Large-scale propensity score (LSPS) models are increasingly used to control confounding in observational studies, but their reliability in small-sample settings is unclear. Small samples can limit a study's ability to estimate propensity scores accurately and achieve adequate covariate balance, raising concerns about insufficient confounding adjustment. Resulting in small datasets being excluded, despite potentially containing valid information. We evaluated the balancing and bias reduction performance of LSPS models using six target-comparator pairs. To emulate a distributed data network analysis setting, we partitioned two large real-world data sources into smaller subsets. Within each subset, LSPS models were fit locally and evaluated on covariate balance, treatment effect bias and precision after empirical calibration, using real negative controls and synthetic positive controls. Performance was compared to a global LSPS model trained on the full dataset. Across most target-comparator pairs, LSPS models substantially reduced bias and, when applying empirical calibration, improved precision. PS matching was more resilient to small sample sizes than PS stratification, achieving adequate balance even at n = 500, while stratification sometimes failed at n = 4000. A slight bias increase was observed at the smallest sample sizes, though not universally. Standard balance diagnostics consistently failed below n = 20 000, while a recently proposed diagnostic accounting for chance imbalance did not. LSPS models generally provide reliable bias reduction in small-sample settings, supporting their use in federated analyses. However, standard balance diagnostics may be misleading in small samples, and alternatives should be considered, such as significance checking. When LSPS fails to reduce bias adequately, additional adjustment strategies are required.
ObjectiveLiver cancer is one of the most fatal types of cancer in the world, and early identification is one of the most crucial considerations that may improve the likelihood of recovery. Hence, building a computer-aided diagnosis (CAD) system that improves radiologists' operations by providing automated, high-precision small-tumor segmentation in complicated medical imaging is the main objective of this research study.MethodsConventional deep learning techniques, like U-Net, have shown impressive overall tumor delineation results, but they frequently struggle to distinguish between large and small tumors. The occurrence of tiny tumors and tumors with different shapes in the intricate liver exacerbates this deficiency. This paper proposed an MSA-Net (Multi-Scale Attention Network), a variant of the U-Net architecture, to address these problems. This is accomplished by the effective extraction of small-tumor features, which is made possible by the architecture's integration of multi-scale convolutional layers into the encoder and decoder pathways, as well as an attention mechanism that concentrates on salient regions and gathers contextual data across several receptive fields.ResultsThe proposed MSA-Net was trained and tested using the publicly accessible 3DIRCADb and LiTS datasets. The 3Dircadb dataset yielded a dice score of 92.00% and a Jaccard index of 86.00% for small tumors, whereas the LiTS dataset yielded a dice score of 72.57% and a Jaccard index of 65.35% for small tumors.ConclusionIn contrast to other research, our technique assesses the outcomes by evaluating large and small tumors independently. The findings demonstrate that MSA-Net greatly improves segmentation, particularly in tiny tumors, demonstrating its usefulness in real-world clinical contexts.
Canine obesity causes metabolic issues and reduces quality of life. Assessing adiposity remains challenging due to limited indirect and reference methods. Electrical bioimpedance (BIA) is a proposed tool, but agreement between morphometric and BIA equations, and the body condition score (BCS) role, remains poorly explored in heterogeneous canine populations. To evaluate agreement among indirect methods (BCS, morphometry, BIA) for estimating canine body fat and assess BIA's viability for nutritional evaluation. A cross-sectional study included 17 healthy dogs from Villamaría, Colombia. Body condition was assessed using 5- and 9-point scales. Morphometric variables and single-frequency 50 kHz BIA parameters (resistance, reactance, phase angle) were recorded. Body fat percentage (%BF) was estimated using four established equations. Method agreement was evaluated via Bland-Altman analysis and Lin's concordance correlation coefficient (CCC). Differences in bioelectrical parameters and lipid profiles between obese and lean dogs were analyzed using independent t-tests. Morphometric methods showed the highest agreement (CCC = 0.759). Conversely, comparisons involving BIA-derived equations exhibited low or negative agreement, with Bland-Altman analyses revealing wide limits of agreement. Obese dogs had higher resistance and lower phase angles than lean dogs, though differences were not statistically significant (p > 0.05). This lack of significance must be interpreted cautiously due to the small sample size, particularly the obese group (n = 4). HDL cholesterol was significantly lower in obese dogs (p = 0.030), with no differences in total cholesterol. The evaluated indirect methods showed poor agreement and are not clinically interchangeable. Without a reference method like DEXA, accuracy cannot be determined. While raw BIA parameters aligned physiologically with body condition, their use remains preliminary and requires validation in larger, reference-controlled studies.
Increasingly, qualitative researchers are considering the more-than-humans that Euro-Western social science largely has ignored. But if social science research methods were made for humans, how does one include everything else? In this article, five scholars describe the methodological steps they each have developed. We explore the role of onto-epistemology as an analytical tool to understand relationships between people and food-producing plants in Toronto migrant gardens; the technique of multimodal noticing used to account for animal agency in fieldwork with women who raise small livestock in Egypt; the use of time as a methodological tool to study human-plant relations in German commercial orchards; a methodological praxis that works with posthuman disability studies to become-with a disability event-assemblage; and how to operationalize the notion of ontological multiplicity in ethnographic fieldwork in a case study of a river in Mexico. These ways of conducting research may lead to innovative responses to complex global challenges.
To compare thevisual outcomes of small-incision lenticule extraction (SMILE) versus femtosecond laser in-situ keratomileusis (FS-LASIK) in eyes with myopia and high astigmatism. This retrospective study was conducted at a tertiary eye hospital between January 2021 and December 2022. Data were collected from individuals with myopia up to - 10.00 diopters (D) and cylinder ≥ 2.50 D who underwent SMILE (VisuMax 500) or FS-LASIK (MEL 90) and completed a 3-month postoperative follow-up. A total of 170 eyes of 123 patients were included: 83 eyes (60 patients) underwent SMILE, and 87 eyes (63 patients) underwent FS-LASIK. The preoperative cylindrical refractive error was - 3.01 ± 0.61 D in the SMILE group and - 3.09 ± 0.66 D in the FS-LASIK group. At 3 months, there was no statistically significant difference in uncorrected visual acuity (UCVA) or manifest refraction spherical equivalent (SEQ) between the two groups (P = 0.26 and P = 0.88, respectively). In the SMILE group, 90.4% of eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better compared to 98.77% with a preoperative corrected distance visual acuity (CDVA) of 20/20 or better. In the FS-LASIK group, 80.46% of eyes achieved a UDVA of 20/20 or better compared to 94.25% with a preoperative CDVA of 20/20 or better. Moreover, 95.1% of eyes in the SMILE group and 94.3% in the FS-LASIK group were within ± 0.50 D. Vector analysis showed comparable results between the two groups in terms of target-induced astigmatism (P = 0.559), difference vector (P = 0.155), index of success (P = 0.091), and angle of error (P = 0.89). The surgically induced astigmatism and correction index were significantly lower in the SMILE group (P < 0.01), whereas the absolute magnitude of error was higher in the SMILE group (P = 0.02). SMILE and FS-LASIK have comparable efficacy, predictability, and safety in correcting myopia associated with high astigmatism ( ≥ 2.50 D).
The aim of this study was to investigate enabling factors of bullying and harassment in the work environment on board ships. This qualitative study was based on semi-structured interviews with seafarers and industry experts. The study also used free-text responses to open-ended questions from a large population-based cross-sectional survey on the prevalence of bullying and harassment on ships in the Danish merchant fleet. The data were imported into NVivo and analyzed thematically. Four themes emerged as enabling factors specific to the work environment on a ship. The first theme, Isolation, covers how the crew - as a group - is physically isolated from the world outside the vessel, but also how new crew members can face challenges when trying to become established within the groups on board. The second theme, Hierarchy, encompasses how challenging the existing rank-based hierarchy is not tolerated and how the hierarchy itself is often maintained through bullying and harassment. The third theme, Crewing, includes how diversity related to, for example, culture, language, gender, or age/experience may create another form of hierarchy, with the same negative consequences as the hierarchy based on formal rank. The fourth theme, Leadership, covers how leadership can enable both good and unacceptable work environment related to bullying and harassment. Bullying and harassment pose serious challenges to the work environment on ships. Four themes were identified as enabling factors of bullying and harassment. Some are inherent conditions, whereas others may be improved through continued awareness and focused educational initiatives.
Colorectal cancer screening through colonoscopy relies on the segmentation of polyps, which becomes difficult when polyps are small in size and flat in shape, with subtle edges, poor contrast, and large variability in appearance. Although new deep learning techniques have improved segmentation performance, most techniques have focused on architectural innovations, leaving aside the issue of limited diversity in the training set. Although generative methods have improved, they often suffer from the lack of control over structure, misalignment of masks and images, and increased computation, making them inefficient in the case of small polyps, where they are most relevant. This study aims to present a dual generative synthesis framework for data-centric augmentation to improve segmentation performance. The proposed framework divides the problem of structure and appearance into two steps. First, procedural generation is used to create realistic masks of small, flat polyps. Second, a mask-conditioned GAN generates colonoscopy images that match the generated masks in texture and lighting conditions. This process produces anatomically realistic and perfectly aligned mask-image pairs. The generated data are incorporated into a U-Net-based segmentation model and evaluated on public polyp segmentation datasets with extensive ablation studies. The proposed method achieved a Dice score of 0.8786 and an Intersection over Union (IoU) of 0.7835. The model also obtained a precision of 0.8930 and a recall of 0.8648, which are significantly higher than those of the baseline U-Net model. The dual generative synthesis framework improves segmentation robustness by generating realistic and aligned training data for small and flat polyps. The results demonstrate its potential to enhance the reliability of automated polyp segmentation in colonoscopy images.
3-Chlorophenmetrazine (3-CPM) is a phenmetrazine analog that has been detected in new psychoactive substance (NPS) products sold on the market. The objective of this study was to perform an analytical characterization of 3-CPM identified in NPS products. In addition, 2-chlorophenmetrazine (2-CPM) and 4-chlorophenmetrazine (4-CPM), which are positional isomers of 3-CPM, were synthesized, and analytical methods for their differentiation were validated to prevent misidentification of the three CPM isomers. Samples were analyzed using liquid chromatography with photodiode array detection (LC/PDA), liquid chromatography-high resolution mass spectrometry (LC/HRMS), gas chromatography-mass spectrometry (GC/MS), gas chromatography-high resolution mass spectrometry (GC/HRMS), nuclear magnetic resonance (NMR) spectroscopy, and X-ray crystallography. Four NPS products sold between October 2022 and February 2023 were found to mainly contain trans-3-CPM, as determined by NMR analysis. Quantitative analysis showed that the powder and crystal products contained approximately 0.86-1.98 g of 3-CPM per package, whereas the tablet product contained approximately 0.10 g of 3-CPM per tablet. In chromatographic analyses, 2-CPM, 3-CPM, and 4-CPM were distinguishable based on retention times using octadecylsilyl silica gel (ODS) and phenyl columns for LC/PDA, and HP-5ms and CycloSil-B columns for GC/MS. Small differences were observed between UV spectra of 2-CPM/3-CPM and that of 4-CPM. Furthermore, 2-CPM produced a characteristic product ion in the LC/HRMS spectrum. The three positional isomers (2-, 3-, and 4-CPM) can be differentiated using LC and GC-based analytical methods. The analytical data presented in this study will facilitate the structural elucidation and accurate identification of novel phenmetrazine analogs in future investigations.
Early developmental screening relies heavily on U.S.-standardized normative benchmarks, raising questions about cross-cultural stability and the relative influence of biological vs. contextual factors during infancy. This study examined Ages and Stages Questionnaire (ASQ-3) outcomes at six months in a Bulgarian infant cohort in comparison with established U.S. norms. In this cross-sectional study, 155 infants (six months chronological or corrected age) were assessed using the ASQ-3 during routine pediatric visits. One-sample t-tests were used to compare domain scores with U.S. normative means. Effect sizes (Cohen's d), 95% confidence intervals, and post hoc power sensitivity analyses were calculated. Secondary analyses evaluated the effects of birth weight, gestational age, and sex. Cross-cultural comparisons showed statistically significant differences in Gross Motor (d = -0.28) and Problem Solving (d = 0.30); however, all effect sizes were small (|d| ≤ 0.30), with no moderate or large deviations observed. In contrast, infants with birth weight <2,500 g demonstrated moderate-to-large effects across multiple domains (d = -0.63 to -0.88), particularly in Gross Motor and Personal-Social functioning. Differences related to gestational age were not clinically meaningful after correction for age. A small female advantage was observed in Communication (d = 0.37). ASQ-3 outcomes at six months suggest a high degree of cross-cultural similarity in this Southeastern European infant cohort. Variability in developmental outcomes in the present cohort appeared more strongly associated with biological risk factors than with cross-cultural contextual variation during early infancy. These findings support the use of ASQ-3 in the Bulgarian clinical context and highlight the importance of integrating perinatal risk factors into early developmental surveillance.
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by impaired social communication, repetitive behaviors, and restricted interests. Dysregulation of the microbiota-gut-brain axis is closely associated with the pathogenesis of ASD. Washed microbiota transplantation (WMT) has emerged as a promising intervention for ASD, but existing cohort studies lack genetically identical controls, making it difficult to distinguish intervention-related changes from genetic and environmental confounding factors. This twin-paired controlled study adopted a study design that minimizes the influence of genetics and shared environment, to explore the associations of WMT with clinical symptoms, gut microbiota, and metabolic profiles in children with ASD. Three pairs of age- and environment-matched twins (one ASD-affected, one typically developing sibling) were enrolled. WMT was administered to the ASD participant in each pair. Fecal samples were collected at baseline and post-intervention. Gut microbiota and metabolic profiles were analyzed using metagenomic sequencing and targeted metabolomics, respectively. Clinical outcomes were evaluated using the Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), Sleep Disturbance Scale for Children (SDSC), and Bristol Stool Form Scale (BSFS). Relevant observations were carried out to explore potential changing trends. After WMT, CARS, ABC, SDSC, and BSFS exhibited small numerical directional shifts toward healthier values, but none reached statistical significance. Gut microbial structure and function presented a shifting trend toward the profile of their typically developing twin siblings. Abnormal lipid and energy metabolism indicators showed partial ameliorative trends, and the number of differential metabolites between ASD patients and healthy siblings was markedly reduced. Tyrosine and phenylalanine metabolic pathways, together with Segatella, Negativibacillus, and Sangeribacter, may be associated with incomplete phenotypic changes in this cohort. Although the twin-pair design has high internal validity and can provide strong causal inference evidence for the effect of microbiota transplantation in treating ASD, this study has limitations such as a small sample size, a single-center non-randomized observational design. All findings in this pilot study are merely descriptive trends, and the relevant mechanism analysis only provides correlational clues. A single session of microbiota transplantation failed to fully adjust aromatic amino acid metabolism in ASD children. No definitive causal relationship can be concluded based on the findings of this small-sample pilot study. Under tightly controlled genetic and environmental conditions, gut microbial dysbiosis presents correlational characteristics with ASD-related phenotypes. WMT was associated with consistent remodeling of gut microbial ecology and partial resolution of metabolic dysregulation in ASD children, with multi-omic signatures converging toward healthy twins. Clinical rating scales only displayed non-significant minor numerical shifts, which cannot be interpreted as evidence of clinical symptom improvement. These initial findings provide exploratory mechanistic clues and phenotypic data supporting WMT as a targeted microbiome intervention approach for ASD, and await further validation through large-scale randomized controlled trials. Identifier ChiCTR2400091105.
Tree shape optimizes canopy architecture; however, its role in regulating within-canopy spatial heterogeneity of fruit quality and the underlying physiological mechanisms remains unclear in jujube (Ziziphus jujuba Mill.). We hypothesized that tree shape drives fruit quality differentiation by restructuring canopy structure, thereby modulating bearing shoot type distribution and mineral element partitioning. A two-year (2024-2025) field trial was conducted on 15-year-old 'Junzao' trees. Following an initial screening of four tree shapes, the two superior forms-Small-canopy shape (S) and Trunk shape (T)-were selected for in-depth analysis in 2025. Canopies were vertically stratified into upper, middle, and lower layers, and fruits were classified by bearing shoot type (lignified vs. deciduous). Canopy structural parameters (LAI, MTA, DIFN), fruit quality traits (sugars, phenolics, flavonoids), mineral elements (K, Ca, Mg, etc.), and yield components were systematically evaluated. Optimized tree shapes (S and T) significantly outperformed Open-central shape and unpruned controls in overall fruit quality. Vertically, a distinct trade-off emerged: single-fruit weight and soluble sugars peaked on lignified shoots in the middle canopy (29.08 g, 26.66%), while total flavonoids and phenolics accumulated predominantly in the upper and lower layers. Potassium distribution aligned closely with sugar accumulation, whereas calcium and magnesium were enriched in zones with higher diffuse light penetration (linked to lower LAI and higher DIFN). Deciduous shoots accumulated more mineral elements than lignified shoots within the same layer, suggesting a compensatory uptake mechanism. Notably, the Small-canopy shape increased yield per plant by 31.46%, Grade 1 fruit percentage by 45.05%, and yield per unit area by 40.49% compared to the Trunk shape. PCA clearly separated the two shapes, with mineral elements (K, Ca, Mg) and quality traits (single-fruit weight, total phenolics) serving as key discriminators. Our results demonstrate that tree shape orchestrates within-canopy quality differentiation through structural modulation of canopy light environments and shoot-type composition, which subsequently alters mineral element source-sink partitioning. These findings provide a mechanistic basis for precision pruning strategies aimed at improving fruit uniformity and marketable yield in jujube production.
Understanding the molecular mechanisms of autism spectrum disorder (ASD) and its psychiatric comorbidities, including bipolar disorder (BD), is pivotal for uncovering pathways that shape neurodevelopmental trajectories and clinical heterogeneity. We aimed to identify ASD-specific gene-expression signatures and disrupted biological processes in prefrontal cortex, contrasting them with those observed in BD. We performed a comparative transcriptomic analysis of RNA-seq datasets from postmortem prefrontal cortex samples of individuals with ASD or BD and controls. Differential expression was assessed with DESeq2, including batch as a covariate in the BD model. Functional interpretation used Gene Ontology over-representation analysis, KEGG Gene Set Enrichment Analysis and gene-concept network visualization. ASD samples showed 45 differentially expressed genes (DEGs), mainly downregulated non-coding RNAs, particularly small nuclear RNAs and small nucleolar RNAs. Enrichment analysis indicated a convergent profile related to RNA processing, spliceosome assembly and spliceosomal activity. In contrast, BD showed 12 candidate DEGs, mostly upregulated protein-coding genes. BD enrichment involved metal ion response and detoxification, amine and peptide hormone responses, vascular regulation and hydrolase activity, with genes associated with neuroinflammation such as SERPINA3 and CHI3L1 contributing to this profile. No shared DEGs or enriched GO Biological Process terms were observed between ASD and BD. These results support transcriptomic divergence in the prefrontal cortex, with ASD characterized by spliceosomal dysregulation, contrasting with metal ion response, vascular regulation and inflammation-associated signals in BD. Our findings provide a transcriptomic framework for future studies investigating disorder-specific molecular mechanisms and candidate signatures in ASD and BD.
In previous studies, obstructive sleep apnea (OSA) severity at diagnosis was independently associated with retinal arteriolar narrowing and reduced retinal pulse amplitude. Participants with severe untreated OSA showed progressive retinal arterial narrowing 2 years post diagnosis, while the use of continuous positive airway pressure (CPAP) ventilation appeared to attenuate these changes. This 7-year prospective study examines whether these protective effects of CPAP persist. We invited 79 participants from the 2-year follow-up cohort for a 7-year review. Of these, 39 completed assessments: medical history, optical coherence tomography, and retinal vessel imaging. The retinal nerve fiber layer (RNFL) thickness, central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriovenous ratio were analyzed. CRAE and CRVE appeared greater in patients with severe OSA + CPAP than untreated OSA. Over 7 years, CRVE observably declined more slowly in severe those with OSA + CPAP than those with untreated severe OSA. Severe OSA + CPAP had a notable smaller decline in CRAE comparison with the control and untreated groups. The RNFL thickness was nonsignificantly reduced in severe OSA + no CPAP compared with those with CPAP in the superotemporal sector. Global RNFL rates of thinning were equivalent across groups. There was a trend for those not on CPAP to have higher rates of hypertension and stroke. In this cohort, the cohort size was too small for robust statistics. It can still be broadly appreciated that CPAP provides long-term protective benefit against retinal arterial narrowing. The protective effect of CPAP on retinal vascular changes seen at the 2-year mark continued to trend in the mean CRAE values and was also potentially demonstrated in preservation of RNFL thickness in this 7-year study.
To evaluate delivery and short-term pre-post changes associated with a single-arm six-week mindset-integrated stress regulation course for postgraduate students at a Chinese medical university. This single-arm pre-post evaluation was conducted at Guangzhou Medical University among postgraduate students aged 18-35 years who provided electronic informed consent and completed baseline and immediate post-course assessments. The course comprised six weekly 90-minute face-to-face group sessions integrating emotion and stress awareness, mindset-oriented psychoeducation, mindfulness-based practice, and transfer exercises. Primary outcomes were the Depression Anxiety Stress Scales-21 (DASS-21) and Chinese Perceived Stress Scale-10 (CPSS-10); secondary outcomes were the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Athens Insomnia Scale (AIS). Pre-post differences were assessed using Wilcoxon signed-rank tests, with exploratory baseline-adjusted models. Among 496 complete-case participants, attendance and assignment completion were high (overall attendance, 99.4%; assignment completion, 98.18%). DASS-21 depression, anxiety, and stress scores decreased, and CPSS-10 showed a statistically significant decrease, although the CPSS-10 median was unchanged (15.00 at both time points). Statistically significant pre-post effect sizes were small (r = 0.127-0.269). PHQ-9 scores increased modestly (r = 0.197), GAD-7 did not change significantly, and AIS showed a small statistical difference without a median shift. In adjusted exploratory models, baseline scores were the most consistent predictors, whereas mindset category did not predict any post-intervention outcome. The course was deliverable in this setting and was associated with mixed short-term changes: selected broad distress measures improved, CPSS-10 and AIS medians were unchanged, and PHQ-9 worsened modestly. These preliminary findings do not establish effectiveness or causal benefit. Controlled studies with follow-up and direct assessment of mindset change are needed.
To evaluate the effect of sublingual immunotherapy with dust mite drops on serum eosinophil cationic protein (ECP), thymus and activation-regulated chemokine (TARC), vascular cell adhesion molecule-1 (VCAM-1) levels and symptom improvement in allergic rhinitis (AR) patients. A prospective randomized controlled trial enrolled 300 AR patients sensitized to dust mites, randomly assigned to control group (conventional treatment, n = 150) and research group (conventional treatment plus sublingual dust mite drops, n = 150) for 6 months. Compared with controls, the research group showed significantly greater reductions in interleukin-4 (IL-4), interleukin-17 (IL-17), ECP, TARC, VCAM-1, lower adverse reaction rates, improved pulmonary function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), FEV1/FVC ratio, and small airway function including maximal mid-expiratory flow (MMEF), expiratory flow rate at 50% of FVC (MEF50), expiratory flow rate at 25% of FVC (MEF25), as well as reduced symptom scores (all p < 0.05). Sublingual immunotherapy with Dust mite drops appears effective in suppressing systemic inflammation, minimizing treatment-related adverse events, enhancing both small airway and pulmonary function, and easing the clinical manifestations of allergic rhinitis. Allergic rhinitis, commonly known as hay fever, is a condition in which the immune system overreacts to harmless substances such as dust mites, leading to symptoms such as sneezing, runny or blocked nose, and itchy eyes. The aim of this study is to investigate whether a treatment method called sublingual immunotherapy, which involves placing drops containing trace amounts of dust mite extract under the tongue, can improve the therapeutic effect of dust mite allergy patients. A total of 300 adults with dust mite allergic rhinitis participated in this study. Half of them received standard treatment (nasal spray and anti-allergy tablets), while the other half received standard treatment plus sublingual drops for 6 months. The research results showed that patients who received additional drops had lower levels of inflammation-related substances in their blood, better lung function, fewer side effects, and more significant improvements in symptoms such as sneezing and nasal congestion compared to patients who only received standard treatment. Among patients who also suffer from asthma, the improvement effect on lung function is most significant. This study suggests that adding sublingual dust mite drops on top of conventional anti-allergic treatment can help control symptoms, reduce inflammation, and improve respiratory conditions, especially for patients with asthma. However, as the study was not a double-blind experiment (patients knew what treatment they were receiving) and was only conducted in one hospital, more research is needed to confirm these findings.
Percutaneous balloon compression (PBC) is a safe and effective surgical technique for treating trigeminal neuralgia. The filling balloon can compress the trigeminal ganglion in Meckel's cave to achieve the interruption of pain signals. The core of the operation is the successful placement of a balloon catheter into Meckel's cave so that effective compression of the trigeminal ganglion can be achieved after the balloon is inflated. In this article, we try to determine the application value of the balloon pre-inflating technique (using contrast agents as guides during positioning) by studying its effect on the ideal balloon formation rate in PBC. A retrospective study. A single center. To compare the small-dose balloon pre-inflating technique with traditional techniques during PBC surgery, we conducted a retrospective study on the clinical data of patients who had primary trigeminal neuralgia and underwent PBC surgery at the Department of Pain Management of the Second Xiangyi Hospital at Central South University in Changsha from January 2018 to January 2024. In total, 170 patients underwent the pre-inflating technique (pre-inflating group), and 199 patients underwent the traditional non-pre-inflating technique (control group). A total of 369 patients were included in the study, with a follow-up period of 12 months. When the initial balloon morphology was suboptimal, the success rate of re-catheterization to obtain the ideal balloon shape in the pre-inflating group and the non-pre-inflating group was 84.3% and 58.9%, respectively. The success rate in the pre-inflating group was significantly higher than in the non-pre-inflated group (P < 0.001). The numbers of re-punctures and re-catheterizations were significantly lower than in the non-pre-inflating group, as was the radiation dose. The instances of re-punctures in the pre-inflating group and the non-pre-inflating group were 0.41(ranging from 0.23 to 0.59 instances) and 0.71 (0.55-0.87 instances), respectively; and the re-catheterizations in the pre-inflating group and the non-pre-inflating group took place a respective 1.08 (0.77-1.40 instances) and 1.59 (1.28-1.90) instances. The radiation dose was 5.59 mGy (4.88-6.38 mGy) in the pre-inflating group and 7.69 mGy (6.86-8.52 mGy) in the non-pre-inflating group. This single-center investigation may be subject to institution-specific protocols and potential physician biases, with the generalizability of findings further constrained by the limited sample size. We found that using the low-dose balloon pre-inflating technique in PBC surgery significantly improved the success rate of subsequent balloon deployment when the initial balloon morphology was suboptimal. This pre-inflating technique may decrease radiation exposure as well as the occurrences of multiple balloon catheter placements and repeated punctures.
Chronic knee (CK) pain has various underlying etiologies with several available therapeutic options that differ in effectiveness, duration, and complication rate. For the past decade, a minimally invasive ablation relying upon genicular radiofrequency has been gaining popularity as a treatment for the condition. To date, however, the literature contains only limited data supporting the effectiveness of this procedure, leading to insurance companies labeling it as "experimental" and denying claims. Benefits described include reduced adverse outcomes and complications, quicker recovery and longer duration of analgesia, and broader scope of applicability when compared to other, traditional treatments. The present investigation focused on genicular radiofrequency ablation (GRFA) and its outcomes, including disability (e.g., stiffness, physical function), pain, and improvement in patients' quality of life. This retrospective, single-center study was conducted to evaluate the safety and effectiveness of GRFAs, plus their associated radiofrequency generators and electrode systems. The equipment consisted of the MultiGen® 2 Radiofrequency Generator (Stryker Corporation) and the RFA Solutions Generator System (Avanos Medical, Inc.). Selected patient age ranged between 26 and 92 years, with a mean age of 56.5 years. Thirty-four (34) individuals were enrolled at LSU Health Shreveport, which was the sole investigational site, between March 2021 and 2025. The Stryker SERFAS Energy Platform (Stryker Corporation) was the primary radiofrequency generator selected for genicular ablation (61.9%), with the Avanos RFA Solutions Generator System (Avanos Medical, Inc.) selected for the remaining cases. As for the outcome measures, scores on the visual analog scale (VAS), disability changes measured on the Western Ontario and McMaster Universities Arthritis Index (WOMAC), adverse outcomes, quality of improvement, and ratings recorded in the Quality of Life subsection of the Knee Injury and Osteoarthritis Outcome Score (KOOS) were compared after GRFA. Mean VAS scores for CK pain intensity decreased significantly, dropping by 3.1 cm from a baseline score of 9.0 cm by the specified end (March 18th, 2025). Furthermore, 66.7% of the patients experienced a 20% or greater improvement in pain, 33.3% of the patients experienced a 40% or greater improvement in pain, and 19.1% of the patients experienced a 60% or greater improvement in pain. Zero (0) procedure-related adverse events or intra- or post-procedural complications occurred during the investigation. The study was retrospective and had no sham operation to determine placebo response. The relatively small sample size (34 total ablations, 21 patients) could have limited the generalizability of the results. Furthermore, the withdrawal rate was 38%, thereby limiting the certainty of the treatment's long-term duration. Results should be considered hypothesis-generating, not confirmatory, but they align well with the growing body of corroborating literature. The results of this study substantially reinforce GRFA as a safe, effective, and minimally invasive treatment option for patients experiencing CK pain over a 6-month period.
To evaluate visual performance, contrast sensitivity (CS), optical quality, and subjective satisfaction of Vivity extended depth-of-focus (EDOF) premium intraocular lens (pIOL) in early keratoconus (KC). In this prospective, interventional, single-center clinical study, ten patients with mild bilateral KC and cataract received AcrySof IQ Vivity pIOL. Pre- and postoperative assessments included monocular and binocular uncorrected and distance-corrected visual acuities at 4 m (UDVA, DCVA), uncorrected and distance-corrected intermediate and near visual acuities at 66 cm (UI66VA, DCI66VA) and 40 cm (UNVA, DCNVA), defocus curve, CS, wavefront aberrometry (RMS, PSF, Strehl ratio), halometry, and subjective outcomes. At 3 months, mean ± SD monocular DCVA in the dominant eyes (primary endpoint) was 0.06 ± 0.13 logMAR. A statistically significant improvement was observed between preoperative and postoperative monocular and binocular UDVA, UNVA, DCNVA (p < 0.001), and DCVA (p = 0.03). Binocular DCI66VA and UI66VA were 0.10 ± 0.15 and 0.14 ± 0.16 logMAR, respectively. The defocus curve was ≤ 0.20 logMAR from + 0.50 D to - 2.00 D. CS peaked under scotopic conditions at 6 cpd, total ocular RMS improved from 2.15 ± 1.98 to 1.09 ± 0.77 (p = 0.09). NEI-RQL-42 scores indicated favourable patient-reported outcomes, particularly for glare, clarity of vision, and satisfaction with correction. In this small prospective pilot study, bilateral implantation of a non-diffractive EDOF IOL was associated with favourable short-term visual outcomes in highly selected patients with stable early keratoconus. These preliminary findings suggest that early stable KC may not represent an absolute contraindication to non-diffractive EDOF IOL implantation, but larger comparative studies with longer follow-up are required.
Vertebral fragility fractures (VFFs) are underdiagnosed despite increasing future fracture risk. In 307 hip fragility fracture patients, 28.0% had prior radiological VFFs-mostly severe, lumbar, and wedge-type-yet only 11.6% were diagnosed. This under-recognition underscores the importance of early VFFs detection to improve outcomes and prevent further fragility fractures. Vertebral fragility fractures (VFFs) are the most common osteoporotic fractures but are often undiagnosed. Despite the frequent absence of pain, VFFs are linked to increased morbidity and a higher risk of future fractures, including hip fractures. The purpose of this study was to determine the prevalence, location, type, and severity of previous VFFs in patients presenting with hip fragility fractures. We conducted a retrospective study of patients aged ≥ 50 years with hip fragility fractures admitted to our FLS between 2019 and 2023. Inclusion criteria required the availability of thoracic and/or lumbar spine imaging performed within the previous five years. Clinical data, lifestyle factors, and FRAX scores were collected. Spine images were independently assessed by two blinded reviewers using Genant's semiquantitative method. Of 357 patients screened, 307 met inclusion criteria. The mean age was 80.9 ± 9.1 years, and 84.0% were women. Radiological VFFs were present in 28.0% of patients, yet only 11.6% had a prior diagnosis. The lumbar (41.9%) and thoracic spine (31.4%) were the most frequently affected regions. Wedge-type fractures were most common (72.9%), and 62.8% were classified as severe. Patients with VFFs were significantly older (p = 0.007) and had higher FRAX scores (p < 0.001). The odds of having VFFs were 2.17 and 2.07 times higher in patients with previous fractures and in those receiving antidepressant therapy, respectively. Over one-fourth of patients with hip fractures have previous VFFs, though only a small portion have been officially diagnosed. These findings underscore the high prevalence and frequent under-recognition of VFFs.
Boron nitride nanotubes (BNNTs) are promising building blocks for next-generation technologies, yet synthesis-derived impurities and structural damage from conventional purification methods (e.g., harsh acid treatments, high-speed centrifugation) hinder their practical applications. Here, we report a theory-guided low-speed centrifugation strategy for high-purity BNNT enrichment without detectable structural damage. Leveraging fundamental sedimentation principles, this approach capitalizes on the distinct sedimentation contrast between compact impurities and high-aspect-ratio BNNTs. This mechanism enables highly selective separation, where impurities sediment rapidly while BNNTs remain suspended. Comprehensive experimental validations confirm that estimated BNNT purity approaching ∼95% is achievable, providing a favorable purity-recovery balance while preserving nanotube morphology and dispersibility under the tested conditions. The strategy exhibits versatility across tested surfactant systems in environmentally benign aqueous media, eliminating the need for strong acids or organic solvents while maintaining compatibility with ionic and nonionic stabilizers. Importantly, the purified BNNT dispersions retain their capacity for Onsager-type anisotropic assembly to form uniformly aligned architectures during subsequent gravity filtration. This offers direct opportunities for advanced anisotropic applications, including thermal management, mechanical reinforcement, and directional transport. By unifying sedimentation theory with practical processing, this work establishes low-speed centrifugation as a viable and sustainable strategy for high-aspect-ratio one-dimensional nanomaterials.