Rapid Recovery Research Articles

Early Clinical Outcomes (ECO) in the Era of Rapid Recovery Total Joint Arthroplasty: A Comparative Evaluation of Three Bearing Surfaces

Early Clinical Outcomes (ECO) in the Era of Rapid Recovery Total Joint Arthroplasty: A Comparative Evaluation of Three Bearing Surfaces

Effect of 0.05% cyclosporine A eye drops on the healing process of corneal epithelial defects in rats

0.05% cyclosporine A eye drops is a kind of new medication for dry eye after corneal refractive surgeries. However, it is still unclear how this eye drops affect the healing process of corneal epithelial defects caused by operative procedures. In this vivo study, the effect of 0.05% cyclosporine A eye drops on the healing process of the corneal epithelium was assessed in a rat model featuring mechanically induced central corneal epithelial defects. These Sprague-Dawley rats were randomly divided into three groups, the 0.05% cyclosporine A eye drops group (CsA group), the 0.1% sodium hyaluronate eye drops group (HA group), and the model control group (MC group). The epithelial healing, tear secretion, epithelial microvilli, expression of apoptosis markers (TUNEL, p53, and bcl-2 proteins), inflammatory factors (IL-1β, TNF-α, and IL-6), and epidermal growth factor (EGF) were detected in the current study using corneal fluorescein sodium staining, phenol red thread test, transmission electron microscopy (TEM), immunofluorescence, and enzyme-linked immunosorbent assay (ELISA), respectively. Compared to the other two groups, lower expression of apoptosis markers and inflammatory factors were exhibited in the CsA group, along with its faster and better epithelial healing and higher tear secretion (P<0.05). In conclusion, 0.05% cyclosporine A eye drops effectively promote the healing process for corneal epithelial defects in rats, potentially offering advantages for rapid corneal recovery after refractive surgical procedures.

Rapid bioproductivity recovery following the Marinoan glaciation: Evidence from Sr-Cr-Cd isotopes and trace elements in the Morraria do Sul cap dolostone, Brazil

Rapid bioproductivity recovery following the Marinoan glaciation: Evidence from Sr-Cr-Cd isotopes and trace elements in the Morraria do Sul cap dolostone, Brazil

Amalgamation of electrocoagulation-flotation and membrane technology: Rapid and efficient microalgal biomass recovery and fouling mitigation

Amalgamation of electrocoagulation-flotation and membrane technology: Rapid and efficient microalgal biomass recovery and fouling mitigation

An optimized non-opioid multimodal analgesia regimen to promote rapid recovery of patients undergoing primary total hip arthroplasty: a randomized controlled trial

An optimized non-opioid multimodal analgesia regimen to promote rapid recovery of patients undergoing primary total hip arthroplasty: a randomized controlled trial

Integrating physiological, metabolome and transcriptome revealed the response of maize seeds to combined cold and high soil moisture stresses.

Combined cold and high moisture stress (CHS) is a prevalent abiotic stress during maize sowing in northeast China, severely affecting the growth of seedlings and seed germination. However, the mechanism underlying seed growth responses to CHS remains unclear. We used Jidan441 (JD441, CHS-resistant) and Jidan558 (JD558, CHS-sensitive) as experimental materials. Treatments of 5-day cold (4°C, CS), high moisture (25%, gravimetric water content, HH), and CHS were initiated at sowing, followed by a return to normal growth conditions (20°C during light/ 15°C during dark, 15%) at 7 days after sowing (DAS). CS, HH, and CHS decreased seed root length and surface area. The reduction in root length and surface area in JD441 due to CHS was less severe than in JD558. We found that the difference between CHS and control in JD441was less than that in JD558 at transcriptional and metabolic levels at 7 DAS. After CHS removal, JD441 exhibited a greater increase in α-amylase activity and antioxidant content than JD558, which facilitated starch decomposition and the rapid removal of O2 - and H2O2 in seeds. The rapid recovery of soluble sugar and soluble protein in JD441 helped maintain osmotic balance. Amino acids and genes related to amino acid metabolism were upregulated in response to combined stress in JD441, whereas they were downregulated in JD558. In conclusion, the stress tolerance of JD441 was attributed to its efficient recovery ability from CHS. This study provides a scientific foundation for exploring seed stress tolerance pathways and developing cold and high-moisture-tolerant hybrids.

P-1489. Shaken Not Stirred: Novel Antibiotic Cocktails to Combat Pan-Drug Resistant Klebsiella pneumoniae

Abstract Background K. pneumoniae producing Metallo-Beta-Lactamases (MBL) confers resistance to a large spectrum of beta-lactam antibiotics which is a cause for significant concern. Novel combinatorial therapies can be an effective option for treating MBL Gram-negatives. The present study assessed the synergistic potential of Polymyxin B combinatorial strategies to combat the rising tide of PDR Gram-negative strains which have emerged worldwide. Methods K. pneumoniae producing blaNDM-5, blaCTX-M-55 and mcr-1 was exposed to an array of therapeutic regimens in a Hollow Fiber Infection Model (HFIM) over 9 days. These regimen arms included Polymyxin B (fCss = 4 mg/L), Aztreonam (fCss = 21 mg/L) + Avibactam (fCss = 5.5 mg/L), Aztreonam (fCss = 21 mg/L) + Avibactam (fCss = 5.5 mg/L) + Polymyxin B (fCss = 4 mg/L). Bacterial plate counts were taken throughout the experiment. Samples were also fixed and imaged under a Scanning Electron Microscope. Results Closely mirroring the growth control, Polymyxin B monotherapy did not inhibit the growth of K. pneumoniae S200. The clinical combination of aztreonam + avibactam demonstrated initial bactericidal activity with 6 log fold reduction (total count 1.6 log10 CFU/mL) over 24h followed by rapid recovery as the counts bounced back to 6.07 log10 CFU/mL by 48h. Reversion experiments demonstrated complete regrowth to 9.53 log10 CFU/mL by the 216h time point. In contrast, the addition of polymyxin B to the β-lactam/β-lactamase inhibitor combination resulted in prolonged marked bactericidal activity with 6.05 log fold reduction within 24h and eventually below the detectable limits over 168h.This was supported by tracking the evolution of salient phenotypic alterations using SEMs over 216h that showed filamentation in response to aztreonam containing regimens and lack of viable cells as well as overwhelming presence of cellular debris in Polymyxin B combination arm at 24 and 168h. Conclusion The results of the present study suggest that despite the intrinsic mcr-1 and blaNDM-5 resistance mechanisms our novel antibiotic cocktails show significant promise. Novel therapeutic options that enhance combinatorial pharmacodynamics are necessary to combat the urgent threat of MBL Gram-negative strains which are resistant to all antibiotics. Disclosures All Authors: No reported disclosures

G-CSF-primed bone marrow transplantation experience in 350 matched sibling donor grafts for Severe Thalassemia.

For matched related hematopoietic cell donor transplantation (HCT) for non-malignant diseases most centres prefer bone marrow (BM) over peripheral stem cell (PBSC) grafts due to increased risk of chronic GVHD associated with the latter. BM generally entails delayed neutrophil and platelet recovery compared to PBSC transplants. G-CSF-primed bone marrow (G-BM) has been associated with faster hematological recovery while retaining a decreased risk of GVHD. Moreover, it may allow for reduced marrow collection volumes. We retrospectively analysed our experience with G-BM as graft source from July 2015 to February 2023 across 350 consecutive first matched sibling transplants in children with severe thalassemia in four centres in India. We observed that G-BM is associated with rapid hematological recovery with relatively low rates of CMV reactivation (16%), low rates of moderate to severe GVHD (grade 3-4 acute GVHD was 5% and moderate to severe chronic GVHD was 3%), reduced marrow collection volumes (12.5 ml/Kg of donor's weight), and thus is potentially safer for both donors and recipients compared with standard bone marrow. This observation was made in a relatively homogenous cohort of multiply transfused patients with thalassemia who are at high risk of rejection. None of the donors required third-party blood transfusion irrespective of donor-recipient weight discrepancy. Our experience suggests that G-BM is associated with prompt engraftment and very low rates of moderate or severe GVHD. It also appears to be safe for donors and decrease the risk for third-party red cell transfusions. Finally, its relatively easy and inexpensive to collect. G-BM should be strongly considered as a preferable graft source in matched-related donor transplantations for thalassemia and potentially other transplant indications.

Catheter-directed thrombolysis of massive pulmonary embolism in high risk bleeding patients (local experience in kenya, single centre study)

Abstract Background Pulmonary Embolism (PE) is the third most common cause of death after myocardial infarction (MI), and cerebrovascular accidents (CVA) (1). For patients who are at risk of major bleeding such as advanced age, recent operation or delivery or major trauma, strategies to minimise bleeding risk should be considered, including catheter directed thrombolysis therapy (2) in reduced dose. Death from massive PE often occurs within the first two hours, and the risk remains elevated for up to 72 hours after presentation (3,4). Thirty-day survival following the diagnosis of a PE is only estimated to be 59.1%, and despite advances in medical care, in-hospital mortality from acute PE has remained stable over the past decade (5). Catheter directed thrombolysis (CDT) is a novel treatment option for massive/sub massive pulmonary embolism as systemic thrombolysis for acute PE carries up to 20% risk of major bleeding, including 2-5% risk of hemorrhagic stroke (6). Purpose To determine the clinical outcomes of catheter directed thrombolysis in patients with massive/ sub massive pulmonary embolism. Methods We conducted a retrospective quantitative study of 15 patients who presented with massive pulmonary embolism. A systematic random sampling was done to select the patients at advanced age, recent operation or first 2 weeks post labour with high bleeding risk, clinical data was recorded. All patients were taken to Cath lab with right heart catheterization, RA, RV and PA pressure were measured. Swan-Ganz catheter were placed in the main pulmonary trunk in case of bilateral PE, or sub-selective in the culprit branch. Alteplase infusion was given for 24-72 hours until proof for significant lysis of the clot. Clinical success defined as: 1. Stabilization of hemodynamics 2. Improvement in pulmonary systolic pressures, D-Dimer, TAPSE, RV/LV ratio and repeat CT findings 3. Survival to hospital discharge 4. Improvement in 30-day morbidity and mortality. Results There were no death on the trial group at discharge or at 30 days follow up. There were significant improvement of RV size and function elucidated by improvement of RV/LV ratio which were reduced from 1.06±0.18 to 0.89±0.2, TAPSE increased from 14.07±1.6 to 17.6±2.2, p &amp;lt; 0.01. There was significant drop in systolic pulmonary pressure(sPA) 67±14.5 mmHg to 38±14.5mmHg, p&amp;lt;0.001. The improvement of RV function and reduced sPA pressure were associated with increase in D-Dimer by at least 35% post thrombolysis, p&amp;lt;0.001. Conclusion Catheter directed thrombolysis (CDT) improves clinical outcomes in patients with acute pulmonary embolism with minimal risk of minor bleeding, and rapid recovery of right ventricular dysfunction. There were no major bleeding or death noticed in the treatment group and at one month follow up. In experienced centres, CDT is a safe and an effective treatment for both massive and/ or submassive PE. Echocardiography findings before CDT Echocardiography findings after CDT

Congenital scoliosis presenting in teenage years outcomes without hemivertebra excision.

In congenital scoliosis, the surgical strategy approach of hemivertebra excision, with or without instrumentation and fusion, is a common approach to correction of scoliosis. However, hemivertebra excisions are technically challenging, with potential complications including spinal cord injury, nerve root injury and cerebrospinal fluid leak. The purpose of this study was to determine whether correction of congenital scoliosis can be achieved using a posterior instrumentation/fusion-only approach without the need for hemivertebra excision. 35 patients with congenital scoliosis and hemivertebra operated between 2007 and 2024 were matched to 35 AIS patients by BMI, levels fused, and preoperative Cobb. Wilcoxonrank-sum tests, chi-square tests, and Fisher's Exact tests were utilized. Age (p = 0.22), BMI (p = 0.25) and preoperative Cobb (p = 0.79) were similar between hemivertebra and AIS patients. Cobb correction (HV: 71.8% vs. AIS: 70.4%; p = 0.92) and EBL (500cc vs. 400cc; p = 1.0) were similar. Operative time (310.0min vs. 242.0min; p < 0.001) and length of stay (7.0days vs. 5.0days; p < 0.001) were statistically different. Patients operated on after 2018, when the Rapid Recovery Protocol was implemented, had a similar length of stay (4.5 vs. 5.0; p = 0.92). Patients in both cohorts had similar SRS-22 scores. Choosing fusion levels in congenital patients, on similar principles to AIS, leads to avoidance of hemivertebra excision, including lumbosacral hemivertebrae. This approach is safer than hemivertebra excision and has similar, or better, curve correction than previously reported.

Effective management of multiple pilonidal sinuses using the sinus laser closure technique: a case report

Pilonidal sinus disease (PSD) is a prevalent condition that significantly affects young adults, particularly males. Despite the variety of treatment options proposed for managing this condition, a definitive gold standard has yet to be established. This case report details the management of multiple pilonidal sinuses in a 22-year-old male using the sinus laser closure (SiLaC) technique, a minimally invasive surgical approach. The patient presented with pain, discharge, and multiple sinus openings in the natal cleft, which had persisted for six months. Imaging studies confirmed the presence of multiple fluid-filled sinus tracts without abscess formation. The SiLaC procedure successfully obliterated the sinus tracts, resulting in rapid recovery and minimal postoperative complications. his case highlights the effectiveness of SiLaC in treating complex pilonidal disease and underscores its potential as a preferred treatment modality in similar cases. Future recommendations include larger studies to further validate these findings and explore long-term outcomes.

Mechanisms Involved in Cell Wall Remodeling in Etiolated Rice Shoots Grown Under Osmotic Stress

Osmotic stress impacts the cell wall properties in plants. This study aimed to elucidate the mechanisms involved in cell wall remodeling in etiolated (dark-grown) rice (Oryza sativa L.) shoots grown under polyethylene glycol (PEG)-induced osmotic stress conditions. Shoot growth was inhibited by 70% by the treatment with 60 mM PEG for 2 days. However, when the stressed seedlings were transferred to a solution without PEG, their shoot growth rate increased significantly. A measurement of the cell wall mechanical properties revealed that the cell walls of the stressed shoots became looser and more extensible than those of unstressed shoots. Among the cell wall constituents, the amounts of cellwall-bound phenolic acids, such as ferulic acid (FA), p-coumaric acid (p-CA), and diferulic acid (DFA), per shoot and per unit of matrix polysaccharide content were significantly reduced in the stressed shoots compared to those in the unstressed shoots. Concerning the formation of cellwall-bound phenolic acids, the activity of cellwall-bound peroxidase (CW-PRX) per unit of cell wall content, which is responsible for the coupling reaction of FA to produce DFA, was 3.5 times higher in stressed shoots than in unstressed shoots, while the activity was reduced by 20% on a shoot basis in stressed shoots compared to that in unstressed shoots. The expression levels of the major class III peroxidase genes in stressed shoots were either comparable to or slightly lower than those in unstressed shoots. Conversely, the phenylalanine ammonia-lyase (PAL) activity, which contributes to the biosynthesis of FA and p-CA, was reduced by 55% and 30% on a shoot and unit-of-protein-content basis, respectively, in stressed shoots compared to that in unstressed shoots. The expression levels of abundantly expressed PAL genes decreased by 14–46% under osmotic stress. Moreover, the gene expression levels of specific BAHD acyltransferases, which are responsible for the addition of FA and p-CA to form ester-linked moieties on cell wall constituents, decreased by 15–33% under osmotic stress. These results suggest that the downregulation of the expression of specific PAL and BAHD acyltransferase genes in osmotically stressed rice shoots is responsible for a reduction in the formation of cellwall-bound phenolic acid monomers. This, in turn, may result in a decrease in the levels of DFAs. The reduction in the formation of DFA-mediated cross-linking structures within the cell wall may contribute to an increase in the mechanical extensibility of the cell wall. The remodeling of cell walls in an extensible and loosened state could assist in maintaining the growth capacity of etiolated rice shoots grown under osmotic stress and contribute to rapid growth recovery following the alleviation of osmotic stress.

Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis

BackgroundPatients with duchenne muscular dystrophy (DMD) have an increased risk of complications when they undergo sedation or general anesthesia. However, due to improvements in cardiopulmonary therapies during anesthetic care, patients with DMD are experiencing an unprecedented duration of survival. We performed a systematic analysis to assess the benefits and risks of pharmacological interventions for the management of anesthesia and sedation in DMD patients.MethodsWe included any type of study reporting any drug intervention to manage anesthesia and sedation in participants previously diagnosed with DMD. Our primary outcomes were the onset time, recovery time, and neurodevelopmental disabilities. Seven electronic databases and three clinical trial registry platforms were searched. Data from the eligible studies were combined to calculate pooled risk ratios or standardized mean differences, and some included studies are presented in a narrative synthesis.ResultsForty studies with 196 DMD participants were included in the analysis. Compared with those of the control group, the sensitivity of patients with DMD to neuromuscular blocking agents (NMBAs) may have resulted in a prolonged onset time [MD = −0.96, 95% CI (0.71, 2.60), I2 = 33%, P &amp;lt; 0.0001] and recovery time [MD = 2.22, 95% CI (1.14, 3.30), I2 = 76%, P &amp;lt; 0.0001] from anesthesia. The neuromuscular blocking effects showed a significant age dependence in DMD patients, and the safe use of 2 mg/kg sugammadex to antagonize deep neuromuscular blockade and rapid recovery has been reported. Furthermore, DMD patients are at risk of developing malignant hyperpyrexia with general/inhaled anesthesia, and dantrolene is often used for effective rescue. In addition, general anesthesia and central neuraxial blockade in patients with severe DMD are unsafe because respiratory depression and myocardial complications may occur after the administration of volatile anesthetics and depolarizing muscle relaxants (succinylcholine) during the induction of anesthesia.ConclusionsPatients with DMD are more sensitive to NMBAs with delayed onset times and prolonged recovery times. Precautions for DMD patients should include quantitative neuromuscular monitoring, electrocardiographic monitoring and rapid airway protection throughout anesthesia. Compared with general anesthesia, regional anesthesia may be a relatively safe option.

Flexible Room‐Temperature Ammonia Sensor Using Multi‐Heterojunction MoO3/CuO/Cu2O Nanoclusters for Noninvasive Kidney Disease Diagnosis

In this study, a flexible room‐temperature ammonia (NH3) sensor is developed based on MoO3/CuO/Cu2O hybrid nanoclusters (HNCs), specifically designed for the noninvasive diagnosis of nephropathy. The MoO3/CuO/Cu2O HNCs achieve an ultralow detection limit of 0.73 ppm, with high sensitivity (0.163 ppm−1) and rapid response and recovery times (16.4 and 90.6 s). The integration of MoO3 (n‐type) with CuO and Cu2O (p‐type) forms multi‐heterojunctions, enhancing gas‐sensing performance through efficient charge separation and improved NH3 adsorption. Additionally, the sensor demonstrates excellent mechanical flexibility and long‐term stability under dynamic deformation. To address humidity interference in exhaled breath analysis, the sensor with a hydrophobic polytetrafluoroethylene layer is coated via radio frequency sputtering, ensuring effective NH3 detection and differentiation between healthy individuals and kidney disease patients. In this work, the potential of multi‐heterojunction nanostructures in developing high‐performance, flexible gas sensors for practical health‐monitoring applications is highlighted.

Optimization of Two Methods for the Rapid and Effective Extraction of Quinine from Cinchona officinalis

This study successfully optimized two advanced extraction methods, microwave-assisted extraction (MAE) and ultrasound-assisted extraction (UAE), for the efficient and rapid recovery of quinine from Cinchona officinalis. Among the evaluated parts of the plant, the bark consistently yielded the highest quinine concentration, highlighting its significance as the primary source for alkaloid extraction. The optimized conditions for MAE (65% ethanol, 130 °C, 34 min) achieved a maximum yield of 3.93 ± 0.11 mg/g, while UAE (61% ethanol, 25 °C, 15 min) provided a faster but slightly lower yield of 2.81 ± 0.04 mg/g. These findings confirm the superiority of MAE and UAE over conventional methods like Soxhlet extraction in terms of time efficiency and sustainability. The quantification of quinine using high-performance liquid chromatography (HPLC) coupled with advanced detection methods further validated the reliability and reproducibility of the results. While this study focused on optimizing extraction and quantification parameters, it sets the groundwork for future research into the sustainable utilization and potential valorization of C. officinalis byproducts. These findings not only provide a standardized protocol for extracting quinine but also contribute to the broader application of green chemistry principles in pharmaceutical production.

Estimation of Short-Term Vegetation Recovery in Post-Fire Siberian Dwarf Pine (Pinus pumila) Shrublands Based on Sentinel-2 Data

The frequency of wildfires ignited by lightning is increasing due to global climate change. Since the forest ecological recovery is influenced by numerous factors, the process of post-fire vegetation recovery in Siberian dwarf pine shrublands remains unclear and demands in-depth study. This paper explored the short-term recovery process of vegetation after two lightning-ignited fires in the Great Xing’an Mountains that occurred in 2017 and 2020, respectively. The study was aimed at presenting a monitoring approach for estimating the post-fire vegetation state and assessing the influence of various driving factors on vegetation recovery. Spectral indices were computed to evaluate forest vegetation recovery dynamics. The differences in vegetation recovery under various fire severity and topography conditions were also examined. Correlation analysis was employed to assess the influence of moisture content on the recovery of fire sites. The results show that fire severity, topographic features, and moisture content significantly impacted the rate of vegetation recovery. Specifically, regeneration takes place more rapidly on warm, high-altitude, and gentle slopes within highly and moderately burned areas. Additionally, areas marked by high moisture content demonstrate rapid recovery. Our study enriches the research cases of global wildfires and vegetation recovery and provides a scientific basis for forest management and the restoration of post-fire ecosystems.

Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study.

This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP). In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study. Hysteroscopic pregnancy tissue removal in patients with typeI CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with typeII-III CSP, the operation success rate (96.97% for typeII and 88.46% for typeIII) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with typeIII CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1mm away from the uterine plasma membrane layer. Hysteroscopic surgery without pretreatment can be adopted for patients with typeI CSP. In contrast, patients with typeII and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery. Clinical Trial Registry Number ChiCTR2000040357.

Pan-neurofascin autoimmune nodoparanodopathy: A case report and literature review.

Locked-in syndrome (and its variant, completely locked-in state) generally has a high mortality rate in the acute setting; however, when induced by conditions such as acute inflammatory polyradiculoneuropathy, it may well be curable such that an attempt at cure should be systematically sought by clinicians. A 52-year-old man presented with acute tetraparesia and areflexia, initially diagnosed as Guillain-Barré syndrome. Despite appropriate treatment, his condition deteriorated, evolving into a completely locked-in state. The detection of anti-pan-neurofascin antibodies led to the correct diagnosis, acute pan-neurofascin autoimmune nodoparanodopathy. Immunosuppressive treatment (rituximab) and plasma exchanges were performed. After several months, the patient's neurological symptoms almost completely subsided, without any major sequelae. In patients with locked-in syndrome (or its variant), neurologists and intensive care physicians must be aware of, and look for, the main etiologies (including pan-neurofascin autoimmune nodoparanodopathy), to allow the prompt initiation of treatment and thus a rapid recovery for these ultimately curable conditions. Despite causing major disability, pan-neurofascin autoimmune nodoparanodopathy is curable if the appropriate treatment is given.

Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases

ObjectivesTo analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis.MethodsThe case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) and group B (non-dysphagia group) based on Bazaz scoring criteria. Baseline data and imaging parameters were collected: O-C2 angle, C2-7 angle, pharyngeal inlet angle (PIA), posterior occipital cervical angle (POCA), O-EA angle, Oc-Ax angle, Atlas-dens interval, C2-7 sagittal vertical axis (SVA), T1 slope, narrowest oropharyngeal airway space (nPAS), and thickness of the prevertebral soft tissue. Potential risk factors were identified via one-way intergroup comparisons and included in multivariable logistic regression analysis. Pearson or Spearman correlation analysis was performed to assess associations between dnPAS% and each parameter and inter-parameter correlations. Predictors were selected to plot receiver operating characteristic (ROC) curves for diagnostic evaluation. Prognosis was analyzed using the Kaplan-Meier method and curvilinear regression.ResultsDysphagia occurred in 17 of 43 patients (39.53%). By the final follow-up (≥ 12 months), 11 patients (25.58%) had residual symptoms. Baseline factors, including dyspnea (P = 0.028), operative segment (P = 0.021), operative time (P = 0.006), anesthesia time (P = 0.025), solitude (P = 0.019), and satisfaction (P < 0.001), differed significantly between groups. Imaging parameters dO-C2a (P < 0.001), dPOCA (P < 0.001), PoPIA (P = 0.036), dPIA (P < 0.001), dOc-Axa (P = 0.001), dC2-7 SVA (P = 0.040), PonPAS (P = 0.004), dnPAS (P = 0.005), and dnPAS% (P < 0.001) were also significantly different. Multivariable regression analysis identified dPIA (OR = 0.870, P = 0.008) as an independent protective factor. ROC analysis showed dPIA had good diagnostic value (AUC = 0.855) with a cutoff of -8°. Prognostic analysis indicated rapid recovery was possible by 3 months postoperatively, with full recovery achieved in ~ 30% of patients by 1 year, after which recovery plateaued.ConclusionPostoperative dysphagia after OCF appears to result from multiple factors involving both “static + dynamic” elements. dPIA is a reliable predictor, with patients having a dPIA >-8° being less likely to develop dysphagia. However, only ~ 30% of patients achieve full recovery.

Hybrid Modular Redundancy: Exploring Modular Redundancy Approaches in RISC-V Multi-core Computing Clusters for Reliable Processing in Space

Space Cyber-Physical Systems such as spacecraft and satellites strongly rely on the reliability of onboard computers to guarantee the success of their missions. Relying solely on radiation-hardened technologies is extremely expensive, and developing inflexible architectural and microarchitectural modifications to introduce modular redundancy within a system leads to significant area increase and performance degradation. To mitigate the overheads of traditional radiation hardening and modular redundancy approaches, we present a novel Hybrid Modular Redundancy approach, a redundancy scheme that features a cluster of RISC-V processors with a flexible on-demand dual-core and triple-core lockstep grouping of computing cores with runtime split-lock capabilities. Further, we propose two recovery approaches, software-based and hardware-based, trading off performance and area overhead. Running at 430 MHz, our fault-tolerant cluster achieves up to 1,160 MOPS on a matrix multiplication benchmark when configured in non-redundant mode and 617 and 414 MOPS in dual and triple mode, respectively. A software-based recovery in triple mode requires 363 clock cycles and occupies 0.612 mm 2 , representing a 1.3% area overhead over a non-redundant 12-core RISC-V cluster. As a high-performance alternative, a new hardware-based method provides rapid fault recovery in just 24 clock cycles and occupies 0.660 mm 2 , namely, ∼9.4% area overhead over the baseline non-redundant RISC-V cluster. The cluster is also enhanced with split-lock capabilities to enter one of the available redundant modes with minimum performance loss, allowing execution of a mission-critical portion of code when in independent mode, or a performance section when in a reliability mode, with &lt;400 clock cycles overhead for entry and exit. The proposed system is the first to integrate these functionalities on an open-source RISC-V-based compute device, enabling finely tunable reliability versus performance trade-offs.