Congenital pulmonary airway malformation (CPAM) is a rare congenital lung lesion that is often diagnosed prenatally. Large macrocystic lesions can cause severe respiratory compromise after birth, requiring urgent decompression. Although staged management with cyst drainage followed by delayed resection has been reported, the optimal method for achieving reliable decompression in critically unstable neonates remains unclear. We report a case in which emergency open cyst drainage under direct visualization enabled secure catheter placement and reliable decompression before definitive surgery. A female neonate with a large macrocystic CPAM underwent thoracoamniotic shunting during the fetal period. After birth, she developed severe respiratory failure caused by rapid enlargement of the cystic lesion and mediastinal shift. Because the precise extent of the lesion remained unclear and immediate definitive resection was considered unsafe, emergency open cyst drainage was performed. Under direct visualization, the previously placed shunt tubes were removed, and drainage catheters were securely inserted into the cystic lesions and fixed to the cyst walls. Continuous drainage achieved reliable decompression, relieved compression of the normal lung, and improved respiratory status. After sufficient lung expansion and a more accurate assessment of the lesion extent, delayed lower lobectomy was safely performed. The postoperative course was favorable. Emergency open cyst drainage under direct visualization may provide reliable decompression in critically ill neonates with severe CPAM. This technique may be a useful alternative to percutaneous drainage when secure catheter placement and predictable decompression are required. Effective decompression may also facilitate staged management and allow definitive resection under safer conditions.
Intertrochanteric fractures of the femur are a prevalent type of hip fracture among the elderly. While surgical treatment is the preferred approach for managing these fractures, conventional tourniquets cannot be applied in hip surgery due to anatomical constraints. As a result, effectively controlling intraoperative and perioperative blood loss has long posed a significant clinical challenge. A 70-year-old male patient with a comminuted fracture in the left intertrochanteric region of the femur underwent closed reduction and internal fixation using a proximal femoral nail anti-rotation (PFNA). During the procedure, a proprietary compression-type femoral artery hemostasis device was used to effectively control regional blood flow. The femoral artery pulsation was palpated inferior to the inguinal ligament and superior to the pubic ramus. A compression device was then applied to achieve precise compression of the femoral artery. Effective compression was indicated by the absence of the dorsalis pedis artery pulse, which helped maintain collateral circulation. The procedure lasted 45 min, with an estimated intraoperative visible blood loss of 50 mL. Quantitative analysis using the Gross formula, based on the patient's hematocrit decline from 0.394 preoperatively to 0.358 on postoperative day 2, revealed a calculated total perioperative blood loss of 433 mL, with hidden blood loss accounting for 383 mL. There were no postoperative complications, including limb ischemia, nerve injury, or deep vein thrombosis. The patient was discharged in good condition 6 days after surgery. A follow-up examination at 6 weeks postoperatively revealed satisfactory callus formation at the fracture site and stable internal fixation. In this single case, application of the self-developed femoral artery compression hemostatic device was associated with reduced intraoperative blood loss and a favorable safety profile during PFNA fixation of an intertrochanteric fracture. The device may offer a novel, non-invasive hemostatic strategy for selected hip fracture surgeries; however, further studies are required to confirm its efficacy and safety.
This study aimed to assess the clinical effectiveness of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) and develop a predictive model for treatment outcomes. A retrospective analysis was conducted of TN patients who underwent PBC between September 2020 and September 2023. Propensity score matching was used to match ineffective and effective cases at a 1:4 ratio. Perioperative data were analyzed using t-tests and chi-square tests. LASSO (least absolute shrinkage and selection operator) regression identified relevant predictors, which were then used to build a multivariate logistic regression model. Among 230 matched patients, PBC was ineffective in 46 and effective in 184. Perioperative parameters differed significantly between the groups, while demographics did not. Balloon volume, compression duration, balloon pressure, and shape were identified as predictors of treatment outcomes. The model achieved an area under the curve of 0.890, indicating strong discriminative ability. PBC showed significant efficacy in treating TN. Balloon volume, compression duration, pressure, and shape were independent predictors of treatment outcomes.
Dysphagia is commonly attributed to intrinsic esophageal pathology; however, extrinsic compression from mediastinal processes remains an important and often underrecognized cause. We report the case of a 69-year-old man who presented with acute dysphagia due to food impaction. Esophagogastroduodenoscopy successfully relieved the obstruction but revealed no intrinsic lesion, instead demonstrating extrinsic compression of the upper esophagus. Subsequent cross-sectional imaging identified a large anterior mediastinal mass extending into the left neck, encasing the aortic arch and its branches, and causing significant esophageal deviation and stenosis. Laboratory evaluation was notable for leukocytosis, anemia, elevated inflammatory markers, and an elevated carcinoembryonic antigen level. Initial attempts at tissue diagnosis, including ultrasound-guided axillary lymph node sampling and endobronchial ultrasound-guided transbronchial needle aspiration, were nondiagnostic due to insufficient or nonrepresentative tissue. Given persistent high clinical suspicion, further tissue sampling was pursued, ultimately establishing a diagnosis of squamous cell carcinoma. This case highlights the diagnostic limitations of endoscopy in the evaluation of extraluminal disease, the challenges of tissue acquisition in mediastinal pathology, and the critical importance of persistence following nondiagnostic biopsies. An imaging-driven, multidisciplinary approach is essential for accurate diagnosis and timely management in patients with suspected mediastinal malignancy.
Intraspinal tophaceous gout is rare but may cause severe neurological deficits when it compresses the spinal cord. Thoracic spinal stenosis due to ossification of the ligamentum flavum (OLF) is an additional, common dorsal compressive pathology. We report a patient with thoracic spinal canal stenosis due to OLF with concomitant epidural tophaceous gout, successfully treated using unilateral biportal endoscopy (UBE) combined with percutaneous pedicle screw fixation. A 50-year-old man with a 4-year history of gout and multiple peripheral tophi presented with a 2-year history of back pain that worsened over 2 weeks, accompanied by bilateral lower-limb pain, numbness, and marked weakness (lower-limb strength grade 2). Preoperative imaging demonstrated severe thoracic canal stenosis at T10-T11 due to OLF and new compression fractures at T8 and T10. Laboratory tests revealed leukocytosis, elevated ESR and CRP, and hyperuricemia. The patient underwent UBE-assisted decompression with resection of the OLF at T10-T11, followed by percutaneous pedicle screw fixation at T7-T9 and T11-T12. Intraoperatively, abundant chalky-white tophaceous material was identified in the epidural space and confirmed histologically as monosodium urate deposits with granulomatous inflammation. His symptoms gradually resolved, muscle strength improved, and he achieved good functional recovery one year post-operatively. This case suggests that UBE may be a precise minimally invasive option for selected patients with thoracic intraspinal gout and underscores the necessity of multidisciplinary care and long-term urate-lowering therapy.
To test whether a pneumatic cold-compression system (CC) improves recovery of maximal voluntary contraction (MVC) at 48 h (T4) versus Sham after a standardized hamstring fatigue protocol. Secondary aims were to compare muscle stiffness, microvascular perfusion, pressure pain threshold (PPT), blood lactate, perceived recovery (TQR), and harms across subgroups. This multicenter, randomized, participant- and assessor-blinded, sham-controlled, two-period crossover trial enrolled 80 participants. After fatigue testing, participants received CC (3 °C, 75 mmHg, 10 min twice daily for 3 days) or Sham (15 °C, 15 mmHg). Outcomes were assessed at baseline (T0), post-fatigue (T1), immediately post-first intervention (T2), 24 h (T3), and 48 h (T4). Continuous outcomes were analyzed using mixed-way ANOVA with Population as the between-subject factor and Condition and Time as within-subject factors, followed by Bonferroni-adjusted pairwise comparisons. Paired Cohen's dz was reported for key within-participant contrasts. TQR was analyzed using rank-based factorial ANOVA, and Borg CR10 scores using ordinal logistic regression. Across populations, MVC was higher under CC than Sham from T2 to T4, with the largest between-condition difference at T4 (all p < .001). Muscle stiffness was lower under CC from T2 to T4 (all p < .001). Microvascular perfusion and pressure pain threshold were higher under CC at T2 - T4 overall (all p < .001), with earlier between-condition differences in MMA athletes and young adults and delayed differences in older adults. Blood lactate was lower under CC only immediately after the first intervention session (T2; p < .001). TQR was higher under CC at T2 - T4 in MMA athletes, at T2 - T3 in older adults, and at T3 only in young adults. No adverse events were reported. CC accelerated recovery after hamstring fatigue, improving strength, stiffness, perfusion, pain thresholds, lactate, and perceived recovery across populations, with earlier benefits in athletes and young adults and delayed but comparable improvements in older adults. Registration: ISRCTN49499065.
We report an unusual case of a 34-year-old woman with liver and right heart failure caused by mass effect from a large hepatic adenoma compressing the bile duct, right atrium, and vena cava that was successfully managed with sequential radioembolization and orthotopic liver transplantation. This case highlights the potential complications of large adenomas and associated downsizing strategies needed to achieve a successful outcome. We believe that this is a topic of interest to the journal readership as hepatic adenomatosis is a rare indication for liver transplantation that many readers may not be familiar with.
Precise regulation of the electronic structure of single-atom catalysts (SACs) remains challenging because conventional approaches rely on chemical perturbations that often disrupt structural uniformity and provide limited tunability. Here, we report a physical strategy for continuous, size-dependent electronic modulation of Pt single atoms using lateral dimension as an experimentally accessible structural descriptor. Pt single atoms were pre-coordinated in Pt-TCPP units and assembled with Co2+ into two-dimensional Co@Pt-SAC nanosheets. Temperature-programmed cooling enabled precise control of nanosheet lateral size while preserving the primary Pt─N coordination environment. Decreasing nanosheet size induced progressive lattice compression, evidenced by the shift of the apparent Pt─N scattering feature in FT-EXAFS spectra from 1.64 to 1.57 Å. Meanwhile, the local electrostatic potential at Pt sites increased from -16.880 to -14.872 kcal mol-1, indicating pronounced Pt-centered electronic modulation. This modulation strengthened the interaction between Pt sites and triiodide species, accelerating interfacial charge transfer during the I3 -/I- redox process. These findings establish a direct correlation between lateral size-dependent lattice evolution and the electronic structure of single-atom active sites, offering a general physical route for continuous electronic tuning of SACs without altering their primary coordination chemistry.
Acute visual loss following transsphenoidal pituitary surgery is rare but potentially reversible if promptly identified and treated. Migration of fat graft into the sella is an infrequently recognised but treatable cause. A woman in her early 60s presented with pituitary acromegaly and underwent endoscopic endonasal transsphenoidal surgery for a pituitary macroadenoma. Postoperatively, she developed sudden bilateral visual loss. MRI revealed optic chiasm compression by migrated fat graft used for sellar reconstruction. Emergency re-exploration and decompression led to complete restoration of vision. Fat graft migration can cause chiasmal compression and sudden painless vision loss after pituitary surgery. Immediate imaging and decompression are critical for visual recovery.
We present a theory for the effects of osmotic pressure exerted by macromolecular crowders on a double-stranded DNA or other semiflexible polymer extended by tension. Our results predict the force and crowder-density dependence of the polymer extension. The lowest-order effect is a crowder-dependent compression that counteracts the external stretching force, which can collapse the polymer at a crowder-dependent critical force f^{*}. This compression is dependent on crowder radius r and density ϕ, with higher densities and smaller radii having greater effects on the force-extension curve. At first order in perturbation theory, we also find a fluctuation-dependent correction to the depletion volume, which can overwhelm the simple compression effect for large crowders, leading to expansion of the polymer.
This paper aims to explore the fracture behavior and bolt anchoring mechanism in circular tunnel under support in layered rock mass. Seven support methods, horizontal and vertical bedding planes are set up, and cubic rock-like material samples with a prefabricated circular hole and bedding planes are tested under uniaxial compression. During the compression, the failure of the hole sidewall is monitored by a camera. The fracture behavior in tunnels under support in layered rock mass is reproduced. After uniaxial compression failure, the fracture behavior of specimens is analyzed via CT scanning, and the bolt anchoring mechanism is analyzed. The results demonstrate that the system bolt and steel floral pipe provide higher improvement. The shotcrete and steel arch can provide supporting pressure for the tunnel, which effectively prevents the surrounding rock from spalling. The strength increment for the vertical bedding specimen is larger than that for the horizontal bedding specimen. CT observations combined with theoretical analysis indicate that the anchor bolt generates anchoring effect by improving the stress state and the mechanical properties of the surrounding rock in the anchorage zone where the fractures are compacted, arrested, and deflected, which could increase the bearing capacity of the surrounding rock.
Piriformis syndrome (PS) is an uncommon entrapment neuropathy in which the sciatic nerve is compressed by the piriformis muscle, producing gluteal and radiating leg pain that closely mimics lumbar disc disease and other causes of sciatica, making accurate diagnosis a persistent clinical challenge. Musculoskeletal (MSK) ultrasound has emerged as a valuable imaging modality in this setting, offering real-time, dynamic assessment of muscle morphology, sciatic nerve architecture, and regional vascularity without the use of ionizing radiation. In this retrospective case series of three patients diagnosed with PS at a tertiary care centre in India over a two-year period, high-resolution MSK ultrasound with dynamic provocative maneuvers was employed to evaluate sciatic nerve behaviour in relation to the piriformis muscle. Dynamic imaging successfully demonstrated nerve compression in all three cases, with measurable changes in nerve caliber at the site of entrapment compared to adjacent unaffected segments, providing objective morphological evidence to support the clinical diagnosis. Following diagnostic confirmation, ultrasound-guided injection therapy was administered with complete positional accuracy; two patients received botulinum toxin A to achieve muscle relaxation and sustained nerve decompression, while one patient received a corticosteroid and local anesthetic combination to address inflammatory pain. All three patients achieved complete symptomatic resolution at four-week follow-up, underscoring the therapeutic efficacy of image-guided intervention when the diagnosis is precise. These cases collectively illustrate that MSK ultrasound, through its capacity for real-time dynamic evaluation and procedural guidance, represents a versatile and indispensable tool in the diagnosis and minimally invasive management of PS within a multidisciplinary clinical framework.
The craniocervical junction can be affected by various congenital or acquired disorders in dogs. When the normal alignment of occipital bone, atlas, and axis is altered, the resulting instability and spinal cord compression can cause mild to severe neurological signs. Occipito-atlanto-axial malformation (OAAM) is a relatively rare craniocervical junction disorder that may require surgical intervention to stabilize the bones and resolve neurological signs. Because OAAM can present in different anatomical forms, individualized decision-making and surgical planning are recommended to treat the malformation and associated instability effectively. A 5-month-old female Miniature Dachshund was referred for cervical pain and progressive gait abnormalities with proprioceptive ataxia. Neurological examination was consistent with C1-C5 myelopathy. Magnetic resonance imaging (MRI) confirmed craniocervical spinal cord compression, and computed tomography (CT) identified severe C1 vertebral malformation, flattened occipital condyles, aplasia of the dens, and subluxation at the atlanto-occipital and atlanto-axial joints. CT-based virtual surgical planning was performed to create a patient-specific drilling guide and a 3D-printed customized Grade-23 titanium locking plate. Surgery was performed via a dorsal approach and included partial dorsal arch resection of the atlas and partial resection of the spinous process of the axis, followed by drilling at predefined positions, trajectories, and depths for screw placement. The implant was fixed to the occiput-atlas-axis complex using ten 2.4 mm titanium locking screws. Postoperative radiographs confirmed proper implant positioning and alignment, and no intraoperative or postoperative complications were observed. Neurological status did not deteriorate, and progressive improvement was noted from the second postoperative week. At 13 months, the dog had normal gait and spinal reflexes, showed no signs of pain or neurological deficits, and follow-up radiographs confirmed stable positioning of the implant and screws without evidence of loosening. Considering the postoperative outcome and other available techniques, this case supports the feasibility of dorsal stabilization of the craniocervical junction. Careful preoperative 3D planning may help identify fixation points and drilling trajectories (particularly when safe corridors are limited), thereby enhancing the surgical safety and enabling the use of a patient-specific biocompatible titanium plate for the fixation.
Erectile dysfunction (ED) is prevalent after traumatic cervical spinal cord injury (CSCI), yet predictive tools for postoperative recovery remain underdeveloped. This study aimed to develop a clinical prediction model for erectile function recovery in male patients undergoing posterior cervical surgery for incomplete traumatic CSCI (iCSCI). In this retrospective cohort study, 207 male patients (aged 18-60 years) with iCSCI (ASIA grades B-D) who underwent posterior cervical decompression between 2018 and 2023 were included. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) at protocol-defined 3-month and 2-year postoperative follow-up visits. Improvement was defined as an increase of ≥ 1 severity category. Candidate predictors were screened via univariate analysis (P ≤ 0.20) and correlation assessment, followed by forward stepwise logistic regression. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve (AUC) and internally validated via bootstrapping. Median total follow-up was 41.00 months. Overall, 72.5% of patients showed erectile function improvement. The final prediction model included four independent predictors: preoperative ASIA grade (OR for grade D vs. B: 30.519, P < 0.001), injury level (C0-C3 vs. C4-C7; OR: 5.749, P = 0.012), injury to surgery interval (OR per day: 0.858, P = 0.018), and spinal cord compression ratio (OR per 1%: 0.937, P = 0.002). The model demonstrated robust discrimination (AUC: 0.881) and good calibration (Hosmer-Lemeshow P = 0.194). Bootstrap internal validation yielded an optimism-corrected AUC of 0.850. A nomogram was constructed to facilitate individualized risk estimation. In male iCSCI patients, erectile function demonstrates significant potential for recovery following posterior cervical surgery. The validated four-factor model-presented as a clinical nomogram-enables personalized preoperative risk stratification to guide counseling and rehabilitation planning. External validation is required before widespread clinical implementation.
The integration of Large Language Models (LLMs) into clinical settings requires quality assurance mechanisms capable of detecting the hidden effects of model compression and architectural instability. Conventional accuracy metrics often fail to capture the behavioral volatility introduced by quantization, distillation, and sparse architectures. We propose the "Single-Token Forced-Choice Logit Probe," a method that generates a "behavioral fingerprint" of a model by analyzing its decision-making stability on a domain-specific (MedQA) benchmark. Validated on 11 local model families, our approach achieved 100% accuracy in distinguishing full-precision models from quantized variants. Furthermore, a longitudinal audit of commercial APIs revealed a distinct "Stability Gap": distilled "Nano" models exhibited nearly double the decision instability (2.82% vs. 1.58% Flip Rate) of their standard counterparts. Forensic classification identified the underlying compression techniques (Q8 vs. FP8), while analysis suggests the inherent non-determinism stems from Sparse Mixture-of-Experts (SMoE) routing. We conclude that Flip Rate is a critical safety metric and that distilled and quantized models require rigorous stability auditing before clinical deployment.
Barocaloric (BC) materials represent a highly promising family of solid-state refrigerants that offer real potential to replace environmentally damaging gas refrigerants. The rational design of BC materials relies on understanding solid-solid phase transitions (SSTs) under pressure. Organic ionic plastic crystals (OIPCs) emerge as promising BC candidates, but direct characterization of their pressure-dependent phase behavior remains a challenge. Herein, we employ high-pressure broadband dielectric spectroscopy (HP-BDS) as a tool to map the phase diagrams of three OIPCs: 4-ethyl-4-methylmorpholinium bis(fluorosulfonyl)imide ([C2mmor][FSI]), tetraethylammonium bis(fluorosulfonyl)imide ([N2222][FSI]), and tetraethylammonium bis(trifluoromethanesulfonyl)imide ([N2222][TFSI]). We demonstrate that the real part of the complex dielectric permittivity (ε') is uniquely sensitive to SSTs in OIPCs, which are driven by changes in dipolar reorientation. By performing both isobaric cooling/heating and isothermal compression/decompression experiments, we directly determine the pressure sensitivity (dTSS/dP) of the SSTs and observe the transition hysteresis in terms of temperature and pressure, finding both properties to be strongly ion-dependent. Furthermore, hysteretic behavior at high pressure is found to be unique to each OIPC, despite similarities in ion structure. In particular, the pressure hysteresis directly observed for [C2mmor][FSI] is lower than that predicted from quasi-direct (isobaric) measurements, indicating the kinetic delay is smaller for a pressure change than a temperature change, which would further improve the already excellent BC metrics of this OIPC.
Median arcuate ligament syndrome (MALS) involves compression of the celiac artery and presents with gastrointestinal symptoms. We evaluated outcomes after surgical versus conservative management in pediatric MALS. We reviewed charts of symptomatic patients aged 7-21 years diagnosed by ultrasound and/or computed tomography angiogram. Outcomes were categorized as resolved, improved, unchanged, or worsened at most recent follow-up and compared between conservative and surgical treatment groups. Among 34 patients (median age 15 years, 79% female, 94% Caucasian), common symptoms included abdominal pain (85%) and nausea (71%); 36% had psychiatric disorders, 56% met criteria for disorders of gut-brain interaction (DGBI). Ten received conservative therapy (100% pharmacologic, 80% behavioral, 30% botulinum toxin, 20% neurostimulation) with a median follow-up of 5 months. Outcomes were resolution (20%), improvement (40%), unchanged (40%), and none worsened. Of 24 surgical patients (median hospital stays: 4 days), outcomes were: resolution (21%), improved (33%), unchanged (17%), worsened (29%); not significantly different from conservative group (p = 0.21). Postoperative complications occurred in 21%. At median 20-day postoperative follow-up, 52% reported resolution, 35% improved, 9% unchanged, 4% worsened. Pain location differed by group (p = 0.005); other demographics and long-term outcomes did not (p > 0.05). Baseline comorbidities and treatment modalities were not significantly associated with outcome (p > 0.05). In our cohort, 60% of children with MALS improved with conservative DGBI-directed therapy and 54% improved with decompression surgery at long-term follow-up, despite a robust short-term postoperative response (87%). Prospective studies are needed to guide patient selection and assess long-term outcomes.
Giant aneurysms are rare vascular anomalies that can induce symptoms through compression of neural structures. This report describes a case of a giant sellar aneurysm initially manifesting as diabetes insipidus (DI), challenging conventional diagnostic paradigms for sellar mass lesions. Although DI typically arises from antidiuretic hormone (ADH) deficiency, its presentation as the primary symptom of a giant sellar aneurysm is exceedingly uncommon. The distinctiveness of this case lies in the occurrence of DI, likely due to aneurysmal compression of the pituitary gland, underscoring the imperative to include aneurysms in the differential diagnosis of sellar lesions. Giant sellar aneurysms are frequently misdiagnosed as pituitary adenomas, particularly when atypical symptoms are present. Through multidisciplinary collaboration, this case was successfully managed, yielding valuable clinical insights. This report not only advances the understanding of giant sellar aneurysms but also provides a foundation for future research to mitigate misdiagnosis and enhance patient quality of life.
Low-density foams are of significant interest in inertial confinement fusion (ICF), with potential applications as fuel carriers, ablation layers, or as a hohlraum filling material. Despite their potential, the shock response of these materials remains poorly characterized, limiting the accuracy of hydrodynamic simulations. Here we report experimental measurements of the equation of state for 90mg/cm^{3} silica (SiO_{2}) aerogel foam under laser-driven shock compression, conducted at the GEKKO XII laser facility. Shock pressures between 50 and 160 GPa were achieved, and the corresponding states were determined using standard impedance-matching techniques with a quartz reference material. Initial measurements appeared to underestimate the foam shock velocity relative to predictions by the Quotidian Equation of State (QEOS) model. Experimental diagnostics indicated the presence of a vacuum gap between the reference material and the foam. The vacuum gaps were characterized, and one-dimensional radiation-hydrodynamic simulations were conducted to estimate their impact on the measured shock velocity. After applying simulation-based corrections, the experimental Hugoniot aligns closely with QEOS predictions, supporting the model's applicability to low-density foams.
Early post-op ambulation benefits burn survivors by expediting return to functional independence, preventing bedrest complications, and shortening hospital admissions. Despite published practice guidelines supporting early ambulation, significant variability in practice continues among burn centers, ranging between 0-14 days post-op. A 3-year retrospective review was completed of this 15 bed, adult verified burn center, to identify 149 patients who underwent split thickness skin graft (STSG) placement and/or Autologous Skin Cell Suspension (ASCS) application to their lower extremities (LE). Patients unable to ambulate at baseline or died during admission were excluded. LE involvement ranged from 1-28% TBSA (Median: 5%). Autograft placement included 83% meshed (1:1-3:1) STSG (n=125), 14.8% ASCS (n=22), and 1.3% sheet STSG (n=2). Grafts crossed joints on 119 patients including the knee (n=58), ankle (n=57), and foot (n=41). Initial ambulation occurred between POD 1-3 (Avg 1.05) with gait distance ranging from 2 to 1,500 ft (Avg 125.4 ft). Twelve patients experienced minor graft loss, which healed conservatively. Additional analysis compared patients with and without graft loss. There was no significance associated between initial POD ambulation and graft loss. However, graft loss was significantly association with history of stroke (p=0.006), renal disorder (p =0.012), and previous amputation (p = 0.006). These findings suggest that, within a structured protocol, early ambulation as soon as POD 1 may be safely implemented without increased graft loss risk. Incorporating standardized mobility protocols, including use of compression and individualized clinical assessment, may help reduce practice variability and support earlier functional recovery in burn survivors.