than 20 nm can be discriminated even with the presence of AuCl4- at concentrations below 20 μg g-1. The developed LA-spICP-MS method was applied to analysis of the uptake of AuNPs and in vivo synthesis of AuNPs in Arabidopsis thaliana. The obtained results provide direct evidence for the transport pathways of exogenous AuNPs and in vivo synthesis of AuNPs. The integrated approach provides a comprehensive solution for multidimensional NPs analysis in biological tissues, facilitating in-depth understanding of NPs behavior in plants.

Optical coherence tomography angiography (OCTA) has rapidly evolved from an experimental imaging technique into a routine component of many retina practices. By providing noninvasive, depth-resolved visualization of retinal and choroidal vasculature without dye injection, OCTA promises safer, faster, and more detailed assessment of retinal vascular disease than fluorescein angiography. However, there is still debate about its clinical applicability and its role in everyday ophthalmology practice, which we review in this article. Over the past decade, OCTA has been extensively applied to diabetic retinopathy, retinal vein occlusion, sickle cell retinopathy, and other ischemic disorders, generating a growing body of literature linking OCTA-derived metrics to disease severity and visual outcomes. Despite this enthusiasm, significant limitations remain, including susceptibility to artifacts, restricted field of view, inability to demonstrate vascular leakage, and uncertain impact on management decisions. We critically evaluate the current role of OCTA in retinal vascular disease by reviewing recently published literature. This review examines OCTA's technical foundations, clinical applications, strengths, limitations, and future directions. We argue that OCTA is neither a replacement for conventional angiography nor a mere technological novelty, but rather a powerful complementary imaging modality whose value depends on appropriate interpretation and thoughtful clinical integration.

Gas chromatography coupled to mass spectrometry (GC-MS) is a robust and well-established technique for the analysis of volatile organic compounds (VOCs). Typically, electron ionization is used to combine these techniques; however, it requires high-vacuum conditions and produces extensive fragmentation. Venturi easy ambient sonic spray ionization (V-EASI) mass spectrometry is an ambient ionization approach suitable for samples in both solution and gas phases, employing high pressure as a soft ionization mechanism. In this work, we present a proof-of-principle for coupling GC to MS via V-EASI, applied to the quantification of acetic acid as a residual solvent in pharmaceutical products for quality control purposes. The system was automated and optimized, achieving a runtime of approximately 70 s per sample. The developed method meets the validation guidelines established by the International Council for Harmonization (ICH). Owing to its speed, simplicity, and broad applicability, GC-V-EASI-MS represents a powerful alternative for real-time, high-throughput VOC analysis.

We, the PTMeXchange Consortium, present a meta-analysis of eight high-quality data sets to map 56,694 phosphosites in brewer's yeast (Saccharomyces cerevisiae) using strict control for false identifications. Each site has been classified into the Gold-Silver-Bronze confidence categories. First, we identified 55 significant motifs and grouped these into kinase classes to perform pathway enrichment analysis. Next, we leveraged disorder region predictions and AlphaFold 3's ability to consider post-translational modifications (PTMs) when modeling proteins to understand the structural context of phosphosites. Here, we determined that phosphorylation tends to occur on disordered serine and threonine residues. AlphaFold predictions suggest that phosphosites induce alpha helices to form in proteins, although many "induced helices" appear to be unusually short and require further validation. As artificial intelligence (AI) is being applied in proteomics, we must ensure that publicly available data are accurate and of high-quality to be used for downstream analyses and training models. With this motivation, our results are available in PRIDE (PXD071918), PeptideAtlas and UniProtKB, ensuring that this PTM data is FAIR and "AI-ready".

The systemic inflammation response index (SIRI) is an emerging inflammation-immune indicator calculated from counts of neutrophils, monocytes, and lymphocytes. The potential prognostic value of SIRI in various tumors has been reported in several studies. However, updated and comprehensive evidence regarding its prognostic value in lung cancer (LC) remains insufficient. This study, through a systematic review and meta-analysis, intends to comprehensively analyze the relationship of SIRI with overall survival (OS) and progression-free survival (PFS) among individuals experiencing LC. Cochrane Library, Web of Science, Embase, and PubMed were systematically searched from the commencement of the databases to October 2025. Cohort studies reporting the relation of SIRI with OS or PFS were included. Hazard ratios (HRs) alongside their 95% confidence intervals (CIs) were obtained, and a random-effects model was employed for data synthesis. Subgroup analysis, sensitivity analysis, and assessment of publication bias were conducted to evaluate the robustness of the findings. In total, 27 studies involving 6195 patients with LC were incorporated into this meta-analysis, which revealed that high SIRI levels were significantly associated with poorer OS (HR = 1.83, 95% CI 1.58-2.13) and PFS (HR = 1.53, 95% CI 1.31-1.79). Differences in age, region, and cutoff value for SIRI were identified as the primary sources of heterogeneity. The sensitivity analysis indicated stable results, while the Egger's test demonstrated publication bias. A higher SIRI level is significantly associated with adverse survival outcomes among individuals suffering from LC. As a simple and low-cost hematological marker, SIRI is potentially applied in the risk stratification and prognosis assessment of LC. In the future, prospective studies based on multicenter data and with a larger sample size, and a unified cutoff standard for SIRI are warranted to further corroborate the clinical utility of SIRI.

Vision-threatening ocular diseases are impacted by aging-associated molecular changes, including mitochondrial dysfunction, cellular senescence, and chronic inflammation. Anti-VEGF therapies targeting VEGF-A/VEGFR2 signaling remain the frontline standard of care, but many patients exhibit suboptimal or nondurable responses, often due to compensatory and/or compromised antiangiogenic and anti-inflammatory pathways. We aimed to elucidate shared mechanisms underlying treatment failure and disease progression. We applied an integrative systems biology framework that combined multiomics datasets, network-based machine learning, and disease-specific pathway mapping. A comprehensive literature review of conditions, including diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, glaucoma, and aging, identified 14 core genes consistently associated with angiogenesis, inflammation, and immune signaling. Multialgorithm centrality and enrichment analyses reconstructed disease-specific interaction networks, revealing consensus mechanistic axes. Integration of cell-type-specific single-cell RNA sequencing data from AMD-RPE clusters identified cluster-specific gene hubs and vertical signaling axes, leading to VEGF blockade failure. EGFR, HSP90AA1, SIRT1, and STAT3 emerged as central resistance hubs linking angiogenesis and inflammatory processes. Pathway enrichment analyses revealed 21 conserved core signaling cascades, grouped into six functional categories, with AGE-RAGE, PI3K-Akt, HIF-1, MAPK, and chemokine pathways playing central roles. A MiRGD-based peptide nanocomplex delivering htsFLT01 achieved efficient RPE transfection and controlled gene activation under basal conditions. This systems-level framework clarifies mechanisms of VEGF blockade resistance and provides a rational basis for next-generation, combinatorial therapeutic strategies requiring validation in disease-relevant models.

Pelvic fractures are classified as stable or unstable. They correlate with a severity of trauma and the initial medical treatment is decisive. This study evaluated the transferrals of such fractures and described the initial treatment as well as the clinical course. We analysed retrospective data from a large cohort of the TraumaRegister DGU&#xae; (TR-DGU), covering the period from 2014 to 2023, comprising a total of n&#x2009;=&#x2009;397,910 patients. All patients aged&#x2009;&#x2265;&#x2009;16 years were included. Injury patterns were described according to the Abbreviated Injury Scale (AIS), the mechanically unstable fractures were classified with an AIS&#x2009;&#x2265;&#x2009;3. We considered all participating hospitals within Germany. The patients were subdivided in three groups: Group 1&#x2009;=&#x2009;primary admitted patients with outcome, group 2&#x2009;=&#x2009;pre-treated patients transferred in from other hospitals, and group 3&#x2009;=&#x2009;primary admitted and early (<&#x2009;48&#xa0;h) transferred out. The majority of the patients was male and about 53 years old. Blunt trauma was the leading trauma mechanism. Concomitant injuries (AIS 2+) affected thorax (56%), spinal cord (41%), lower extremities (38%), head (31%) and abdomen (24%). Among primary admitted cases with pelvic fractures (n&#x2009;=&#x2009;36,398), 21,091 cases (57.9%) had an unstable pelvic fracture (AIS pelvis 3-5). Level 1 trauma centers not only treated 12,836 primary admitted cases with unstable pelvic fractures (83.5%) but also received 2,365 patients (15.4%) from other hospitals via transfer; while only 1% of cases were transferred out early (n&#x2009;=&#x2009;170). Transfusion was administered in 5,984 patients (16.5%) (AIS 2-5). A pelvic binder was applied in 7,096 (36.3%) patients and surgical stabilisation was performed in 4,075 (14.9%) patients. The length of stay on intensive care unit was highest in AIS 5 with 6 days. The mortality rate was 38.5% in AIS 5, and 9.9% in AIS 2. Over the course of the last 10 years, the prevalence of unstable pelvic ring fractures (AIS 3-5) constantly remained around 9%. Unstable pelvic fractures were increasingly transferred to a Level I trauma center. Unstable pelvic fractures correlated with a high Injury Severity Score (ISS). The early treatment involved the transfusion of packed red blood cells, the application of a pelvic binder and the surgical stabilisation. Though, these tools were increasingly utilized with the severity of trauma.

Cleavage of C(sp2)-O bonds in anisoles typically requires transition metal catalysis or harsh reaction conditions. Herein, we report a mild and metal-free photocatalytic strategy for the direct conversion of anisole derivatives into epoxyquinols and para-quinols. This method uses in situ generated singlet oxygen and water as nucleophiles to control divergent pathways. The transformation exhibits a broad substrate scope and excellent functional group tolerance and can be applied to the late-stage functionalization of complex natural products. This work provides a sustainable alternative to traditional transition-metal-catalyzed C(sp2)-O functionalization and expands photoredox catalysis in dearomative synthesis.

To compare subjective visual quality and patient-reported outcomes after bilateral implantation of three diffractive trifocal intraocular lenses (IOLs): AT LISA tri 839MP, AcrySof IQ PanOptix, and Tecnis Synergy. Prospective, randomized, comparative clinical trial. Forty-three patients with bilateral cataract were randomized to one of the three trifocal IOL models. A single surgeon used standardized techniques, and assessments were performed 3 months after second-eye surgery. Subjective visual quality was evaluated using three validated patient-reported outcome measures: Cataract TyPE Spec (TyPE), Near Activity Visual Questionnaire (NAVQ), and Catquest-9SF (Rasch-modeled). Outcomes included global and item-level scores, satisfaction, and photic phenomena. Nonparametric tests (Kruskal-Wallis; Mann-Whitney U with Bonferroni) were applied at the patient level. All IOLs yielded high visual function and satisfaction, with ceiling effects across questionnaires. The median TyPE global scores were 56 (AT LISA tri), 54 (PanOptix), and 59 (Synergy) ( P = 0.322). NAVQ indicated minimal difficulty with near/intermediate tasks ( P = 0.127). The Catquest-9SF Rasch person measures were -3.52 &#xb1; 0.77, -3.64 &#xb1; 0.35, and -3.79 &#xb1; 0.29, respectively ( P = 0.221). One TyPE intermediate-vision item favored Synergy over PanOptix ( P = 0.015). Photic phenomena were infrequent and comparable among groups. All three diffractive trifocal IOLs provided excellent subjective visual performance, satisfaction, and spectacle independence. Although Synergy showed a slight advantage for intermediate tasks, overall differences were minimal, supporting consistently high patient-reported outcomes with current trifocal optics.

Spinal muscular atrophy (SMA) is a rare autosomal recessive hereditary neuromuscular disease that leads to progressive muscle weakness and atrophy. Available treatments differ significantly in terms of effectiveness, administration, costs, and side-effect profiles. Currently, evidence regarding patient treatment preferences remains scarce, especially in developing countries. This study aimed to provide evidence on patient preferences toward SMA treatments. We conducted a discrete choice experiment (DCE) among patients with SMA in China. Attributes were selected on the basis of a systematic literature review, in-depth patient and expert interviews, and validation through a focus group discussion. Five attributes were included: mode of administration, annual out-of-pocket costs, motor function, respiratory function, and incidence of side effects. A mixed logit model was applied for preference estimation. On the basis of the model results, we derived attribute relative importance (RI), conducted scenario analyses to predict the uptake of hypothetical treatment profiles, and performed willingness-to-pay (WTP) analyses to quantify the monetary value of attribute improvements. A total of 202 patients completed the questionnaire, with 190 included in the final analysis. Respondents had a mean age of 29.2 years, were predominantly diagnosed with type 3 SMA (67%), and mainly received parental care (70%). Annual out-of-pocket expenses (RI = 56%) emerged as the most influential attribute, followed by motor function improvements (RI = 20%), incidence of side effects (RI = 13%), respiratory function (RI = 8%), and mode of administration (RI = 3%). Patients expressed a substantial willingness to pay of renminbi (RMB) 32,217 annually for improvements in motor function. Scenario analyses indicated that 95% of patients would prefer a new treatment profile providing enhanced motor function, even at higher costs. Adult patients with type 2 or type 3 SMA in China strongly prefer affordable treatments with oral administration, improved motor and respiratory functions, and minimal side effects. Understanding these preferences can guide clinical decision-making, supporting personalized treatment strategies that may ultimately enhance treatment adherence and clinical outcomes. This study asked adults in China with type 2 or 3 SMA about their preferences for treatment. We found that lower out-of-pocket costs were the most important factor in their choices. Improvements in movement ability were also highly valued, and patients were willing to pay over 32,000 RMB per year for such benefits. Most patients preferred a new treatment that improved movement, even if it cost more. These results can help doctors and policymakers better understand what matters most to patients when choosing treatments.

Here we report high-performance all-polymer transparent heaters based on the air-stable n-doped polymer poly(benzodifurandione) (n-PBDF). Using a scalable ethanol-based ink and a single-step, post-treatment-free spray-coating process, the resulting films combine low sheet resistance (Rs &#x2248; 60 &#x3a9; sq.-1), high visible light transmittance (VLT > 80%), and low optical haze (<0.30%). The heaters reach steady-state temperatures above 180 &#xb0;C at low DC voltages (<24 V) with rapid heating rates (>2.5 &#xb0;C s-1). Measurements of the in-plane and cross-plane thermal conductivities reveal a pronounced thermal anisotropy (&#x3ba;x,y/&#x3ba;z &#x2248; (35 to 37)), with a high in-plane conductivity of &#x2248;3.4 W m-1 K-1 that promotes uniform heating. A thermal model accounting for the Temperature Coefficient of Resistance (TCR) is applied to extract key heater parameters, revealing rapid, predictable thermal response times (t90% &#x2248; (90 to 150) s). The n-PBDF heaters retain >85% of their initial performance after 7 days of continuous operation and withstand 60 000 bending cycles (10 mm radius), demonstrating both robust operational stability and mechanical durability. Finally, we demonstrate practical utility by rapid deicing of surface frost on glass-substrate heaters cooled on dry ice (-78.5 &#xb0;C), and by integrating heaters fabricated on flexible PET substrates into ski goggles and motorcycle visors to enable rapid, low-voltage defogging.

Ebola virus disease (EVD) is a highly pathogenic and lethal disease caused by Ebola virus (EBOV). Endemic to Sub-Saharan Africa, EBOV has been causing global health concerns during infrequent EVD outbreaks since 1976, particularly during the 2013 -2016 epidemic in West Africa. Spread by contact of contaminated bodily fluids with mucous membranes or breaks in the skin, EBOV yields an incredibly high mortality rate and, as a result, has been designated a priority pathogen and a select agent to be studied exclusively in maximum containment laboratories. EBOV has historically been studied in animal models that accurately recapitulate disease progression, symptoms, and outcomes as seen in humans via more artificial infection routes such as intramuscular (IM) and intraperitoneal (IP) inoculation. There has recently been a concerted effort to characterize disease in animal models with mucosal inoculation routes with the goal to more accurately replicate human infection and development of EVD. This review aims to summarize and characterize the different inoculation routes used in the various animal models applied in EBOV research. We also outline the differences in disease progression between "artificial" and mucosal infection routes, comparing them to the course of EVD as seen in humans to highlight similarities and differences.

The use of a 4-F platform is increasingly used during peripheral arterial interventions, with most of the devices now being compatible with 0.018&#x2033; and 0.014&#x2033; wires. Unexpected complications/procedural steps during such procedures can require sudden sheath upsize. In this occasion, to maintain the original low-profile guidewire(s), usually positioned across the target lesion(s), can be extremely important. Hereby we describe a technique to safely allow bailout sheath upsizing without losing access to the target lesion(s), which can be applied in a various number of clinical scenarios.