Efficient data compression is crucial for reducing storage and transmission costs associated to vast volumes of nanopore raw sequencing data. Surpassing the state-of-the-art compression performance has been challenging, and all recent progress in this direction either incur a computational performance over-cost or resort to lossy compression schemes, which are not always desirable. In this article, we present PDZ, a lossless compression algorithm that outperforms VBZ, the current defacto standard, both in compression performance and computational efficiency. In our experimental evaluation, the compression ratio improvement ranges from 0.87% to 2.84% depending on the dataset, the compression speed is 1.09× to 2.25× faster depending on the hardware, and the decompression speed is 1.01× to 1.52× faster depending on the hardware. Compared to EX-ZD, a compression algorithm with similar compression performance, the speedup factor for both compression and decompression goes from approximately 1.39 × to 1.83 × , depending on the hardware. PDZ is implemented in C++ as a new compression method within the POD5 format. The source code is available as a fork of the open-source NanoporeTech library at https://github.com/Rafael-Cast/Piecewise-Differential-Zstd-Coder-POD5-Demo.
Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of taxane-based chemotherapy with limited preventive options. We evaluated whether dual-site mechanical compression during paclitaxel infusion reduces CIPN in women with gynecologic cancers. In this prospective, intraindividual, self-controlled study, patients receiving carboplatin-paclitaxel underwent compression of the nondominant hand (two surgical gloves) and ipsilateral lower limb (Class II stocking), while contralateral limbs served as controls. CIPN was assessed using CTCAE v5.0 and EORTC QLQ-CIPN20 at baseline, Cycle 3, end of treatment (EOT), and 3- and 6-month follow-up. Among 76 patients (median age, 61 years), moderate-to-severe CIPN was observed less frequently in compression limbs than in control limbs at Cycle 3 (35.5% vs. 53.9%; p = 0.001), EOT (59.2% vs. 69.7%; p = 0.021), 3 months (28.9% vs. 52.6%; p = 0.015), and 6 months (20.3% vs. 33.8%; p = 0.002). Repeated-measures analyzes showed significant time-by-limb interactions for sensory (p = 0.003), lower-extremity sensory (p = 0.018), and motor domains (p = 0.041). Sensory CIPN20 scores were lower in compression limbs in the upper extremities from EOT onward (7.5 vs. 10.2; p < 0.001) and in the lower extremities at 3-month (8.7 vs. 10.7; p < 0.001) and 6-month follow-up (7.0 vs. 10.0; p < 0.001). EORTC QLQ-CIPN20 sensory scores identified grade ≥ 2 neuropathy with AUC values > 0.92 at all time points. Dual-site mechanical compression was associated with reduced incidence and persistence of CIPN. As a low-cost and scalable intervention, this strategy may improve treatment tolerability and survivorship outcomes. Trial Registration: ClinicalTrials.gov identifier: NCT07105553.
Reconstructing high-quality images under low bitrate conditions has long been a challenging task. Previous studies have made this task feasible by leveraging the prior knowledge of diffusion models. However, in image compression tasks, the diffusion model baseline fails to adequately integrate advanced semantic information, and the alignment between the diffusion priors and the learning objectives of the compressor is also lacking. To address this issue, we propose the Diffusion Prior Refinement for Efficient Low-rate Image Compression (DiRIC), an image compression scheme based on Stable Diffusion. DiRIC can efficiently encode low-level image information and achieve a highly realistic reconstruction of the original image by leveraging high-level semantic features and the prior knowledge inherent in diffusion models. Specifically, DiRIC employs a multi-feature compressor to represent crucial low-level information with ex tremely low bitrates; meanwhile, it acquires more robust hy brid semantics through a pre-embedding mechanism, providing abundant contextual support for the decoding end. Furthermore, we design a consistency skip module to enhance and refine the diffusion prior. To further improve decoding efficiency, we employ a noise-level estimator to reduce the number of sampling steps, aiming to achieve high-fidelity and efficient decoding. Extensive experimental results show that this method not only achieves the current state-of-the-art perceptual fidelity but also significantly outperforms previous perceptual image compression methods in terms of statistical fidelity. In comparison to SoTA diffusion baselines [1], we have achieved a 147.44% and 84.63% BD Rate improvement in terms of FID and PSNR, alongside a 19× increase in decoding speed.
Adenosine-induced transient cardiac asystole is used in intracranial aneurysm surgery to achieve flow arrest and facilitate clipping, particularly when proximal control is unavailable. Inadequate asystole duration or refractory responses can limit its utility, especially during intra-operative rupture. We describe a 48-year-old man with subarachnoid haemorrhage from a ruptured left supraclinoid internal carotid artery aneurysm and an unruptured right supraclinoid aneurysm. Both were approached via single left craniotomy. After uneventful clipping of the left aneurysm, clipping of the right aneurysm was attempted with 12 mg and 18 mg of adenosine, resulting in brief (8 s and 11 s, respectively) periods of asystole. During the rupture, carotid compression combined with 24 mg adenosine achieved asystole lasting 30 s with return of electrical activity only upon release of carotid compression, enabling safe clipping within 25 s of asystole onset. Hypotension persisted for an additional 60 s, after which the patient fully recovered. Combining mechanical carotid compression with adenosine synergistically prolonged asystole beyond that expected from adenosine alone, likely via enhanced parasympathetic effects on sino-atrial and atrioventricular nodes.
Although rare, dilation of the pulmonary artery, which can be present in patients with pulmonary arterial hypertension (PAH), can cause compression of the left main coronary artery (LMCA), leading to progressive dyspnoea, fatigue, syncope, and angina. Over time, this rare complication might lead to acute coronary syndrome. A 63-year-old White female with a background of systemic hypertension and mild obstructive sleep apnoea was admitted to the emergency unit because of gradually worsening shortness of breath and generalized weakness, without associated anginal symptoms. Blood gas evaluation demonstrated impaired oxygenation, with a partial pressure of oxygen of 6.8 kPa and an oxygen saturation of 87.9%. Transthoracic echocardiography demonstrated marked right ventricular strain along with features consistent with pulmonary arterial hypertension. A CT pulmonary angiographic study showed pronounced enlargement of the pulmonary trunk, measuring 62 mm in diameter. Subsequent coronary angiography combined with intravascular ultrasound identified greater than 50% narrowing of the left main coronary artery due to extrinsic compression, which was corroborated by dynamic CT imaging. The patient underwent IVUS-guided percutaneous revascularization of the left main coronary artery with placement of a drug-eluting stent. One week post-discharge, prior to additional diagnostic evaluation and management of pulmonary arterial hypertension, the patient reported significant symptomatic relief, with functional status improving from New York Heart Association (NYHA) class III to class II. This case underscores that extrinsic compression of the LMCA due to pulmonary artery dilatation warrants consideration as a potential aetiology of symptoms, even in the absence of angina.
A 7-year-old male intact German shorthaired pointer was referred to a board-certified veterinary neurologist for further evaluation of a chronic (> 6 months) history of gradually progressive paraparesis, limp tail, and spinal pain despite medical management of these clinical signs and presumptive neurologic disease with the family veterinarian. Radiographs revealed evidence of intervertebral disc space collapse, endplate sclerosis, and bridging spondylosis at L7-S1, and the patient was presumptively diagnosed with degenerative lumbosacral stenosis (DLSS). Initial medical management included oral analgesics, oral anti-inflammatories, lifestyle changes, and epidural steroid injections. Ultimately, progression of the patient's clinical signs resulted in referral to a board-certified veterinary neurologist. Magnetic resonance imaging revealed marked bilateral L7 nerve root enlargement with L7-S1 foraminal widening and concurrent L7-S1 intervertebral disc extrusion, causing moderate to severe left-sided compression of the cauda equina. Given the marked changes of nerve roots on imaging and foraminal widening, consideration was given to a neoplastic process versus inflammatory neuritis. A lumbosacral dorsal laminectomy, partial discectomy, and left L7 nerve biopsy were performed. Histopathology of the L7 nerve root revealed chronic neural fibrosis with atrophy and mild neuritis, consistent with the chronic, progressive nature of the patient's clinical signs and severe compression of the cauda equina. These dramatic and irreversible changes may have been avoidable or at least minimized with earlier diagnosis and aggressive surgical intervention, highlighting the importance of developing standardized, evidence-based recommendations for management of dogs with DLSS similar to the framework that exists in human intervention for treatment of cauda equina syndrome (CES).
This study aims to experimentally investigate the performance, combustion, emissions, and vibration characteristics of a single-cylinder, four-stroke, water-cooled variable compression ratio (VCR) diesel engine fueled with diesel and Karanja biodiesel blends (B20 and B30). Experiments were conducted under varying engine load, compression ratio (CR), and hot exhaust gas recirculation (EGR-HOT) conditions. Engine vibration was evaluated using root mean square acceleration (RMS Accel), and a novel integrated approach was adopted to correlate vibration behavior with performance and emission characteristics. The results show that vibration increases with engine load but decreases with higher compression ratios, while under EGR conditions it initially decreases and then rises at higher rates. The results show that vibration increases with engine load but decreases with higher compression ratios, while under EGR-HOT conditions it initially decreases and then rises at higher rates. Compared to diesel, RMS acceleration decreased by 4.3 and 8.49% under load variation, 3.01 and 7.18% under CR variation, and 2.66 and 6.75% under EGR-HOT conditions for B20 and B30, respectively. Emission analysis revealed reductions of 13.3% in hydrocarbon (HC), 6.58% in carbon monoxide (CO), and 17.98% in smoke opacity for B30, although nitric oxide (Nox) increased by 15.8% as compared to diesel. Combustion analysis indicated a 3.43% increase in maximum cylinder pressure (CPMax) and a 14.94% decrease in net heat release (NHR). In terms of performance, brake thermal efficiency (BTHE) decreased by 10.74%, while brake-specific fuel consumption (BSFC) increased by 18.52%. Overall, the study demonstrates that biodiesel blends improve emission and vibration characteristics but slightly compromise performance, while the integrated analysis provides deeper insight into combustion behavior and engine condition.
Cauda equina syndrome (CES) is an uncommon but severe neurological condition resulting from compression of the lumbosacral nerve roots, leading to motor, sensory, and autonomic dysfunction. Despite its low incidence, CES carries a high risk of permanent disability and medico-legal consequences due to the narrow therapeutic window for intervention. This narrative review synthesizes current evidence on the anatomical basis, pathophysiology, etiology, clinical presentation, diagnostic pathways, classification systems, and management strategies for CES. Particular emphasis is placed on the prognostic distinction between incomplete CES (CES-I) and CES with urinary retention (CES-R), as well as the ongoing debate surrounding the optimal timing of surgical decompression. Long-term outcomes, rehabilitation principles, and emerging neuroprotective strategies are also discussed. Early recognition, prompt imaging, and urgent decompression remain central to improving neurological recovery and quality of life in affected patients.
Thoracic spinal tuberculosis (TSTB) can lead to vertebral destruction, spinal instability, and neurological deficits. Paraplegia is one of its most severe manifestations, yet a concise and clinically interpretable framework for assessing neurological severity at presentation remains lacking. We retrospectively reviewed 148 patients with thoracic spinal tuberculosis who underwent surgery at a tertiary referral centre between 2019 and 2024. Clinical, laboratory, and imaging variables associated with paraplegia at presentation were evaluated using logistic regression analysis. A clinical-imaging severity stratification framework was subsequently developed using routinely available preoperative variables. Model discrimination and calibration were assessed using receiver operating characteristic analysis and bootstrap resampling, and LASSO regression was performed as a sensitivity analysis. Among 148 patients, 54 (36.5%) presented with paraplegia. In complete-case multivariable analysis (n = 113), lower body mass index (BMI) (OR 0.79, 95% CI 0.67-0.92; P = 0.004), longer duration of neurological impairment (OR 1.06 per week, 95% CI 1.01-1.11; P = 0.010), and higher compression grade (OR 2.47, 95% CI 1.50-4.07; P < 0.001) were independently associated with paraplegia. A framework incorporating age, BMI, duration of neurological impairment, and compression grade demonstrated acceptable discrimination (AUC 0.903, 95% CI 0.85-0.96) and calibration within the development cohort. Internal validation showed generally consistent performance. In surgically treated patients with thoracic spinal tuberculosis, prolonged neurological symptom duration, greater compression severity, and lower BMI were independently associated with paraplegia at presentation. The proposed framework, based on routinely available variables, may support structured assessment of neurological severity in patients with thoracic spinal tuberculosis.
Severe pectus excavatum is an uncommon cause of hemodynamic compromise in adults and may present with unexplained tachycardia when preload filling is impaired by cardiac compression. A 65-year-old woman with long-standing palpitations presented with sinus tachycardia despite high-dose beta-blockade. Electrocardiogram and ambulatory monitoring showed sinus rhythm with marked heart rate variability. Right heart catheterization revealed low filling pressures, with a mean right atrial pressure of 1 mm Hg and preserved cardiac output. Cardiovascular magnetic resonance showed severe pectus excavatum (Haller index: 8.1) with anterior cardiac compression. Pectus-induced preload insufficiency was deemed responsible for her symptoms. She underwent a modified Ravitch repair with complete resolution of palpitations and normalization of heart rate. Chest wall deformity can cause clinically significant cardiac compression, preload insufficiency, and compensatory sinus tachycardia, even in late adulthood. Severe pectus excavatum should be recognized as a reversible cause of preload insufficiency and sinus tachycardia, and surgical correction may result in symptom resolution.
Immobilized neurosurgical patients are at high risk for deep vein thrombosis (DVT). While routine prophylaxis exists, a systematic, nurse-led bundle of care may offer a more comprehensive and effective approach to prevention. To evaluate the effectiveness of a nurse-led, multifaceted bundled care intervention on the incidence of DVT, patient compliance, and clinical outcomes in immobilized neurosurgical patients. This quasi-experimental study with a historical control group was conducted in the Department of Neurosurgery, Xichang People's Hospital. Adult neurosurgical patients requiring immobilization for at least 72 h were enrolled. The control group (n = 1,163, recruited January 2021-September 2022) received standard neurosurgical care. The intervention group (n = 1,625, recruited January 2023-December 2024) received a nurse-led bundled care protocol consisting of: (1) dynamic Caprini risk assessment; (2) standardized mechanical prophylaxis with graduated compression stockings (GCS) and intermittent pneumatic compression (IPC); (3) structured health education; and (4) individualized early mobilization. The primary outcome was symptomatic ultrasound-confirmed DVT incidence. Secondary outcomes included compliance, DVT-related knowledge, limb circumference difference, pain scores (Visual Analogue Scale, VAS), and patient satisfaction. Multivariable logistic regression was used to adjust for potential confounders. Baseline characteristics were comparable between groups. The incidence of DVT was significantly lower in the intervention group (1.66% vs. 2.75%, p = 0.041). Intervention group patients demonstrated significantly higher compliance with GCS/IPC use (76.5% vs. 58.1%, p < 0.001) and early mobilization (72.1% vs. 51.5%, p < 0.001), as well as significantly greater DVT-related knowledge (85.2 ± 8.5 vs. 62.1 ± 10.2, p < 0.001). The intervention group showed significantly greater reduction in limb circumference difference (1.2 ± 0.8 cm vs. 2.1 ± 1.1 cm, p < 0.001) and lower pain scores (2.3 ± 1.2 vs. 4.1 ± 1.6, p < 0.001). Patient satisfaction was significantly higher in the intervention group (94.1 ± 3.3 vs. 85.6 ± 4.8, p < 0.001). Pulmonary embolism (PE) incidence was low in both groups (0.12% vs. 0.17%, p = 0.715). After adjustment for age, sex, diagnosis, type of surgery, Caprini score, pharmacological prophylaxis, and calendar year, the intervention remained independently associated with lower DVT risk (adjusted OR = 0.54, 95% CI 0.32-0.92, p = 0.023). This nurse-led bundled care intervention was associated with a significantly lower DVT incidence and improved clinical outcomes in immobilized neurosurgical patients. The protocol's structured, evidence-based approach provides a practical model for VTE prevention in neurosurgical settings.
Low back disorders are highly prevalent and disproportionately affect women and older adults, yet the biomechanical mechanisms underlying these demographic disparities remain unclear. This study aimed to investigate how sex- and age-related anatomical differences in vertebral geometry influence lumbar spine loading patterns. Three hundred sixty lumbar motion segments were derived from CT scans of 60 asymptomatic adults (30 males, 30 females; ages 20-69, evenly distributed by decade). Subject-specific multibody dynamic models were developed for each segment featuring anatomically accurate vertebrae and facet joints with simplified discs and loading conditions to isolate geometric effects. Segments were tested under seven physiologic load cases, and disc and facet measures were examined to assess the effects of sex and age on spinal loading. Age significantly influenced facet contact forces and the magnitude of intervertebral disc loading with older subjects exhibiting increased facet forces and elevated shear loads but reduced compression. Sex-based differences were pronounced when loads were normalized by endplate cross-sectional areas. Females exhibited up to 31% higher normalized compression and shear loads than males. Significant asymmetry and inter-subject variability were also observed, particularly in the younger and older age groups. Sex- and age-related anatomical variation in vertebral geometry significantly impacts lumbar spine biomechanics. These findings highlight the need for more inclusive and anatomically realistic modeling approaches that reflect the diversity of the population for accurate risk assessment and personalized clinical strategies.
Seat cushion materials affect the mechanical demands of sit-to-stand (STS) movements; however, the effects of specific material properties, such as resilience and hardness, remain unclear. Understanding how these factors influence lower-limb joint moments and movement strategies during STS may contribute to the development of seat designs that assist individuals with reduced lower-limb strength. Therefore, this study aimed to clarify the fundamental mechanical effects of seat cushion resilience and hardness on STS. Fifteen healthy young adults performed STS from five polyurethane foam cushions that differed in resilience (14-55%) and 40% compression hardness (66-336 N). The material ranges were determined with reference to technical documents and a published patent specification to ensure they were within the range commonly used in everyday seating products. Kinematic and kinetic data were collected using a motion capture system and two force plates. Net joint moments were calculated via inverse dynamics, and differences among seat conditions were analyzed using repeated-measures ANOVA or the Friedman test, with Bonferroni-adjusted pairwise comparisons (α = 0.05). Seat resilience significantly affected the peak hip and knee extensor moments (p < 0.01, η² = 0.35-0.48). High-resilience cushions delayed seat-off timing and maintained greater seat reaction force at the timings of peak hip and knee extensor moments. In contrast, seat hardness mainly influenced horizontal center-of-mass (COM) velocity and hip joint moment (p < 0.01, η² = 0.31-0.37), with softer seats producing larger values. High-resilience cushions delayed seat-off and maintained buttock support for a longer duration, thereby reducing the peak hip and knee extensor moments. In contrast, softer seats promoted a strategy involving greater horizontal momentum generation by the upper body, which consequently required an increased hip extensor moment to decelerate this momentum. Cushions with a resilience of ≥ 53% and 40% compression hardness of ≥ 180 N effectively reduced lower-limb joint loading. The results of this study provide fundamental insights that may contribute to future research on chair design and cushion selection in clinical and caregiving environments. Not applicable.
Generative modeling for 3D brain MRI is challenged by a trade-off between anatomical fidelity, sample diversity, and computational efficiency. Diffusion-based approaches achieve strong visual quality but typically require hundreds to thousands of sampling steps, while latent-space compression can introduce reconstruction artifacts and degrade fine-grained anatomy. We introduce FlowLet, a conditional generative framework that performs Flow Matching in an invertible 3D wavelet domain. This representation enables multi-scale generation without learned latent compression, while deterministic ODE sampling allows fast inference. Age conditioning is modeled through complementary feature-wise modulation and spatially adaptive cross-attention, enabling explicit control over age-related morphological variation. Across multi-site neuroimaging datasets, FlowLet achieves competitive and, in several settings, superior global fidelity compared to diffusion-based baselines using as few as 10 sampling steps. Region-based evaluation across 95 cortical and subcortical brain regions demonstrates improved local anatomical plausibility beyond what is captured by global similarity metrics alone. In a downstream brain age prediction study, models augmented with FlowLet-generated data consistently reduce prediction error relative to real-only training and other generative baselines. Rather than focusing on a single dominant metric improvement, these results highlight a consistent trade-off between efficiency, controllability, and anatomically meaningful 3D brain MRI generation. The proposed framework is released as open-source to support reproducibility.
Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by chronic and intermittent abdominal pain, typically postprandial, and weight loss, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. The pathophysiology of the disease is not fully understood. Diagnosis is challenging due to nonspecific symptoms, and requires a careful correlation between clinical findings and imaging studies. To demonstrate the feasibility, safety, and technical aspects of robotic median arcuate ligament release using a case-based approach with detailed imaging correlation. The authors report the technical aspects in an elderly male patient with typical symptoms of MALS, who underwent robotic-assisted median arcuate ligament release using the da Vinci X platform. Preoperative evaluation included CT angiography and color Doppler ultrasound, demonstrating focal proximal celiac trunk stenosis. The robotic approach allowed precise dissection and complete decompression of the celiac trunk without intraoperative complications. Postoperative imaging demonstrated resolution of the stenosis and normalization of Doppler flow parameters. The patient experienced complete symptom resolution, and remained asymptomatic after one year of follow-up. Robotic median arcuate ligament release is a safe and effective minimally invasive option, providing excellent visualization and precise dissection in a challenging anatomical region. This technique should be considered a valuable approach for selected patients with MALS. Robotic surgery, due to the surgeon's ergonomics and the stability of the arms and instruments, wrist movement, and magnified threedimensional vision, allows for facilitated and safe access to the origin of the celiac artery as well as the dissection of fibrous tissues, innervation, and lymphatic vessels surrounding it. Given this, robotic surgery becomes feasible, effective, and safe for treating this syndrome, and it should be considered a preferred option in selected patients. The median arcuate ligament syndrome should be considered in cases of abdominal pain with no defined causes. A high index of suspicion can diagnose and treat more cases. Moreover, it is expected that robotic surgery will become increasingly accessible, allowing for an expansion of its indications. A síndrome do ligamento arqueado mediano (SLAM) é uma condição incomum caracterizada por dor abdominal crônica e intermitente, tipicamente pós-prandial, com perda de peso, causada pela compressão extrínseca do tronco celíaco pelo ligamento arqueado mediano. A fisiopatologia da doença não é totalmente compreendida. O diagnóstico é desafiador devido aos sintomas inespecíficos e requer uma correlação cuidadosa entre os achados clínicos e os exames de imagem. Demonstrar a viabilidade, segurança e aspectos técnicos da liberação robótica do ligamento arqueado mediano utilizando uma abordagem baseada em casos clínicos com correlação detalhada por imagem. Os autores relatam os aspectos técniocos em um paciente idoso do sexo masculino com sintomas típicos de SLAM foi submetido à liberação robótica do ligamento arqueado mediano utilizando a plataforma da Vinci X. A avaliação pré-operatória incluiu angiotomografia computadorizada e a ultrassonografia Doppler colorida, demonstrando estenose focal proximal do tronco celíaco. A abordagem robótica permitiu a dissecção precisa e a descompressão completa do tronco celíaco sem complicações intraoperatórias. Os exames de imagem pós-operatórios demonstraram a resolução da estenose e a normalização dos parâmetros de fluxo Doppler. O paciente apresentou resolução completa dos sintomas e permaneceu assintomático, após um ano de acompanhamento. A liberação robótica do ligamento arqueado mediano é uma opção minimamente invasiva segura e eficaz, proporcionando excelente visualização e dissecção precisa em uma região anatômica complexa. Essa técnica deve ser considerada uma abordagem valiosa para pacientes selecionados, com síndrome do ligamento arqueado mediano.
Closed reduction is an important adjunct in the surgical management of traumatic cervical facet dislocations, particularly jumped and locked facets. By restoring normal spinal alignment, successful closed reduction allows the surgeon to proceed with surgical stabilization via an anterior-first approach, obviating the need to rotate a dislocated, biomechanically unstable cervical spine, thereby minimizing the risk of iatrogenic spinal cord injury. While closed reduction has traditionally been achieved with Gardner-Wells tongs and weights, this reduction method requires the patient to remain bedbound for prolonged periods of time, is not MRI-compatible, and is associated with inconsistent results. We present two patients with bilaterally jumped and locked cervical facets, in whom a closed manual reduction technique was used, allowing rapid spinal realignment prior to surgical stabilization. We provide a detailed video illustration of this technique, emphasizing the steps involved and relevant technical nuances. While this technique might have been previously used and rarely reported, it has not, to the best of our knowledge, been described in a detailed, step-by-step fashion. Closed manual reduction of traumatic cervical facet dislocations can be performed safely and effectively in the operating room prior to definitive surgical stabilization of the spine. This technique should not be attempted in patients with severe spinal cord compression or neurologic compromise. The importance of adequate muscle relaxation provided by general anesthesia and continuous intraoperative feedback provided by live fluoroscopy and neurophysiologic monitoring cannot be overemphasized.
Peripheral neuropathic pain (pNP) is a prevalent and complex clinical condition that presents significant therapeutic challenges, with pharmacological options demonstrating variable efficacy and safety. To establish expert consensus recommendations on the clinical use of pregabalin in the management of diverse pNP conditions. A multidisciplinary panel of Chinese experts from orthopedics, pain management, neurology, oncology, dermatology, and pharmacy conducted a comprehensive literature review and synthesized clinical evidence to formulate consensus-based recommendations. Pregabalin, a second-generation calcium channel regulator, demonstrated broad efficacy across multiple pNP conditions, including postherpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), neuropathic cancer pain (NCP), postoperative and post-traumatic neuralgia, and trigeminal neuralgia (TN). In PHN, pregabalin significantly reduced pain intensity and improved sleep quality. In DPN, it provided consistent analgesia with improved pain scores and good tolerability. In NCP, pregabalin effectively alleviated pain, showed no significant drug-drug interactions, and was safely co-administered with chemotherapy. It was also effective in postoperative and post-traumatic neuralgia, although caution is warranted in cases of traumatic neuroma. In TN, pregabalin exhibited favorable low-dose efficacy, particularly in elderly patients, with minimal adverse effects. However, cautious use is advised in patients with nerve compression syndromes, such as carpal tunnel syndrome, and in individuals with a history of substance abuse. This consensus highlights pregabalin as an effective and generally well-tolerated therapeutic option for a broad range of pNP conditions. These recommendations provide clinically relevant guidance for optimizing pregabalin use, particularly within the Chinese healthcare context.
• Abnormal PV Doppler flow can be the first clue to extracardiac disease. • Routine PV assessment should be part of every comprehensive TEE. • TEE can detect thoracic pathology not directly related to the primary cardiac indication. • Small cell carcinoma may present with PV compression and Doppler turbulence. [Figure: see text]
Phase-change materials have received attention as candidates for next-generation memory storage due to the robustness of multiple solid phases with different electronic and optical properties under ambient conditions. The phase change material Ge15Sb85, the eutectic composition of Ge-Sb, also exhibits a Peierls-like distortion which opens a pseudogap in the electronic density of states that can be exploited for materials design. It is known that this distortion diminishes on heating, and it has been speculated that the competition between distorted and nondistorted states may give rise to an amorphous-amorphous phase transition. To explore these possibilities, we developed a machine-learned interatomic potential for Ge-Sb mixtures that is transferable across densities and compositions using the atomic cluster expansion (ACE) model. Applying this potential to the Ge15Sb85 system, we reproduce experimentally measured structural changes and confirm the presence of a Peierls-like distortion that is suppressed at high temperatures and high pressures. We define a scalar structural order parameter to quantify the strength of the distortion and classify the dependence of this parameter on the pressure, temperature, and stoichiometry. We find that the Peierls-like distortion depends on thermodynamic conditions and is most prominent at low temperature and low density. However, energy minimization of equilibrium configurations reveals that density is the predominant driver of the underlying motif governing the local structure, with temperature affecting solely the sharpness of structural features. We demonstrate that the variation in both density and distortion strength under compression is smooth and continuous, leading us to conclude that structural changes occur via a gradual crossover as opposed to a discrete phase transition.
The aim of the study Conducting a comparative analysis of the strength characteristics of model samples of modern polymer materials used for the manufacture of temporary orthopedic structures. The materials used were Dental Sand Pro (HARZ Labs, Russia) and Huge PMMA Monolayer (Huge, China). Dental SAND PRO material is positioned as a ceramic-filled polymer material designed for 3D printing of temporary crowns and bridge-like structures for long-term wear. As part of the experimental part of the work, models were developed and manufactured for conducting a series of comparative compression tests. Two modern production technologies are compared: milling from ready-made factory blocks (CAD/CAM) and 3D printing. Tests have shown that structures made of HUGE PMMA Monolayer material using CAD/CAM technology have higher mechanical strength compared to crowns made of HARZ Labs "Dental Sand Pro" material made by 3D printing. The destructive load of milled samples from HUGE PMMA is 2-4 times higher. Model molar crowns also had higher values for milled samples. Bridge-like prostheses made by milling could withstand about 1600 N, and 3D printing - about 500 N (p<0.05). Temporary structures made by milling from ready-made polymer blocks have a sufficient margin of safety for use in all areas of the dentition. In turn, 3D-printed structures, due to their lower strength characteristics, should be used mainly in the area of frontal teeth and premolars, where the load is significantly. Сравнительный анализ прочностных характеристик модельных образцов современных полимерных материалов, применяемых для изготовления временных ортопедических конструкций. Исследовали материалы Dental Sand Pro («HARZ Labs», Россия) и Huge PMMA Monolayer («Huge», Китай). Материал Dental SAND PRO позиционируется как керамонаполненный полимерный материал, предназначенный для 3D-печати временных коронок и мостовидных конструкций длительного ношения. В рамках экспериментальной части работы разработаны и изготовлены модели для проведения серии сравнительных тестов на сжатие. Проведено сравнение двух современных технологий производства: фрезерования из готовых заводских блоков (CAD/CAM) и 3D-печати. Испытания показали, что конструкции, изготовленные из материала HUGE PMMA Monolayer по технологии CAD/CAM, обладают более высокой механической прочностью по сравнению с коронками из материала HARZ Labs «Dental Sand Pro», изготовленными методом 3D-печати. Разрушающая нагрузка у фрезерованных образцов из HUGE PMMA в 2—4 раза выше. Модельные коронки моляров также имели более высокие показатели у фрезерованных образцов. Мостовидные протезы, изготовленные методом фрезерования, выдерживали около 1600 Н, а изготовленные методом 3D-печати — около 500 Н (p<0,05). Временные конструкции, изготовленные методом фрезерования из готовых полимерных блоков, обладают достаточным запасом прочности для применения во всех зонах зубного ряда. В свою очередь конструкции, выполненные методом 3D-печати, ввиду их более низких прочностных показателей целесообразно использовать преимущественно в области фронтальных зубов и премоляров, где нагрузка существенно ниже.