Multicellular organisms are not just collections of cells; they are evolutionary compromises in which cell-level fitness is subordinated to organism-level integrity. Cancer begins when that compromise is locally subverted, but metastasis is the decisive escalation: malignant cells must cross tissue boundaries, survive a hostile systemic phase, condition remote organs, enter or escape dormancy and construct a new permissive ecology. This Perspective uses the social-contract metaphor as a disciplined heuristic, not as a claim of intention or moral agency, to integrate metastasis biology with eco-evolutionary thinking. We argue that the metastatic cascade can be read as serial failure of multicellular governance: local architecture loses territorial control; vascular and immune systems fail to exclude or destroy emigrant cells; distant tissues become preconditioned by tumour-derived signals; dormant disseminated cells persist as residual insurgencies and colonisation emerges when organ-specific restraint is converted into support. The framework becomes most useful when it also explains the paradox that cells which defect from host-level cooperation may cooperate locally with each other and with recruited stroma. Public goods, collective dissemination, metabolic exchange and premetastatic niche construction create dependencies that may be exploitable therapeutically. We give the Black Queen Hypothesis a precise but bounded role: it is a testable model for dependency-generating loss or outsourcing of costly shared functions, not a universal law of cancer evolution. Finally, we outline translational implications for metastasis: rearming immune enforcement, blocking niche education, maintaining or eradicating dormant disease, disrupting shared dependencies and using adaptive schedules to manage evolutionary escape. The social-contract lens is valuable only when it remains evidence-led and mechanistically anchored; used this way, it makes metastatic dormancy and colonisation a sharper target for ecological cancer therapy.
A primary way the US federal government delivers public goods and services is via monetary payments. Ensuring that these payments are calculated accurately, delivered on time, and made to the correct recipients is important for government fiscal health. Inaccurate or delayed payments can weaken public trust in the government and undermine government accountability. In this article, we examine findings from a set of impact evaluations assessing interventions designed to improve payment integrity in US federal programs. The low-cost, evidence-based interventions draw on insights from the social and behavioral sciences and include modification of forms, changes to how and when agencies request information, and altering existing communications. The evaluations were conducted by the US General Services Administration's Office of Evaluation Sciences in collaboration with agency partners. We extract three takeaways across four representative evaluations. First, the real-world evaluations validate a key implication of the behavioral science literature: interventions that reduce burdens for individuals have small effects that meaningfully improve payment integrity at scale. Second, effects attenuate across interventions and over time, suggesting a need for iterative evaluation. Finally, bureaucratic hurdles and administrative complexity are the main barriers to translating academic insights into real-world government programs. Addressing these challenges will require close collaboration between behavioral scientists and practitioners throughout the intervention design and evaluation process.
The establishment of BUMN (State-Owned Enterprises) involved in the management of state-owned enterprises aims to contribute to national economic development and state revenue, provide high-quality goods and services to meet the needs of the community, and become a pioneer in business fields that have not been widely managed by the private sector. Problems related to losses in BUMN occur due to negligence and mismanagement by the Board of Directors. Eliminating criminal liability for directors who cause losses to BUMN can create opportunities for crimes and criminal acts that further cause losses to BUMN. The importance of this study is to analyze the limits of directors' actions that cannot be punished criminally and this study aims to evaluate the institutional consequences of violations committed by directors in BUMN. The enactment of Law Number 1 of 2025 concerning State-Owned Enterprises, which states that the Board of Directors is not a state administrator, has sparked debate over the legal accountability of the Board of Directors. The research method used focusses on the legal norms, rules, and principles found in legislation or other legal sources. This research approach uses a case study approach aimed at analysing the rules and their application, as well as the sanctions imposed. The entire data will be analysed to find solutions to the existing problems. The research results explain that legal liability, whether criminal, civil, or administrative, can be applied as long as the Board of Directors is proven to have committed the act. Harmonisation of laws related to the management of BUMN must be carried out, particularly concerning the status of BUMN as legal subjects equal to other legal subjects, namely individuals and private corporations, to ensure legal certainty in the application of the law regarding the legal accountability of the Board of Directors.
The withdrawal of traditional foreign suppliers and subsequent legalization of parallel importation, called upon to saturate market with necessary production, objectively created favorable conditions for penetration of counterfeit goods into medical sector, posing direct threat to health and life of population. In response to these challenges, the state authorities initiated launch of system of mandatory labeling for medical articles that conditioned actuality of considered topic. The article presents comprehensive analysis of phased implementation of mandatory labeling as key mechanism ensuring traceability of medical articles turnover. The article considers in detail chronology of introduction of mandatory requirements from initial registration of participants in the system "Honest Sign" and application of Data Matrix codes to step-by-step expansion of list of articles. The special attention is paid to analysis of technical aspects of labeling, including structure of identification code and practical tools for importers, such as information retrieval system for customs and logistics warehouses. Уход традиционных иностранных поставщиков и последующая легализация параллельного импорта, призванная насытить рынок необходимой продукцией, объективно создали благоприятные условия для проникновения в медицинский сектор фальсифицированных товаров, представляющих прямую угрозу здоровью и жизни населения. В ответ на эти вызовы государством был инициирован запуск системы обязательной маркировки медицинских изделий, чем обусловлена актуальность рассматриваемой темы. В статье проведен комплексный анализ поэтапного внедрения инструмента обязательной маркировки как ключевого механизма обеспечения прослеживаемости оборота медицинских изделий. В статье подробно рассмотрена хронология введения обязательных требований — от первоначальной регистрации участников в системе «Честный знак» и нанесения кодов Data Matrix до поэтапного расширения перечня товаров. Особое внимание уделено анализу технических аспектов маркировки, включая структуру кода идентификации и практические инструменты для импортеров, таких как поисковая система таможенных и логистических складов.
We examine how social behaviours emerge and stabilize across childhood. A sample of 537 Italian-speaking children (3-10 years) were randomly assigned to respond under time pressure (intuitive) or time delay (deliberative) in social decision tasks (Public Goods, Dictator, Ultimatum, Deception and Moral Dilemmas). Factor analysis identified three latent dimensions: Prosociality (cooperative, altruistic and honest actions), Social Optimism (beliefs about others' cooperation) and Acquiescence (tendency to accept offers). Intuitive responses were more prosocial than deliberative ones in early childhood (β = 0.66; 95% CI = (0.35, 0.97)), but this difference diminished with age (β = -0.11; 95% CI = (-0.18, -0.05)). We found no evidence that Social Optimism varied across age or decision mode, whereas Acquiescence declined with age (β = -0.14; 95% CI = (-0.19, -0.10)). These findings suggest a developmental shift whereby prosocial behaviour is initially driven by intuitive responses and gradually becomes embedded within reflective, deliberative decision-making systems, as cooperative dispositions stabilize across childhood.
Traffic-related air and noise pollution continues to pose significant health threats to the urban population. This study develops a transferable methodology to estimate key health co-benefits of electric mobility at a city scale. It is the first study to consider electrifying both passenger and goods vehicles. Using city-wide data, we adopt a bottom-up approach based on empirical traffic volume, vehicle mix and speed on the road network. Under four scenarios of different vehicle types, noise propagation and air dispersion models are used to estimate reductions of noise level and five roadside air pollutants associated with electric mobility. Combining with population distribution data, health outcomes are calculated in terms of the number of preventable deaths and year of life lost in disability. Hong Kong is used as a case study because of its high population density, importance of buses, and role as an international transport and logistics hub. The findings reveal that the total preventable deaths per year combining all scenarios is 836.2, which includes 512.2 deaths attributable to reduced traffic noise and 324.1 deaths attributable to lower traffic-related air pollution. Each year, the total year of life lost due to disability (YLD) reduction amounted to 21,264.8. Comparing across vehicle types, electrifying heavy-duty vehicles, notably buses and medium- and heavy-duty trucks, generates the greatest public health benefits. Notably, low-income, ageing and high-unemployment neighbourhoods can benefit from reductions in preventable deaths by 12.23-12.96 per 100,000 population, compared to 10.84-10.93 per 100,000 population in their counterparts. This indicates the potential of electric mobility in overcoming the environmental injustice caused by internal combustion engine vehicles in a compact city.
Venous thromboembolism (VTE) is a frequent complication following femoral fracture surgery. While intermittent pneumatic compression (IPC) devices serve as an effective mechanical prophylaxis, patient compliance is often suboptimal. This study aimed to investigate the effectiveness of IPC in preventing VTE after femoral fracture surgery and to analyse the key factors influencing patient compliance. This retrospective study included 213 patients with femoral fractures who underwent surgical treatment at Ningbo No.6 Hospital between December 2021 and December 2024. Based on postoperative IPC device usage records from medical charts, patients were divided into a good compliance group (n = 51) and a compliance barrier group (n = 162). Postoperative coagulation parameters [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer (D-D)], VTE incidence at 5 days postoperatively, and the length of hospital stay were systematically collected and compared between the two groups. A self-designed questionnaire was used to assess factors influencing IPC compliance barriers. Among the 213 included patients who underwent femoral fracture surgery, the incidence of postoperative IPC device compliance barriers was 76.06% (162/213). At 5 days postoperatively, significant differences were observed in all coagulation parameters between the two groups. Specifically, the good compliance group had significantly higher PT, APTT, and TT levels compared with the compliance barrier group (all p < 0.05). In contrast, FIB and D-D levels were significantly lower in the good compliance group (all p < 0.05). Regarding clinical outcomes, the incidence of VTE in the good compliance group was 19.61%, significantly lower than the 38.27% in the compliance barrier group (p = 0.014). Furthermore, the median length of hospital stay in the good compliance group [8.00 (8.00, 17.00) days] was significantly shorter than that in the compliance barrier group [12.00 (9.00, 17.00) days] (p = 0.009). The survey results of 162 patients in the compliance barrier group showed that the main obstacles affecting IPC device application compliance were concentrated at the level of patient cognition, experience, and perception. A smaller proportion of patients had concerns about out-of-pocket costs. Healthcare-related factors and device-related factors had a relatively lower impact. The use of IPC after femoral fracture surgery can effectively improve the hypercoagulable state, reduce the incidence of VTE, and shorten hospitalization. However, patient compliance is generally low, primarily influenced by insufficient cognition, poor user experience, and low perceived value of treatment. It is recommended to improve compliance through systematic health education, optimizing comfort and convenience of use, strengthening healthcare follow-up and feedback, and ensuring device maintenance and configuration.
Replacing missing anterior teeth presents both functional and esthetic challenges, and selecting the most appropriate treatment requires careful consideration of patient age, specific needs, invasiveness, and long-term prognosis. While dental implants are frequently the treatment of choice, they are not always suitable-particularly in younger patients still undergoing skeletal growth. Cantilever zirconia resin-bonded fixed dental prostheses (RBFDPs) offer a minimally invasive, cost-effective alternative with excellent long-term outcomes, including survival rates approaching 98% at 15 years. This article reviews the current evidence on zirconia RBFDPs, outlines key treatment planning and design principles, and describes clinical and laboratory steps for achieving optimal esthetic and long-term durable results, including soft-tissue augmentation, pontic site management, and proven bonding protocols. A step-by-step clinical case is presented to illustrate how these restorations can successfully restore both white and pink esthetics with minimal intervention.
Microbial enzymes are central to numerous industrial applications, yet their large-scale production remains constrained by persistent biological and process-level limitations. These include restricted secretion capacity, insufficient operational stability, scale-up inefficiencies, and downstream processing costs that can account for 45-65% of total manufacturing expenses. This review critically examines integrated genetic, physiological, and bioprocess engineering strategies developed to overcome these interconnected bottlenecks. Comparative analysis across major enzyme classes-cellulases, proteases, lipases, and amylases-reveals both universal constraints and enzyme-specific production challenges. Quantitative benchmarks indicate that multiplex genome engineering typically delivers 3-8-fold productivity improvements in optimized strains, while adaptive laboratory evolution enhances industrial robustness by 15-30%. Process intensification and continuous production approaches reduce processing times by 40-55%, albeit with increased capital requirements, and immobilization strategies enable 50-200 operational cycles with 65-85% retention of native activity. By synthesizing advances in strain engineering, secretion optimization, fermentation design, enzyme stabilization, and downstream integration within a techno-economic framework, this review highlights how coordinated interventions yield multiplicative gains over isolated strategies. Key future directions include systems-level characterization of secretion limits, AI-assisted enzyme stability engineering, and integrated manufacturing platforms. Collectively, these insights provide practical guidance for translating laboratory advances into economically viable microbial enzyme production systems.
Spigelian hernia is a rare abdominal wall hernia with a high risk of incarceration. Laparoscopic repair is common, but the optimal approach remains controversial. We evaluated the feasibility and outcomes of laparoscopic transabdominal preperitoneal repair of Spigelian hernia using self-fixating mesh. Patients who underwent this repair between 2019 and 2023 were reviewed. All were treated using a standardized approach with self-fixating mesh without additional fixation. Patient demographics, operative findings, and outcomes were analyzed. Four patients underwent transabdominal preperitoneal repair. All patients had favorable outcomes with no recurrence during follow-up. Laparoscopic transabdominal preperitoneal repair using self-fixating mesh is a feasible technique for Spigelian hernia repair.
Peri-implant diseases are characterized by complex host-microbe interactions. This study aimed to investigate the levels of pro-apoptotic Bcl-2 family proteins and their relationship with Porphyromonas gingivalis-gingipain and Treponema denticola-dentilisin in peri-implant tissues. Tissue samples were collected from 72 participants: healthy controls (n = 24), peri-implant mucositis (n = 23), and peri-implantitis (n = 25). Levels of pro-apoptotic proteins (Bax, Bad, Bim, Smac, and Lamin B) quantified via multiplex immunoassays, and proteases were analyzed using western blotting and normalized to total protein content. Regression models adjusted for age and clinical parameters assessed associations between microbial protease levels and apoptotic proteins. Pro-apoptotic protein levels were significantly lower in diseased sites compared to healthy controls (p < 0.001). While absolute protease levels did not differ significantly between groups (p > 0.05), multivariate regression models, adjusted for clinical parameters, revealed significant associations between gingipain/dentilisin and Bax/Bad levels (p < 0.05). The downregulation of pro-apoptotic proteins suggests a suppressed apoptotic response in peri-implant lesions, potentially contributing to disease persistence. The preliminary associations between bacterial proteases and apoptotic markers, independent of clinical severity, highlights these virulence factors as potential modulators of tissue homeostasis and candidates for future diagnostic and therapeutic targets. Bacterial proteases show modest associations with host apoptotic pathways in peri-implant diseases. A better understanding of these relationships may potentially help develop new preventive and therapeutic strategies in the future.
Progress in the field of exosome research is hindered by the small cell numbers and low productivity of secreted exosomes in traditional 2-D cell culture. High-density cell cultures in hollow fiber bioreactors (HFBRs) allow continuous production of secreted biomolecules and extracellular vesicles (EVs), from large numbers of cells, over extended periods of time, at high concentrations in 3D culture. This protocol describes the collection of concentrated secreted exosomes while maintaining optimal cell mass and 3D perfusion culture conditions supporting high-density cell growth over several weeks or months of continuous production in a commercially available HFBR. The system is compact, closed, single-use, can be cGMP compliant, simple to use, and fits in a standard CO2 incubator. Certain cells, such as mesenchymal stem cells (MSCs) and human amniotic fluid stem cells (HAFSCs), may exhibit reduced proliferation under these conditions, potentially influencing differentiation and phenotype over time. Representative results demonstrate typical EV yields and cell viability over weeks or longer of continuous production. This method provides reproducible, high-quality EV harvests suitable for both research and clinical applications.
Endoscopic instruments are vulnerable to structural damage due to frequent reuse. This study aimed to evaluate the effectiveness of quality control circle (QCC) activities in reducing instrument damage. A multidisciplinary QCC team was established to implement interventions including enhanced staff training, standardized maintenance protocols, and peer-reviewed inspections. Instrument damage rates were compared before and after the intervention using chi-square analysis. The damage rate declined significantly from 2.33% to 0.27% (P <.001). Common issues such as missing parts and assembly confusion were markedly reduced, achieving a target improvement rate of 137.33%. Implementation of QCC activities in instrument management effectively reduced equipment damage, improved workflow, and enhanced patient safety. These findings suggest that QCC methods have potential for broader application in hospital quality-improvement initiatives.
Seatbelt-related breast trauma is an uncommon consequence of motor vehicle collisions. Most injuries present as localized contusion or hematoma, whereas progressive breast hematomas requiring surgical intervention are exceedingly rare, particularly in patients without coagulation abnormalities. Obesity may further alter trauma biomechanics and influence hematoma progression. A 49-yearold woman with obesity (Body Mass Index: 38 kg/m2) presented to the emergency department one hour after a motor vehicle collision with left breast swelling, firmness, and ecchymosis. Body temperature, blood pressure, and heart rate were within normal limits. Contrast-enhanced computed tomography (CT) demonstrated a 62×52 mm breast hematoma without evidence of arterial extravasation. Conservative treatment with compression therapy was continued for three days; however, pain and breast tension progressively increased, and ultrasonography demonstrated mild enlargement of the hematoma. On the fourth day, minimally invasive surgical evacuation was performed, yielding a large volume of organized hematoma. Postoperatively, symptoms improved rapidly. At two-week follow-up, breast symmetry was fully restored with no residual deformity. This case represents a rare presentation of seatbelt-related breast trauma: a progressive breast hematoma without active bleeding that ultimately required surgical evacuation. Obesity may have contributed to the failure of conservative management and earlier clinical progression. Early recognition of symptom worsening is essential to optimize cosmetic and functional outcomes.
This study aims to evaluate and compare central and peripheral retinal image quality after corneal and intraocular refractive correction in high myopia. Additionally, it examines how different refractive correction strategies influence optical image quality across the visual field. In a large cohort of myopic eyes undergoing femtosecond laser-assisted in situ keratomileusis (FS-LASIK), small-incision lenticule extraction (SMILE), or phakic implantable collamer lens (ICL) implantation, on-axis and ± 30° off-axis wavefront aberrations were measured preoperatively and at 6 months postoperatively. Wavefront aberrations were analyzed using Zernike decomposition based on a standardized pupil. Central retinal image quality was quantified using the visual Strehl ratio based on the optical transfer function (VSOTF), whereas peripheral retinal image quality was assessed using the modulation transfer function area (MTFa). Differences were further compared among procedures and across varying levels of preoperative refractive error. All three refractive procedures effectively corrected low-order aberrations on-axis, resulting in significant improvements in central retinal optical quality. Median VSOTF increased markedly following FS-LASIK, SMILE, and ICL implantation. Peripheral image quality, assessed by MTFa, showed procedure-dependent differences. All procedures improved peripheral MTFa, but the magnitude of change differed among techniques. FS-LASIK showed the largest central-peripheral separation, SMILE showed an intermediate pattern, and ICL implantation showed the smallest separation, corresponding to a relatively smaller reduction in peripheral MTFa relative to on-axis values. FS-LASIK, SMILE, and phakic ICL implantation effectively restore high central retinal image quality in high myopia, although the impact on peripheral retinal optical quality varies. Corneal refractive procedures exhibit greater central-peripheral discrepancy, whereas intraocular correction strategies better preserve peripheral retinal image quality. Assessing peripheral retinal optical performance provides valuable insights into evaluating refractive correction methods beyond central visual outcomes.
Running VMAT plan-complexity surveillance directly inside an oncology information system (OIS) makes it practical to monitor plan quality across a large, multi-linac program. Complexity metrics are increasingly used to anticipate patient-specific QA (PSQA) outcomes, but few studies span multiple years or tie complexity monitoring to the OIS at scale, which leaves published benchmarks hard to generalize and prospective monitoring slow to enter routine practice. To describe an automated Python pipeline integrated with the MOSAIQ OIS for computing eight established VMAT plan complexity metrics from DICOM-RT files at scale, and to characterize the resulting distributions across a three-year institutional VMAT program stratified by treatment planning system (TPS), anatomic site, dosimetrist, and calendar year, with correlation to matched PSQA outcomes. All clinically approved VMAT plans from March 2023 to March 2026 were identified via MOSAIQ OIS (v2.6, Elekta AB) at a multisite comprehensive cancer center. A purpose-built Python tool queried the MOSAIQ SQL Server database and parsed DICOM-RT plan files to compute MU Factor, mean aperture area (MAA), mean leaf gap (MLG), aperture irregularity (AI), small aperture scores (SASs) at 5 and 10 mm, modulation complexity score for VMAT (MCSv), and Modulation Index Total (MITotal). Plans were stratified by TPS (Pinnacle3 vs. Monaco), anatomic site group (11 groups), dosimetrist, and year. Mann-Whitney U and Kruskal-Wallis tests were applied for group comparisons. PSQA pass rates (3%/2 mm global gamma, ≥95% threshold) were extracted from MOSAIQ and matched to complexity data for 3402 of 3751 plans (90.7%); Spearman rank correlations quantified complexity-pass-rate associations. The institutional median (IQR) MU Factor was 2.96 (2.26-4.00) MU/cGy and MCSv was 0.966 (0.955-0.978). Monaco plans showed significantly higher MU Factors (+32%, p < 0.001), narrower apertures (MLG -16%), and higher MCSv (+1.0%) than Pinnacle3 plans. Pelvis and head and neck plans had the highest median MU Factors (3.77 and 3.40 MU/cGy); Breast plans were most efficient (2.10 MU/cGy). Institutional MU Factor rose 20% over three years. Of 3402 PSQA-matched plans, the mean gamma pass rate was 98.7% (median 99.6%); 115 (3.4%) fell below 95%. All complexity metrics correlated significantly with pass rate (all p < 0.001); AI (ρ = -0.358) and MCSv (ρ = +0.336) were the strongest predictors. Monaco plans achieved a higher mean PSQA pass rate than Pinnacle3 (99.0% vs. 98.5-98.6%) despite greater modulation. Significant linac-level variation in pass rates was observed (97.3%-99.2%), not fully explained by plan complexity. OIS-integrated VMAT complexity and PSQA surveillance is feasible at scale and yields clinically useful information. AI and MCSv were the strongest complexity-based predictors of PSQA outcome. The TPS-, site-, and linac-specific complexity profiles we observed argue for risk-stratified PSQA design. The pipeline is readily transferable to other MOSAIQ-based programs for prospective plan-quality monitoring.
Catheter-related right atrial thrombosis is a rare, potentially fatal complication of central venous catheterization. While most reported cases involve thrombi attached to the catheter tip or mobile intracardiac masses, systemic sclerosis (SSc) is associated with endothelial injury and impaired vascular repair, presenting a unique risk profile characterized by increased susceptibility to thrombus formation. A 56-year-old woman on maintenance hemodialysis for 20 years for IgA nephropathy has had SSc for 10 years after developing digital ulcers. One year before presentation, she developed steal syndrome, causing the closure of her arteriovenous access. Consequently, a tunneled dialysis catheter was inserted via the right internal jugular vein. Transthoracic echocardiography performed 1 year later revealed a right atrial mass, prompting referral for further evaluation. Anticoagulation with warfarin was initiated for a suspected right atrial thrombus. However, the mass enlarged progressively, raising suspicion of a neoplastic lesion. Surgical resection identified a 20 × 20 mm mass attached to the posterior-inferior right atrial wall, which was confirmed as an organized thrombus on histopathological examination. Although the catheter tip was not adherent to the thrombus, repetitive contact between the catheter tip and the right atrial wall occurred during atrial motion. Thus, thrombus formation was attributed to chronic mechanical irritation from the catheter tip, exacerbated by systemic sclerosis-related endothelial vulnerability. This case highlights that chronic mechanical irritation from a deeply positioned dialysis catheter tip can cause a non-catheter-adherent mural right atrial thrombus. SSc-associated endothelial vulnerability may have contributed to impaired recovery from chronic endothelial injury.
The development of high-performance photothermal thermometers for high-temperature applications is critically needed. As a response, we propose an efficient optical thermometry strategy based on a valley-to-peak ratio (VPR) approach utilizing negative thermal expansion (NTE) lattice materials, as demonstrated in Y2W3O12:18Yb/2Er (YWO:Yb/Er). The upconversion emission intensity of the 2H11/2 level in YWO:Yb/Er powder was observed to progressively increase with temperature. Also, the temperature-dependent spectra revealed gradual broadening and merging of Stark sublevels due to enhanced electron-phonon coupling, accompanied by thermally induced peak shifts arising from lattice contraction and modifications to the crystal field. Furthermore, the VPR-based optical thermometer exhibits competitive sensitivity compared to its FIR-based counterpart, with an absolute sensitivity (Sa) of 0.0134 K-1 and a relative sensitivity (Sr) of 1.186% K-1, while the maximum values for the FIR-based one are only 0.0092 K-1 and 0.626% K-1, respectively. This work provides a pathway for developing efficient optical thermometers based on rare-earth-doped NTE materials utilizing the VPR approach for operation in moderate-to-high temperature environments.
The role of intermediate screws in long-segment posterior fixation for thoracolumbar fractures remains controversial. This study aimed to evaluate their effectiveness in improving alignment, maintaining correction, and reducing complications. This retrospective comparative study included 91 patients with unstable thoracolumbar burst fractures (T11-L2) treated between 2014 and 2022. Patients were divided into two cohorts: Group A (n=61), who underwent long-segment fixation with intermediate screws inserted at the fracture level, and Group B (n=30), who received conventional fixation. Radiological outcomes, including vertebral compression angle (VCA) and anterior/posterior vertebral body height (ABH/PBH), intraoperative parameters (operative time and fluoroscopy use), clinical pain scores assessed using the Visual Analog Scale (VAS), and complications were analyzed. Statistical comparisons were performed using t-tests and chi-square tests. Both groups demonstrated significant postoperative improvements in VCA and vertebral body height (p<0.0001). Group A achieved superior early correction of VCA compared with Group B (4.78°±3.47 vs. 6.82°±4.02, p=0.014), and this difference remained significant at the two-year follow-up (5.67°±3.08 vs. 8.59°±3.76, p=0.0005). Although correction loss was lower in Group A (1.22°±1.13 vs. 1.95°±2.12, p=0.122), the difference was not statistically significant. Group A required longer operative times (160.25±19.4 vs. 150.17±26.9 minutes, p=0.044) and greater fluoroscopy exposure (26.38±2.3 vs. 20.00±2.13, p<0.001). No significant differences were observed between groups in preoperative or follow-up VAS scores (p>0.05). Placement of intermediate screws in long-segment constructs was associated with significantly enhanced restoration and maintenance of radiographic alignment in patients with thoracolumbar fractures, although it required longer operative time and increased fluoroscopy use. Clinical pain outcomes were comparable between groups. These findings suggest that intermediate screw placement may provide biomechanical and radiographic advantages in selected cases where optimal anatomical restoration is prioritized. This technique was associated with improved initial and long-term radiographic alignment, at the cost of longer operative time and greater radiation exposure, but did not improve pain outcomes. However, the non-random assignment of patients according to surgeon preference should be considered when interpreting these results.
For the success of recirculating aquaculture systems (RASs), effective biological filtration is essential. This study examined the biofiltration efficiency of four moving bed biofilm reactor (MBBR; abbreviated BF) configurations inoculated with a Bacillus spp. consortium (BC) and their effects on tilapia performance and health. Four treatments were tested: (1) BF120BC0: Biofiltration process lasted 120 days, 60 days before and 60 days during the experiment, without Bacillus spp. consortium addition. (2) BF67BC67: Biofiltration process lasted 67 days;7 before and 60 during the experiment. The MBBR received 1 g BC/m3 media every 15 days. (3) BF120BC60: Biofiltration process lasted 120 days, with 60 days without Bacillus spp. Consortium addition before the experiment. Then, the MBBR received 1 g BC/m3 media every 15 days for 60 days. (4) BF120BC67: From day 60 to day 7 before the experiment, the MBBR's media was half (2.5 L) and then full (5 L). The MBBR was given 1 g BC/m3 media every 15 days for 67 days, starting from day 7 before the experiment. Using 12 RAS units, 120 tilapia weighing 72.41 g were stocked at 10 fish per tank, totaling 12 kg/m3, in four groups of three replicates. The first month's water exchange was 1%, the second 2%. The results showed that adding Bacillus spp. consortium to the longer MBBR configuration period improved water quality, fish performance, and tilapia health. Compared with the other treatments, the BF120BC60 treatment showed enhanced performance in tilapia growth, feed utilization, and body composition. It also had a significant (P ≤ 0.05) effect on serum digestive enzymes, lipid profiles, liver and kidney enzymes, immunity, stress levels, antioxidants, immune/growth-related hormones, and health indicators in the gills, intestines, and liver.