Diabetes technologies-including continuous glucose monitoring (CGM), insulin pumps, and hybrid closed-loop systems-have profoundly transformed self-management in type 1 diabetes (T1D). While these technologies offer improved glycemic control and safety, their use in ultraendurance sports introduces specific cognitive, material, and organizational challenges that remain underexplored in digital health research. This study aimed to explore how adults living with T1D experience and use diabetes technologies in ultraendurance sports, with particular attention to tensions between autonomy, mental load, and vulnerability. We conducted semistructured interviews with 13 French-speaking adults with T1D who had completed at least one marathon or ultra-endurance event within the last 5 years and used ≥1 diabetes technology (CGM, pump, or hybrid closed loop). We adopted constructivist grounded theory (Charmaz), using iterative cycles of line-by-line and focused coding, constant comparison, and memo-writing to build and refine analytic categories. Sampling combined purposive strategies through associations and online communities with theoretical orientation (additional participants sought to elaborate emergent categories). Data collection ceased upon theoretical sufficiency, when further interviews no longer yielded substantively new insights for core categories. Two patient partners contributed to question framing, interim sense-checking, and manuscript review. Reporting followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Five interrelated categories described how athletes negotiated technology in practice: (1) From episodic control to continuous anticipation (reframing glucose management through real-time visibility); (2) Gains in safety and performance (perceived benefits and expanded possibilities); (3) Redistributed mental work (hyper-vigilance, logistics, device management); (4) Keeping things working when they break (fragility in extreme conditions, redundancy, improvisation, and experiential expertise); and (5) Making diabetes visible (technologies mediating identity, solidarity, and stigma). Across categories, participants articulated a tension between optimization-oriented performance and a user-constructed robustness-the capacity to maintain function under uncertainty through redundancy and adaptive know-how. In ultraendurance contexts, diabetes technologies act as both enablers and obligations: they open participation while shifting and sometimes intensifying cognitive and organizational work. A grounded account centered on robustness-in-use highlights practical implications for clinicians (pre-event routines, redundancy planning), designers (context-aware algorithms; improved physical durability), and policy makers (equitable access and exercise-specific education). These findings underscore the value of constructivist, practice-oriented inquiry to inform digital health tool design and support for people living with chronic illness.
Tuberculosis is the main cause of death among hospitalised people living with HIV. Non-sputum-based diagnostics could improve patient outcomes. The EXULTANT trial aims to evaluate an expanded tuberculosis screening strategy among people with HIV in two African countries with a high tuberculosis and HIV burden. This pragmatic, individually randomised controlled superiority trial was conducted across 11 hospitals in Tanzania and Mozambique. We consecutively enrolled adults living with HIV (aged ≥18 years) without an existing tuberculosis diagnosis or recent tuberculosis treatment, within 24 h of admission. The intervention group underwent Xpert MTB/RIF Ultra (Xpert Ultra) testing from sputum, stool, and urine, plus lateral flow urine lipoarabinomannan (LF-LAM) testing (Determine TB LAM Ag assay), irrespective of symptoms. The control group followed standard-of-care, symptom-based, WHO-recommended sputum Xpert Ultra and LF-LAM testing. The primary endpoint was the proportion of participants with microbiologically confirmed tuberculosis starting treatment within 72 h. Secondary endpoints included 8-week all-cause mortality and time to tuberculosis diagnosis. The trial is registered at ClinicalTrials.gov (NCT04568967) and is completed. From Sept 25, 2022, to March 15, 2024, we screened 1534 participants, and randomly assigned 1172 (76·6%) to either the intervention group (n=582) or the control group (n=590). At admission, 715 participants (61·0%) were female, 845 (75·4%) were on antiretroviral therapy (ART), and median CD4 count was 232 cells per μL (IQR 87-490). In the control group, 505 (85·6%) had tuberculosis-compatible symptoms and were eligible for sputum Xpert Ultra testing (306 of them [60·6%] provided a sample) and 538 (91·2%) met WHO criteria for LF-LAM testing. In the intention-to-treat analysis, 93 (16·0%) of 582 participants in the intervention group and 90 (15·3%) of 590 in the control group had microbiologically confirmed tuberculosis and started treatment within 72 h (difference 0·7%, 95% CI -3·4 to 4·8, p=0·73). 8-week all-cause mortality was 25·8% (150 of 582) in the intervention group and 28·8% (170 of 590) in the control group (hazard ratio 0·86, 95% CI 0·69 to 1·07, p=0·18). Median time to tuberculosis treatment initiation was 0·98 days (IQR 0·83-1·92) and 0·92 days (0·79-1·86) in the intervention and control groups, respectively (hazard ratio 1·05, 95% CI 0·82 to 1·33, p=0·72). An expanded screening strategy among people living with HIV admitted to hospital did not increase the proportion of individuals with microbiologically confirmed tuberculosis starting treatment or reduce 8-week mortality. EDCTP2 programme, supported by the EU.
Drowning can lead to acute respiratory distress syndrome (ARDS), which is associated with high mortality and poses substantial clinical management challenges. Ultra-protective ventilation strategy combined with veno-venous extracorporeal membrane oxygenation (VV-ECMO) present a viable alternative, yet evidence supporting these strategies in drowning-related ARDS patients remains scarce. This case report describes an 18-year-old female who experienced cardiac arrest following near-drowning. After the return of spontaneous circulation, the patient developed severe pulmonary edema leading to ARDS. VV-ECMO was initiated, resulting in a significant improvement in the Horowitz coefficient. Using a combination of VV-ECMO and an ultra-protective ventilation strategy with a lowest tidal volume of 2.8 ml/kg (predicted body weight, PBW), the patient's lung condition improved significantly. Static lung compliance rose from 11 ml/cm H₂O to 46 ml/cm H₂O. The patient was successfully weaned from VV-ECMO on Day 15, extubated on Day 27, and eventually discharged with no obvious pulmonary sequelae. The present case indicate that combining ultra-protective ventilation and VV-ECMO may be an effective approach for managing severe near-drowning-related ARDS by improving lung function and increasing the likelihood of successful extubation. This strategy minimizes ventilator-induced lung injury (VILI) while optimizing oxygenation, providing a new perspective for treating similar patients. Further studies are needed to validate its efficacy and optimize treatment protocols.
Intra-articular hyaluronic acid (HA) injections are widely used for knee osteoarthritis (OA) to reduce pain and improve function. The efficacy of cross-linked HA over placebo remains debated. This study aimed to compare the efficacy of 2 single-injection, ultra-high, and high molecular weight (HMW) cross-linked HAs against a saline placebo for symptomatic knee OA. We conducted a single-center, double-blind, randomized, placebo-controlled trial with 24-week follow-up. A total of 276 patients with primary knee OA were randomized into 3 groups: ultra-high MW HA (Hyruan ONE), HMW HA (hylan G-F 20), and saline. All participants received a single intra-articular injection. Primary outcomes were visual analog scale (VAS) pain scores at rest and during motion at weeks 1 to 24 and the change from baseline over the 24-week period. Secondary outcomes included the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), Lequesne index, Time Up and Go (TUG) test, and active knee flexion at weeks 2, 4, 12, and 24. Patients who did not improve could receive a rescue corticosteroid injection, after which they were excluded from further analysis. No significant differences in pain reduction were observed between the HA and saline groups at rest (p = 0.92) and during motion (p = 0.99). All groups showed significant improvement in VAS scores over 24 weeks (p < 0.0001). Modified WOMAC scores were also similar among the 3 groups (p > 0.05). All groups had comparable outcomes for the SF-36 (p = 0.91), Lequesne index (p = 0.93), TUG test (p = 0.48), and knee flexion (p = 0.90). The rates of rescued corticosteroid injections rates were similar across the 3 groups (17% vs. 21% vs. 25%, p = 0.98). Ultra-high and HMW cross-linked HA injections did not provide superior pain or functional outcomes compared with saline for knee OA. These findings provided high-level evidence challenging the clinical benefit of cross-linked HAs. Consequently, the cost-effectiveness is uncertain and warrants formal economic evaluation. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The recently validly published phylum Minisyncoccota (previously Ca. Patescibacteriota or candidate phyla radiation) had long been an enigma, with members having remained uncultivated for several decades since the first SSU ribosomal sequence was recovered. We reported on the first isolated strain of Minisyncoccota, Nanosynbacter lyticus type strain TM7xT (ATCC TSD-290T), in 2015, using directed cultivation from human oral samples. Strain TM7xT had an extremely reduced genome (705 CDS), ultra-small cell size (200-300 nm), and replicated as an obligate epibiont on the surface of another commonly found oral species: Pauljensenia odontolytica_C strain XH001 (host bacterium). TM7xT also exhibited what has been defined as a parasitic phase, where it disrupts the membrane of the bacterial host cell, resulting in host bacteria lysis. However, free-floating, host-free TM7xT cells remain viable and can re-infect fresh host bacterial cells when available. This discovery and coculture marked the first concrete evidence of how these ultrasmall organisms within the Minisyncoccota survive and persist despite their reduced genomes missing de novo biosynthesis of many essential compounds, including all amino acids and vitamins. This model dual species system has now allowed a deeper understanding of the TM7x-host bacterium interaction and dynamics, with over 15 publications reporting on various aspects of this strain to date. We propose the name Nanosynbacter lyticus gen. nov. sp. nov. for strain TM7xT. We also propose Nanosynbacteraceae fam. nov., Nanosynbacterales ord. nov. and Nanosynbacteria class nov. to accommodate the genus Nanosynbacter.
The remediation of saline land is of great strategic significance for ensuring food security and promoting ecological restoration. Interfacial solar evaporator shows considerable potential in soil remediation but still faces challenges, such as low solar-steam efficiency and high freshwater consumption. Herein, we report for the first time a passive multistage solar distiller for ultra-efficient saline soil desalination that integrates the latent heat recovery, water recycling and edge salt rejection. Under one-sun irradiation (1 kW m-2), the 7-stage solar distiller achieves a water yield of 3.0 kg m-2 h-1 with a solar-steam efficiency of 200% in saline soil. After 12 days of treatment, the salinity in 30 cm-thick saline soil had decreased from 22.5 to 2.33 g kg-1, with a water consumption (water-to-soil ratio) of 40.1 kg m-2. Furthermore, the large-scale saline soil desalination using the multistage solar distiller works efficiently outdoors, indicating that such technology can promote the green remediation of global saline land and the sustainable development of agriculture.
Noninvasive imaging through scattering media is crucial for diverse applications but remains constrained by a narrow field of view (FOV). Although recent learning-based methods have a larger FOV, they often require large-scale real experimental datasets and struggle when the FOV is far beyond the optical memory effect (OME). Here, we propose a physics-guided adaptive dual-domain diffusion model for ultra-wide-field noninvasive imaging through scattering media, namely UNI-Net. Specifically, we first develop a physical scattering imaging model to synthesize large-scale pre-training data, thereby reducing dependence on real experimental datasets. Second, to maximize the utilization of speckle information, we partition each speckle pattern into multi-channel patches to guide the diffusion process. Third, we propose a spatial-channel parallel attention block to model the spatial sparsity and inter-channel similarity of speckle patches with linear complexity. Extensive experiments show that our method cuts reliance on real experimental data by an order of magnitude and achieves a PSNR of 31.23 dB at a 41 × $\times$ OME range in complex scenes, which is 49.5% higher than existing approaches while requiring significantly lower computational and memory costs. Even at an extreme 164 × $\times$ OME range where other methods fail, it still reliably reconstructs complex scenes with a PSNR of 27.21 dB.
Off-flavor compounds often bind to proteins during extraction from animal byproducts and compromise protein applicability. This study proposed the integration of ultra-high pressure (UHP) pretreatment with propylene glycol and trehalose addition (UNPA) to facilitate off-flavor dissociation during duck liver protein (DLvP) extraction. UHP treatment at 350 MPa for 10 min induced a molten globule-like state with loosened tertiary packing and increased hydrophobic exposure, whereas propylene glycol and trehalose helped maintain the pressure-modulated conformation and limit aggregation. UNPA decreased the total peak area of headspace volatiles by approximately 50.8%, and reduced trimethylamine, dimethylamine, histamine, and formaldehyde by 28.78%, 32.19%, 12.21%, and 44.00%, respectively (p < 0.05). Water-holding capacity and emulsifying activity were improved by 13.6% and 60.1%, respectively (p < 0.05). These findings indicate that controlled UHP-induced unfolding, assisted by conformational stabilization, can promote off-flavor release while improving selected functional properties of DLvP.
Currently, the "one-size-fits-all" therapeutic window strategy for Hemoporfin-mediated photodynamic therapy of port-wine stains overlooks intralesional heterogeneity and interindividual pharmacokinetic differences. Simultaneously, this strategy lacks real-time feedback and personalized adjustment mechanisms. Therefore, the real-time monitoring of hemoporfin distribution in blood vessel and interstitial fluid is very important for finding the best laser illumination time window depended on personalized characterizes including the height, weight and so on. This study developed an ultra-sensitive sensor by integrating surface-enhanced Raman spectroscopy technology with microneedles (SERS-MNs) for monitoring the distribution dynamics of hemoporfin in blood and interstitial fluid within animal skin. Specifically, calcium ions were employed as an aggregating agent to induce the aggregation of gold/silver nanocage particles on the microneedle surface, thereby forming abundant SERS-enhanced "hot spots". Using this sensor, characteristic Raman fingerprint signals of hemoporfin were successfully obtained for the first time, with a detection limit as low as 50 pg/mL. Furthermore, the SERS-MNs sensor not only quantitatively detected hemoporfin in pig skin but also successfully captured characteristic hemoporfin Raman signals in mouse interstitial fluid, blood, and treated patient blood. This revealed the spatiotemporal distribution mechanism of hemoporfin within the vascular system and interstitial fluid. This advancement will aid in determining the optimal therapeutic window for patients, thereby preventing both overtreatment and undertreatment, ultimately achieve precise therapy characterized by "individualization, visualization, and dynamization".
Ultra-processed foods (UPFs) are a hallmark of unhealthy dietary patterns and have been linked to chronic low-grade inflammation, insulin resistance, and obesity - key risk factors for preeclampsia (PE). Growing epidemiological evidence associates UPF-rich dietary patterns with increased risk of hypertensive disorders of hypertension (HDP), including PE. UPFs may promote PE pathophysiology through inflammation, gut microbiota dysbiosis, immune dysregulation, oxidative stress, endothelial dysfunction, and angiogenic imbalance. In this narrative review we synthesize the epidemiological and mechanistic evidence linking UPF consumption to PE and claim that recognizing UPFs as a modifiable dietary risk factor represents a meaningful and underexplored opportunity for PE prevention.
Emerging evidence suggests an association between ultra-processed food (UPF) consumption and neurodegenerative diseases, but there is limited evidence for multiple sclerosis (MS). Diets rich in UPFs promote inflammation and oxidative stress that both play an important role in modulating the immune system, and thereby, potentially the pathogenesis of MS. This study aimed to investigate the longitudinal association between UPF consumption and MS onset in middle-aged and older adults. The study included 185,788 adults who completed at least one valid dietary assessment and did not have MS at baseline (2009-2012). Dietary data was collected at 5 time points using a web-based 24-h dietary recall, and UPFs were categorised using the Nova food classification system. MS cases were identified based on medical history and linkage to data on hospital admissions (using ICD-coded diagnoses ICD10-g35; ICD9-3409), and self-reported MS diagnosis. Prospective associations between UPF consumption (as a percentage of total food intake in grams per day) and risk of MS onset were assessed using multivariable Cox proportional hazards models were adjusted for age, sex, ethnicity, education, Townsend deprivation index, smoking status, total energy intake and serum 25-hydroxyvitamin D. Participants had a mean age of 56.0 years (SD 8.0) and 54% were female. UPFs comprised 19.1% of total dietary grams intake, with carbonated drinks, ready-to- eat/heat meals and industrial-processed breads being the most consumed UPF subgroups. Over a mean follow-up of 8.9 years (SD: 2.7), 384 incident MS cases occurred. Each 10% increase in UPF consumption was associated with an estimated 9% increase in risk of MS (HR 1.09; 95% CI: 1.003 to 1.19; p-value = 0.04). This study found a weak yet significant association between higher UPF consumption and increased risk of MS in middle-aged and older adults. Given the modest effect size and inconsistency of statistical significance across sensitivity analyses, these findings should be interpreted with caution. Research to confirm these findings in other population groups and contexts is needed.
To evaluate the feasibility and diagnostic performance of ultra-low-dose CT (ULD-CT) for screening malignant metastasis using super-resolution deep learning reconstruction (SR-DLR) compared with normal-resolution DLR (NR-DLR) and hybrid iterative reconstruction (HIR). Patients with cancer undergoing surveillance were enrolled prospectively and underwent contrast-enhanced whole-body ULD-CT. The images were reconstructed using HIR, NR-DLR, and SR-DLR. Two radiologists independently evaluated image quality, lesion detectability, and diagnostic performance. Radiation dose metrics were compared with prior standard-dose CT. Of the 271 patients (mean age 66.3 ± 12.2 years; 134 men), 56 (20.7%) had disease requiring therapeutic intervention. The ULD-CT images reduced the volume CT dose index by 71.1%, dose-length product by 70.2%, effective dose by 70.6%, and size-specific dose estimate by 70.9%. SR-DLR yielded significant improvement in the overall image quality, sharpness, and image noise reduction compared with HIR and NR-DLR (p < 0.001). The mean attenuation values measured in all organs did not differ significantly among the three reconstruction algorithms (p > 0.05). SR-DLR significantly reduced quantitative image noise by 50% compared with HIR (p ≤ 0.004) and significantly improved SNR across all organs (p < 0.001), without altering attenuation values. SR-DLR demonstrated superior detection rates for malignant lesions for 17 primary cancers and 178 metastatic lesions compared with HIR and NR-DLR. For benign lesions, SR-DLR achieved a nearly 100% detection rate across 9 lesion types (n = 1,264). SR-DLR enables approximately 70% radiation dose reduction, while maintaining superior image quality and high diagnostic performance for detection of visceral and soft-tissue metastatic disease in oncological patients undergoing cancer surveillance.
Soft x-ray angle-resolved photoemission spectroscopy (SX-ARPES) is one of the most powerful spectroscopic techniques to visualize the three-dimensional bulk electronic structure in reciprocal lattice space. Compared with ARPES employing low-energy photon sources, the time burden imposed by a lower photoelectron yield, stemming from the photoionization cross-section, has been a persistent technical challenge. To address this challenge, we have developed a noise-reduction system by using the deep prior-based approach and integrated it into the micro-focused SX-ARPES (μSX-ARPES) system at BL25SU in SPring-8. The implemented system effectively eliminates instrumental artifacts, such as grid and spike structures typical of ARPES data acquired using the voltage Fixed mode, within ∼30 s. We demonstrate, through the μSX-ARPES measurements on a single crystal of CeRu2Si2, that data with sufficient statistical accuracy can be obtained in ∼40 s. In addition, we present the potential of high signal-to-noise ratio ARPES measurement, achieving an energy resolution of 51.6 meV at an excitation energy of 708 eV in μSX-ARPES measurements on polycrystalline gold. Our developed system successfully reduces the time burden in SX-ARPES and paves the way for advancements in lower photoelectron yield measurements, such as those requiring higher energy resolution and three-dimensional nonequilibrium measurements.
Advancement of next-generation information technologies is driving the increasing integration of millimeter-wave and terahertz (THz) communication, detection, and artificial intelligence technologies, thereby creating a demand for multifunctional absorbing materials to address complex electromagnetic interference. In this study, a flexible WPU-MXene@FC composite fabric with ultra-broadband absorption, superhydrophobicity, and excellent durability is developed. The base fabric (FC) is modified via surface plasma treatment to introduce positively charged active sites on fibers. Driven by electrostatic interaction, negatively charged MXene is self-assembled with modified FC. The electrostatic interactions process induces a "nest-like" structure on fibers, building construct MXene multiple loss paths. Waterborne polyurethane (WPU) is finally coated to endow the FC with MXene oxidation protection, superhydrophobicity, and stability. Results show that a 1.8 mm-thick WPU-MXene@FC achieves an effective absorption bandwidth spanning 25.3-1200 GHz. Within 0.2-1.0 THz, the reflection loss (RL) value is below -30 dB, reaching a minimum of -45.2 dB. After 500 bending cycles, its RL remains below -30 dB. The WPU-MXene@FC exhibits superhydrophobicity (contact angle 151.3°, sliding angle 1.2°), excellent air permeability, and flexibility. This multifunctional FC has important applications in wearable devices, communications, and provides strong support for the development of lightweight stealth structures and flexible electromagnetic camouflage.
Silicon-based optoelectronic devices represent a cornerstone of modern optoelectronics, owing to their low cost and mature fabrication infrastructure. Their performance optimization hinges critically on precise control of the Schottky barrier height (SBH). As a nondestructive, continuously tunable physical parameter, pressure offers a novel strategy for dynamic SBH modulation. Here, we employed high-pressure techniques to investigate Pt/Si Schottky junctions. With increasing pressure, the SBH decreased monotonically from 0.713 to 0.446 eV at a rate of -165.8 meV/GPa and was completely eliminated above 4.3 GPa, indicating a pressure-driven Schottky-to-Ohmic transition. Mechanistic analysis revealed that pressure modulates SBH primarily by regulating interfacial gap state density and reconstructing the band structure. This transition led to a drastically enhanced photoresponse, with photocurrent intensities increasing by 100-fold and 3400-fold under 532 and 660 nm laser excitation, respectively. This work elucidates the pressure-tuning behavior of silicon-based Schottky junctions and their regulatory mechanism on photoelectric performance, providing a new strategy for the design of high-performance silicon optoelectronic devices.
暂无摘要（点击查看详情）
Additive manufacturing allows for the creation of custom acetabular components with unique shapes, geometries, and sizes for patients who have massive bone loss. The aim of the present study was to evaluate the implant survivorship, imaging results, and clinical outcomes of custom, three-dimensional (3D) printed hemipelvis reconstructions in both the oncologic and non-oncologic setting. We retrospectively identified seven total hip arthroplasties (THAs) from 2018 to 2023 that utilized a novel ultra-porous, custom, 3D-printed component. Indications for surgery were chondrosarcoma in three patients, aseptic loosening of the acetabular component in two patients, osteosarcoma in one patient, and reimplantation as part of two-stage revision for infection in one patient. All revision THAs had massive acetabular bone loss (Paprosky IIIB), and all primary neoplasm resections were Enneking-Dunham type III. The mean age was 56 years, 86% were men, and the mean body mass index was 33. The mean follow-up was four years (range, one to six). At final follow-up, all ultra-porous, 3D-printed constructs remained in situ. There was one patient revised to a constrained liner for dislocation, and one other reoperation occurred for infection. There was an additional dislocation treated with a closed reduction. On radiographic and computed tomography images, the proximal portion of all components were osseointegrated to the ilium with no radiolucent lines. The inferior ischial flange had ingrowth failure in four cases. At the final follow-up, all patients were ambulatory (three without any gait aids, three patients who had a cane, and one who had a walker). There was no patient who died of disease, and there were no local recurrences. Ultra-porous, custom, 3D-printed components used for hemipelvis reconstructions in salvage cases of arthroplasty and oncologic reconstruction demonstrated promising excellent early results with all osseointegrated to the ilium, all in situ to date, and all patients independently ambulatory. Dislocation continues to be the most common complication.
This work presents a geometrically simple topology for developing an ultra-wideband directional coupler with improved coupling and directivity. A short-ended coupled-line structure is used to achieve an ultra-wideband, tightly coupled symmetric three-section coupler using the microstrip line technology. The proposed design demonstrates an explicit improvement of approximately 1.2 dB in coupling compared to conventional multi-section directional couplers. Calculated, simulated, and measured responses validate the effectiveness of the proposed configuration in terms of low-ripple coupling bandwidth, low insertion loss, and improved directivity performance compared to respective responses of the conventional structure. Couplers featuring a higher number of sections to implement different bandwidths and couplings can be fabricated using the presented structure due to its transmission line-based approach. A prototype of the three-section directional coupler with coupling of 7.6 dB, 8.1 dB, and 8.3 dB and corresponding bandwidths of 104%, 123% and 133% is designed, fabricated, and measured. The experimental results confirm that the coupler can reliably achieve higher coupling with ultra-wideband response from 0.75 GHz to 3.75 GHz (5:1) with 8.3 ± 1.4 dB (ripple). Additionally, the design yields promising performance with return loss > 16 dB, isolation > 20 dB, a phase difference of 90 ± 4°, and directivity > 30 dB, and the maximum circuit size is 0.067λ02. This work aligns with SDG 9: Industry, Innovation and Infrastructure by advancing high-performance microwave components that support efficient, reliable, and scalable communication infrastructure.
The advancement of indirect ceramic restorations helps to establish new boundaries between conservative practices and prosthetics, thus Vonlay restorations were introduced to achieve the desired results in cases that involve the occlusal surface and extends to entire buccal surface due to either esthetic or functional considerations. This in vitro study evaluated the fracture resistance and failure modes of ceramic vonlay restorations fabricated from four CAD/CAM materials: lithium disilicate, zirconia-reinforced lithium silicate, super high-translucent zirconia, and polymer-infiltrated ceramic after cyclic loading. Fifty-six extracted human maxillary premolars were prepared and restored with vonlays from lithium disilicate glass ceramics (control group), zirconia-reinforced lithium silicate (ZLS), ultra-translucent monolithic zirconia, and polymer-infiltrated ceramic networks (PICNs) (n = 14/group). Restorations were milled, finished, and adhesively luted with dual-cure resin cement. All specimens underwent 500,000 cycles of mechanical loading (100 N, 1 Hz) before static fracture testing. Failure modes were assessed microscopically. Data were analyzed using one-way ANOVA, Tukey's post hoc, and Chi-square/Fisher's exact tests (α = 0.05). Ultra-translucent monolithic zirconia showed the highest fracture resistance, followed by lithium disilicate glass ceramics and zirconia-reinforced lithium silicate (ZLS) while polymer-infiltrated ceramic networks (PICNs) showed the lowest values (p < 0.001). Failure patterns differed significantly among groups (p = 0.005), with polymer-infiltrated ceramic networks (PICNs) having more restorable failures. Ceramic material significantly influences the mechanical performance of vonlay restorations. High-strength ceramics, such as lithium disilicate glass ceramics, ultra-translucent monolithic zirconia, offer superior resistance and clinical predictability in premolars under cyclic loading.