Short Time Research Articles

MRGazer: decoding eye gaze points from functional magnetic resonance imaging in individual space

Objective. Eye-tracking research has proven valuable in understanding numerous cognitive functions. Recently, Freyet alprovided an exciting deep learning method for learning eye movements from functional magnetic resonance imaging (fMRI) data. It employed the multi-step co-registration of fMRI into the group template to obtain eyeball signal, and thus required additional templates and was time consuming. To resolve this issue, in this paper, we propose a framework named MRGazer for predicting eye gaze points from fMRI in individual space.Approach. The MRGazer consists of an eyeball extraction module and a residual network-based eye gaze prediction module. Compared to the previous method, the proposed framework skips the fMRI co-registration step, simplifies the processing protocol, and achieves end-to-end eye gaze regression.Main results. The proposed method achieved superior performance in eye fixation regression (Euclidean error, EE = 2.04°) than the co-registration-based method (EE = 2.89°), and delivered objective results within a shorter time (∼0.02 s volume-1) than prior method (∼0.3 s volume-1).Significance. The MRGazer is an efficient, simple, and accurate deep learning framework for predicting eye movement from fMRI data, and can be employed during fMRI scans in psychological and cognitive research. The code is available athttps://github.com/ustc-bmec/MRGazer.

Tympanic Cavity Packing in Tympanoplasty Type 1: A Meta-Analysis.

Packing of tympanic cavity is generally considered an essential step in myringoplasty. However, each packing material comes with one or another side effect. The objective of this meta-analysis was to compare the results of Type 1 myringoplasty with or without packing. Pubmed, Cochrane database, Embase, Google Scholar, and clinicaltrials.gov were searched using 'tympanoplasty or myringoplasty and packing' as the search query. All RCTs / quasi-RCTs comparing tympanoplasty Type 1 with packing (control) versus without packing (intervention) of tympanic cavity in the human population were included. For dichotomous and continuous outcomes, relative risks (RR) and mean differences (MD) were calculated with 95% confidence interval, respectively. Heterogeneity was assessed using I2 statistics. Publication bias was checked using funnel plot and Egger's test, if applicable. Quality of evidence was assessed for each outcome using GRADE approach. Eleven studies were deemed eligible. For graft uptake and functional success rate, RR of 1.01 and 1.05 were obtained, respectively, showing no significant differences between the intervention and control groups. At 1st and 3rd postoperative month, no-packing group showed 3.86 dB and 2.08 dB better air-bone gap (ABG) closure than the packing group, respectively. Also, intervention with no-packing was 9.28-minute shorter procedure. With RR 0.35, no-packing had significantly lesser postoperative aural fullness. Type 1 tympanoplasty performed with or without packing show comparable results in terms of graft uptake and functional success rate. However, if performed without packing, it takes shorter time, provides early hearing improvement and causes less aural fullness. Key Words: Tympanoplasty Type 1, Packing, Gelfoam, No-packing, Meta-analysis, Endoscopic myringoplasty.

Perioperative Outcomes and Reimbursement Patterns Associated with the Anterior Versus Posterior Approach for Treatment of Type 2 Odontoid Fractures, a NSQIP Analysis

To evaluate the short-term surgical outcomes and the reimbursement patterns, after treatment of Type 2 odontoid fractures using the anterior or posterior approach. The NSQIP database was queried for surgically treated patients with Type 2 odontoid fractures by the anterior or posterior approach between 2016 and 2020. Propensity score matching with the optimal approach was used to balance the cohorts. A total of 96 patients in the anterior and 352 patients in the posterior surgery group were included in the unmatched analysis. After propensity score matching 1:1, 96 anterior and 96 posterior cases were included in the matched analysis. Operative times were shorter in the anterior group (92.0 vs. 145.0 minutes, p<0.001). The need for intra- or postoperative transfusions was higher in the posterior group (15% vs. 2.1% ; p=0.002). However, there were no significant differences in complications between groups (p>0.05). Hospital stay was significantly longer in the posterior group (4.5 days vs. 3.0; p=0.049). Non-routine discharge was more frequent in the posterior group (55% vs. 40%, p=0.030). However, the rate of 30-day readmission, reoperation, and mortality did not differ between groups (p>0.05). Also, the work relative value units (WRVUs) were significantly higher in the anterior group (22.7 vs. 20.6, p<0.001), indicating higher reimbursement trends for this approach. In this matched analysis, the anterior approach for type 2 odontoid fractures was superior to the posterior approach. The anterior approach was associated with significantly shorter operation times, hospital stays, fewer transfusions, non-routine discharges, and higher reimbursements.

Improved corrosion resistance of hydroxyapatite-reinforced plasma electrolytic oxide coatings on AZ31 alloy from one-step and two-step fabrications

The improved corrosion resistance of AZ31 alloy by plasma electrolytic oxidation (PEO) counteracts its apatite-forming ability. To overcome the issue, apatite-containing coatings were fabricated. One-step and two-step fabrications were compared to incorporate the nanoparticle hydroxyapatite (HA) in the coating and to evaluate their effect on the corrosion resistance. The corrosion resistance was evaluated by polarization test and EIS measurement in 0.9% NaCl solution. The electron microscopy and chemical analysis revealed that the HA particles were dispersed in the one-step coatings, while an interspersed HA distribution was observed in the two-step coatings. The dispersed particles enhanced the coating’s hardness from 490 to 554 HV. In the two-step coatings, the HA particles mainly accumulated inside the pores, reducing the coating porosity down to 3.9%. The one-step coatings were more stable in the corrosive solution, offering a remarkably higher corrosion resistance, than the two-step coatings. Moreover, the one-step coating required a shorter (half) processing time (10 min) than the two-step process (20 min) to achieve a similar order of corrosion current density of 10−7 A cm−2. The results demonstrated that the arrangement of reinforcement in the PEO coatings and its effect on the corrosion resistance can be adjusted.

CBCT-based synthetic CT image generation using a diffusion model for CBCT-guided lung radiotherapy.

Although cone beam computed tomography (CBCT) has lower resolution compared to planning CTs (pCT), its lower dose, higher high-contrast resolution, and shorter scanning time support its widespread use in clinical applications, especially in ensuring accurate patient positioning during the image-guided radiation therapy (IGRT) process. While CBCT is critical to IGRT, CBCT image quality can be compromised by severe stripe and scattering artifacts. Tumor movement secondary to respiratory motion also decreases CBCT resolution. In order to improve the image quality of CBCT, we propose a Lung Diffusion Model (L-DM) framework. Our proposed algorithm is based on a conditional diffusion model trained on pCT and deformed CBCT (dCBCT) image pairs to synthesize lung CT images from dCBCT images and benefit CBCT-based radiotherapy. dCBCT images were used as the constraint for the L-DM. The image quality and Hounsfield unit (HU) values of the synthetic CTs (sCT) images generated by the proposed L-DM were compared to three selected mainstream generation models. We verified our model in both an institutional lung cancer dataset and a selected public dataset. Our L-DM showed significant improvement in the four metrics of mean absolute error (MAE), peak signal-to-noise ratio (PSNR), normalized cross-correlation (NCC), and structural similarity index measure (SSIM). In our institutional dataset, our proposed L-DM decreased the MAE from 101.47 to 37.87HU and increased the PSNR from 24.97 to 29.89 dB, the NCC from 0.81 to 0.97, and the SSIM from 0.80 to 0.93. In the public dataset, our proposed L-DM decreased the MAE from 173.65 to 58.95HU, while increasing the PSNR, NCC, and SSIM from 13.07 to 24.05 dB, 0.68 to 0.94, and 0.41 to 0.88, respectively. The proposed L-DM significantly improved sCT image quality compared to the pre-correction CBCT andthree mainstream generative models. Our model can benefit CBCT-based IGRT and other potential clinical applications as it increases the HU accuracy and decreases the artifacts from input CBCT images.

Does Sequential Thoracoscopic Sympathectomy Affect the Development of Postoperative Compensatory Sweating in Children?

BackgroundThe development of compensatory sweating (CS) following thoracoscopic sympathectomy (TS) for palmar hyperhidrosis (PH) is the major drawback of this procedure. Several techniques were proposed to minimize the occurrence of CS such as changing the level of sympathectomy or conducting it sequentially on both sides with an interval between the two procedures. The aim of this study is to compare sequential T3-T4 TS versus bilateral same-setting T3-T4 TS regarding the development and severity of postoperative compensatory sweating. MethodsThis comparative study included 38 patients (18 males and 20 females) with primary palmar hyperhidrosis between March 2020 and March 2023. Patient’s ages ranged between 5 to 18 years, and they were divided into two groups: group I included 23 patients treated with sequential T3-T4 TS; and group II included 15 patients who underwent bilateral same-setting T3-T4 TS. Both groups were compared with regard to patient characteristics, operative details, and postoperative outcomes. ResultsThere were no significant sex or age distribution differences among both groups. The mean cumulative operative time was significantly longer in group I (38 versus 27 min). There was no statistically significant difference in the rate of compensatory sweating between groups I and II (6/23 [26%] vs 5/15 [33%], respectively; p = 0.77). No over-dryness or recurrence occurred in any patient in either group. ConclusionSequential TS does not seem to have superior results when compared to bilateral same-setting TS regarding the development of compensatory sweating. Conducting bilateral same-setting TS is both safe and feasible with shorter operative time, hospital stay, and overall cost. Level of EvidenceIV

Application of machine learning technique for a fast forecast of aggregation kinetics in space-inhomogeneous systems

Modelling of aggregation processes in space-inhomogeneous systems is extremely numerically challenging since complicated aggregation equations, Smoluchowski equations, are to be solved at each space point along with the computation of particle propagation. Low rank approximation for the aggregation kernels can significantly speed up the solution of Smoluchowski equations, while the particle propagation could be done in parallel. Yet the numerics with many aggregate sizes remains quite resource-demanding. Here, we explore the way to reduce the amount of direct computations by replacing the actual numerical solution of the Smoluchowki equations with the respective density transformations learned with the application of one of machine learning (ML) methods, the conditional normalising flow. We demonstrate that the ML predictions for the space distribution of aggregates and their size distribution require drastically shorter computation time and agree fairly well with the results of direct numerical simulations. Such an opportunity of a quick forecast of space-dependent particle size distribution could be important in practice, especially for the fast (on the timescale of data reading) prediction and visualisation of pollution processes, providing a tool with a reasonable trade off between the prediction accuracy and the computational time.

Neuroendoscopic versus Craniotomy Approach in Supratentorial Hypertensive Intracerebral Hemorrhage: An Updated Meta-Analysis

Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuro-endoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compares the effectiveness of NES versus craniotomy in treating ICH. A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials (RCTs) or observational studies (OSs) with confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using Comprehensive Meta-Analysis. Twenty-six studies (n=3237 patients) were included in the analysis. NES was associated with significantly lower mortality compared to craniotomy (OR: 0.45, 95% CI 0.33 to 0.60, p < 0.00001). Hematoma evacuation rates were higher with NES (SDM: 1.505, 95% CI 0.835 to 2.160, p < 0.00001). NES also showed better functional outcomes (OR: 3.31, 95% CI 1.78 to 6.17, p = 0.0002) and reduced blood loss (SDM: -3.06, 95% CI -3.979 to -2.141, p = 0.000). Additionally, NES was associated with shorter hospital and ICU stays, shorter operative times, and fewer complications such as infection and rebleeding. NES emerges as a promising alternative to craniotomy for treating ICH, offering advantages in terms of mortality reduction, improved functional outcomes, and fewer complications. Future studies should explore advancements in neuro-endoscopic techniques to optimize patient outcomes further.

Extended applications of the small-scale radio frequency system for improving the heating performance of multi-component rice

With the changing lifestyles and the rapid development of the prepared food industry, there are many different multi-component rice-based foods on the market today. Further, manufacturers of multi-component foods prepare different types of rice products and provide them to markets and restaurants. In this study, the multi-component rice was heated by a self-built small 50 Ω, 13.56 MHz radio frequency (RF) heating system to explore the effective scheme for improving heating uniformity. The dielectric properties (DPs) of the single-component material (cooked rice, carrot, and sausage) were first measured and the heating rates were recorded at a selected input power level of 500 W and electrode gap of 80 mm. Based on the above results and the occurrence of edge effect, three types (I, II, and III) of the multi-component test samples were designed to compare the heating performances and the quality changes after RF treatment with three different electrode gaps (70, 80, and 90 mm). Results demonstrated that the Type-I sample arrangement resulted in a relatively shorter treatment time and a lower heating uniformity index as compared to the other two sample arrangements (Types of II and III). It also resulted in a more uniform temperature distribution and better-quality retention than that was possible with the single-component treatment. Thus, the layered scheme (Type-I) based on the DPs of the material could effectively improve the RF heating uniformity of multi-component food.

Adaptive cognitive tasks for mental fatigue: An innovative paradigm for cognitive loading in human performance

ObjectivesMental fatigue (MF) can impair cognitive and physical performance in sport. We tested the hypothesis that a shorter adaptive Time Load Dual Back (TLDB) task induces MF faster than a longer Stroop; and subsequently impairs cognitive and intermittent running performance. DesignThis study employed a randomized within-participant design. Methods25 trained individuals performed a Yo-Yo test after one of four experimental conditions (30-min Stroop, 20-min and 10-min TLDB tasks, and active control). Cognitive performance was assessed using the Psychomotor Vigilance Task (PVT) before and after the experimental conditions. Measures of mood, workload, MF, RPE, heart rate (HR), heart rate variability (HRV) and blood lactate were collected. ANOVAs determined the effect of the 4 conditions. ResultsStroop and 20-min TLDB conditions impaired running performance similarly (p = .015), while no differences are reported for 10-min TLDB and Control. No significant differences in physiological parameters were reported during the Yo-Yo test although RPE was significantly higher in the Stroop and 20-min TLDB conditions (p = .014). Stroop and both TLDBs conditions impaired PVT's cognitive performance (p = .029), MF (p = .012), mental demand (p < .001), HR (p = .021) and HRV (p = .033); with 20-min TLDB task having the higher significant impact. Mood alterations were similar between Stroop and TLDB conditions. ConclusionsIntermittent running (Yo-Yo) and cognitive (PVT) performances, and subjective ratings were impaired by 30-min Stroop and 20-min TLDB tasks; while 10-min TLDB did not to impair performance. Shorter adaptive modes seem to be more effective in inducing MF and could have relevant clinical applications to assess conditions such as traumatic brain injury and concussion.

Shorter observation times and smaller gauge needles in outpatient kidney biopsies.

Controversy exists as to the optimal observational time (OT) after outpatient percutaneous kidney biopsy. Further, there is some uncertainty about the benefit of smaller (18-gauge) vs. larger (16-gauge) biopsy needles. At our institution, we have been lowering the OT after outpatient kidney biopsies. Initially in 2015, we were monitoring for 6 hours and gradually began to decrease the OT over time. From 2020, we have adopted an OT of less than 4 hours. During this time period (in 2018), we also began using a smaller gauge needle (18 gauge). We reviewed all outpatient kidney biopsies performed by the nephrology division at our institution since 2015. There were 137 biopsies reviewed. 63 had OT of 4-6 hours, and 74 had OT &lt;4 hours. There was a total of 4 significant complications (2.9%). Two complications, symptomatic retroperitoneal bleeds, were detected in less than 3 hours. The other 2 complications were seen at 9 hours (clot retention) and 72 hours (retroperitoneal bleed after anticoagulation restarted). 63% of the biopsies were done using 18-gauge needles with 1 complication in this group vs. 3 in the 16-gauge group. All cases had adequate tissue for interpretation based on the ability to make a kidney diagnosis. The number of glomeruli obtained in the 18-gauge group was 29 ± 13 glomeruli, and in the 16-gauge group was 25 ± 10, which did not differ between groups. In summary, in an outpatient population, all significant post-biopsy complications were evident either within the first 3 hours or after 9 hours, and this suggests the feasibility of using shorter than standard OT in outpatient kidney biopsies. Furthermore, an 18-gauge needle may lower the risk of complications and obtain adequate tissue.

Impact of slit compared with nonslit mesh in laparoscopic groin hernia repairs—A comprehensive propensity score analysis of a cohort of 611 hernias

BackgroundThe slit-mesh technique for laparoscopic groin hernia repair remains controversial. We present the largest cohort of patients to date that have undergone laparoscopic hernia repair with this technique and aim to evaluate the impact of both techniques on postoperative recurrence and other secondary outcomes. MethodsA retrospective, single-institution cohort study of patients who underwent a laparoscopic groin hernia repair over a 5.5-year period was performed. Univariate and multivariate analyses were performed to identify factors associated with recurrence, chronic pain, complications, length of stay, and operative time. A propensity score analysis also was performed. Time to recurrence was then subsequently plotted on a Kaplan-Meier survival analysis. ResultsIn total, 611 laparoscopic groin hernia repairs (nonslit: n = 353; slit: n = 258) were reviewed. Mean follow-up duration was 6.6 months. On the multivariate analysis, body mass index was inversely correlated with recurrence (odds ratio, 0.792; 95% confidence interval, 0.656–0.956), whereas a slit mesh had lower recurrence (odds ratio, 0.228; 95% confidence interval, 0.064–0.809). In the propensity score–adjusted analysis, slit mesh remained significantly associated with reduced recurrence (adjusted odds ratio, 0.251; 95% confidence interval, 0.070–0.900), with no differences in chronic pain (adjusted odds ratio, 1.297; 95% confidence interval, 0.275–6.128) or postoperative complications (adjusted odds ratio, 1.808; 95% confidence interval, 0.429–7.620). Operative time also was reduced in the slit-mesh group (P = .009). ConclusionsThe slit-mesh technique was associated with a reduced likelihood of postoperative recurrence and shorter operative time, with no impact on postoperative chronic pain or complications. A lower body mass index was also correlated with increased likelihood of postoperative recurrence.

The application of a novel biomimetic enzyme p-BEs cascade catalytic platform for the rapid detection of glucose

The blood glucose concentration in aquatic organisms, a crucial indicator reflecting their health status, holds significant importance for detecting glucose levels in serum in terms of processing and quality monitoring. In this study, a novel POD biomimetic enzyme (p-BEs) with horseradish peroxidase catalytic properties was designed, optimized, and its mechanism was discussed in detail. Based on this, a portable system has been developed capable of determining glucose levels in three ways: quantitatively analyzed through UV–Vis/MD, quantitatively analyzed on-site using a mobile phone RGB, and semi-quantitatively analyzed through a drip plate. Meanwhile, compared with other catalytic methods for detecting glucose, we achieved a lower limit of detection (0.03 μM) and shorter detection time (12 min), with high catalytic activity. This study provides new insights into the design of efficient and reliable cascade catalytic systems responsive to glucose, offering a low-cost, simplicity of operation method for glucose detection.

MKELM based multi-classification model for foreign accent identification

The automatic identification of foreign accents can play a crucial role in various speech systems, including speaker identification, e-learning, telephone banking, and more. Additionally, it can greatly enhance the robustness of Automatic Speech Recognition (ASR) systems. Non-native accents in speech signals are characterized by distinct pronunciations, prosody, and voice characteristics of the speaker. However, automatically identifying foreign accents poses significant challenges, particularly in the context of multi-class modeling. Multi-classification models face difficulties in achieving high performance and dealing with computational challenges when confronted with multi-dimensional and unbalanced datasets, such as those with more than two accents. Furthermore, the choice of features remains a bottleneck problem for Foreign Accent Identification (FAID), further hindering performance in these tasks. Consequently, the accuracy of current systems is typically low. To address these challenges, this paper proposes a framework based on the Multi-Kernel Extreme Learning Machine (MKELM) model for the multi-classification of FAID. The MKELM model utilizes a novel weighted scheme to classify various non-native English accents, including Arabic, Chinese, Korean, French, and Spanish. The model first combines Mel-frequency cepstral coefficients (MFCCs) and prosodic features as input, trains pairwise binary classifiers independently, and subsequently employs a weighting scheme to distinguish between classes and identify accents. Through experiments, the proposed model achieves an accuracy rate of 84.72% using a paired weighting scheme. In contrast, the accuracy rate drops to 66.5% when employing the traditional non-weighted multi-classification scheme. A comparison with other models demonstrates the significant advantages of the proposed model in FAID multi-class classification, showcasing improved accuracy, reduced computational complexity (requiring fewer computations, faster learning rates, and shorter training time), and enhanced stability compared to state-of-the-art classification methods.

Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double-blinded randomized controlled trial.

Prior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient-reported outcomes, such as postoperative pain, which could influence surgical choice. To compare pain scores at 6 and 24h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula. Prospective, double-blinded randomized controlled trial. A quaternary hospital in Malaysia. Patients aged 18-75years with high transsphincteric fistulas. Fistula laser closure versus ligation of the fistula tract (LIFT) treatment. Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi-square, Fisher's exact test, student t-test, or Mann-Whitney with p<0.05 denoting statistical significance. Fifty-six patients were recruited (laser, n=28, LIFT, n=28). Median pain scores for laser versus LIFT at 6h postoperatively were 1.0 versus 2.0 (Rest, p=0.213) and 3.0 versus 4.0 (Movement, p=0.448), respectively. At 24h, this reduced to 2.5 in both arms at rest (p=0.842) but increased to 4.8 versus 3.5 on movement (p=0.383). Median operative time for laser was significantly shorter (32.5min) than LIFT (p<0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p=0.181) but treatment failure was similar (54% vs. 50%, p=0.71). No patients developed postoperative incontinence. Mean SF-36 scores increased from baseline (67.1±17.0; 95% CI 63.6-82.4 vs. 71.3±11.4; 95% CI 64.0-75.0) to 6months postoperatively (77.7±21.0; 95% CI 57.0-80.3 vs. 74.0±14.3; 95% CI 67.6-81.4) regardless of the type of surgery (P>0.05). Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy. Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL. ClinicalTrials.gov: NCT06212739.

Effect of microwave irradiation and conventional heating on high pressure modified white finger millet starch hydrogel properties

High pressure modified (200 MPa and 400 MPa for 10 min) white finger millet starch hydrogels were prepared with three starch concentrations (12 %, 15 % and 18 % (w/v)), by conventional heat treatment (75 °C for 12 min) and microwave treatment (50 s at 900 W, surface temperature 75 °C). The prepared hydrogels were compared to native white finger starch hydrogels for understanding the effect of modification as well as the gel synthesis method. Effect of the storage period on physical stability was evaluated for ten days by evaluating weight loss, water activity, and color. The whiteness index of the prepared hydrogel intensified during the storage period, and water activity was reduced (0.99–0.976). While stored at 4 °C, the hydrogel weight decreased due to moisture migration. The results emphasize that treatment conditions, starch modification, and concentration significantly affected water absorption. The maximum gel strength was identified for conventional heat-induced 400 MPa high-pressure modified hydrogel stored for ten days. 1H NMR relaxation time showed microwave-induced gel synthesis had a shorter relaxation time. The gel microstructure helped to correlate the swelling and gel strength increment in the modified gel sample, as it had a higher wall thickness and a smaller pore size than heat-induced hydrogels. These findings help to conclude high pressure modified white finger millet starch hydrogel synthesised by microwave irradiation can be alternative to conventional heat gelatinisation method.

A Novel Method of 3D Lyapunov Guidance Vector Field to Avoid Intercepting Satellite Based on Reinforcement Learning

This paper proposes a new 3D Lyapunov guidance vector field(3D-LGV) avoidance strategy based on reinforcement learning for the satellite evasion and interception problem. Combining it with the interfered fluid dynamical system (IFDS) enables the satellite to evade and smoothly enter orbit according to the state of the intercepting satellite in real time. 3D-LGV provides an initial flow field approaching an elliptical orbit, while IFDS provides a perturbed flow field based on the intercepting satellite position. The combined potential field of the initial flow field and the disturbed flow field is the planned velocity direction of the satellite. As a decision-making layer, the proximal policy optimization (PPO) dynamically adjusts the perturbed flow field in the IFDS to increase the avoidance success rate in different scenarios. The experimental results show that, compared with the particle swarm optimization with rolling horizon control algorithm, the algorithm proposed in this paper has a shorter decision time and a higher avoidance success rate. At the same time, Monte Carlo simulation shows that the evasion success rate of the proposed algorithm reaches 98%.

Periprosthetic Femoral Fractures-Beyond B2.

The proliferation of hip arthroplasty has seen concomitant increases in periprosthetic femoral fractures (PFFs). The most common pattern involves fracture at the level of a loose prosthesis (B2). B2 PFFs have a unique mechanopathogenesis linked to the tendency of polished taper-slip cemented stems to subside in the cement. Such stems carry a much higher PFF risk than other cemented designs. Mega-data, consistent across national registries, suggest that increasing application of the taper-slip principle has resulted in the emergence of highly polished, very low friction cemented prostheses. These have the propensity to migrate within the cement, increasing B2 PFF risk. This would explain the strong association between cobalt-chromium stems and PFF. Is PFF the mode of failure of polished taper-slip stems rather than aseptic loosening? Established wisdom teaches that B2 PFFs should be managed with revision surgery. There is a large body of new evidence that, in certain instances, fixation results in outcomes at least equivalent to revision arthroplasty, with shorter surgical time, decreased transfusion requirements, and lower dislocation risk. This is so in B2 PFFs around cemented polished taper-slip stems with an intact bone-cement interface. We outline advances in understanding of B2 PFF with special reference to mechanopathogenesis and indications for fixation.

Safety and Feasibility of Laparoscopic Anatomical Liver Resection for Hepatocellular Carcinoma: A Propensity Score-matched Study.

Laparoscopic anatomical liver resection (LAR) for hepatocellular carcinoma (HCC) is technically demanding. Therefore, this study aimed to compare the perioperative and long-term oncological outcomes of LAR and open anatomical liver resection (OAR) for HCC. We retrospectively analyzed 460 consecutive patients who underwent anatomical liver resection as the initial treatment for primary HCC between January 2010 and February 2024. Patients were categorized into the LAR and OAR groups, and surgical outcomes between the groups were compared using 1:1 propensity score matching (PSM). After PSM, the LAR and OAR groups included 100 patients each. The LAR group exhibited significantly less blood loss (80 vs. 436 ml; p<0.0001), lower transfusion rates (0% vs. 12%; p=0.0002), shorter operative time (345 vs. 398 min; p=0.0009), lower postoperative morbidity rates (6% vs. 34%; p<0.0001), and shorter postoperative hospital stay (8 vs. 15 days; p<0.0001) than the OAR group. The 1-, 3-, and 5-year overall survival rates were 97.7%, 96.2%, and 89.7%, respectively, in the LAR group and 98.0%, 92.7%, and 88.4%, respectively, in the OAR group (p=0.5874). The 1-, 3-, and 5-year recurrence-free survival rates were 93.2%, 75.7%, and 60.7%, respectively, in the LAR group and 86.0%, 64.5%, and 59.1%, respectively, in the OAR group (p=0.2314). LAR showed improvements in perioperative complications, reduced postoperative hospital stay, and comparable recurrence-free and overall survival rates with those of OAR. Therefore, LAR for HCC is considered safe, feasible, and oncologically acceptable in selected patients.

The significance of different intervertebral spaces in combined spinal epidural anesthesia in cesarean section.

The number of cesarean sections performed is increasing every year, and obstetric anesthesia is of great interest to physicians and research scholars because of its specificity, high risk, and high complication rate. To investigate the effects of combined spinal epidural anesthesia (CSEA) with different intervertebral spaces during cesarean section on anesthesia effect, anesthesia onset time, anesthesia recovery time, maternal adverse reactions, and neonates. Ninety-two women who underwent cesarean section in our hospital from September 2022 to February 2023 were selected as the study subjects and randomly divided them into two groups (group A and group B), 46 women in each group. Group A underwent CSEA via an L2-3 gap and group B underwent CSEA via an L3-4 gap puncture. The anesthesia effect, anesthesia onset time, sensory recovery time, adverse effects, and neonatal Apgar score were compared between the two groups. When CSEA was performed from L2-3, the anesthesia efficiency was higher, but the difference was not statistically significant. When anesthesia was performed by puncture from L2-3, the onset of anesthesia and recovery time was shorter, and the incidence of intraoperative maternal nausea and vomiting, hypotension, respiratory depression, and other adverse reactions was low with a statistically significant difference. However, the Apgar scores of the neonates in the two groups have no difference. When CSEA is induced via L2-3 interspace, anesthesia has a rapid onset of action, shorter recovery time, and few maternal adverse effects, without affecting the final anesthetic outcome.