Search Results (5,702)

Background and Objectives: The selection of the optimal distal level of fusion in long-level fusion surgery remains controversial. Fusion ending at L5 preserves motion but increases the risk of L5–S1 disc degeneration. The L5 laminar hook has been introduced to enhance distal fixation, but its indications and clinical effects remain unclear. This study aimed to investigate the indication of the L5 laminar hook and its effect on adjacent segment degeneration when performing long-level fusion terminating at L5 in patients with degenerative sagittal imbalance (DSI). Materials and Methods: 112 patients with DSI who had undergone corrective surgery and ended at L5 were analyzed retrospectively. Finally, 64 were treated with an L5 laminar hook (Group I), while 48 were not (Group II). We compared radiographic spinopelvic parameters between the two groups and followed up disc degeneration at the L5–S1 level. Additional analysis was conducted within Group I to determine the indications for L5 laminar hook. Results: Preoperative C7 sagittal vertical axis (C7SVA), lumbar lordosis (LL), and pelvic incidence (PI)-LL mismatch were significantly greater in Group I than in Group II (p < 0.05). At 2 years of follow-up, advanced L5–S1 disc degeneration had developed in 14 patients (21.9%) in Group I and 36 patients (75%) in Group II. Patients in Group B (exacerbated L5–S1) had a significantly higher body mass index (BMI), larger preoperative C7SVA, and PI-LL mismatch than patients in Group A (preserved L5–S1). The C7SVA and PI-LL mismatch cut-off values for Group A were 15.8 cm and 40.8°, respectively. Conclusions: L5 laminar hook helps to reduce disc degeneration at the L5–S1 level and can be used to maintain the deformity correction ending at L5 in patients with DSI. We propose a series of indicators for the use of L5 laminar hooks in patients with DSI: a low BMI, a PI-LL mismatch < 40.8°, and a C7SVA < 15.8 cm. Full article

Fly ash from coal-fired power plants is a promising precursor for zeolite synthesis due to its aluminosilicate-rich composition. However, its direct utilization is often limited by impurities and a low silicon-to-aluminum ratio (SAR). This study demonstrates the conversion of Class C fly ash from the Soma thermal power plant (Turkey) into FAU- and CHA-type zeolites through optimized acid leaching and hydrothermal synthesis. Acid treatment increased the SAR from 1.33 to 2.85 and effectively reduced calcium-, sulfur-, and iron-bearing impurities. The SAR enhancement by acid leaching was found to be reproducible among Class C fly ashes, whereas Class F materials exhibited a limited response due to their acid-resistant framework. Subsequent optimization of alkaline fusion-assisted synthesis enabled selective crystallization of FAU and CHA, while GIS and MER appeared under prolonged crystallization or higher alkalinity. SEM revealed distinct morphologies, with MER forming rod-shaped clusters, and CHA exhibiting disc-like aggregates. Water sorption analysis showed superior uptake for metastable FAU (~23 wt%) and CHA (~18 wt%) compared to stable GIS and MER (~12–13 wt%). Overall, this study establishes a scalable and sustainable route for producing high-performance zeolites from industrial fly ash waste, offering significant potential for adsorption-based applications in dehumidification, heat pumps, and gas separation. Full article

Rupture discs are critical safety devices for pressure vessels, yet defining replacement intervals for discs that have not ruptured remains challenging due to limited quantitative life-prediction methods. This study investigates forward-acting rupture discs made of 316 L stainless steel and Inconel 600 under three test conditions: low pressure at room temperature, low pressure at elevated temperature, and ultra-high pressure at elevated temperature. Static hold life and fatigue life were measured over a range of operating ratios R = P_w/P_b. To model life–ratio relationships while avoiding far-reaching extrapolation, static life was fitted with a log-normal accelerated-life (AFT) model and fatigue life with a Basquin relation following ASTM E739, reporting 95% prediction bands. Predictions were restricted to validated domains (static: R ≥ 0.86) and truncated at five times the groupwise maximum observed life/cycles. Results show a consistent trend for both materials and all conditions: life decreases as R increases, with steep sensitivities within the observed range. At matched R, Inconel 600 generally exhibits longer life than 316 L. Qualitative failure analysis under constant and cyclic loading indicates progressive plastic deformation, local thinning, and a concomitant reduction in bursting pressure until failure. The proposed in-range predictive framework provides actionable guidance for determining conservative replacement intervals for rupture discs. Full article

Background/Objectives: Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for large, centrally located calcified discs. Methods: We performed a narrative review of the literature and retrospective case series of seven patients who underwent transpedicular–transdural thoracic discectomy for central or centrolateral calcified disc herniations at our institution in recent years. All patients were followed clinically for a minimum of three months postoperatively. Surgical technique and intraoperative nuances were also documented. Results: The transdural approach enabled direct access to the ventral thoracic spine, allowing for the effective decompression of calcified herniations in all cases. Six out of seven patients (86%) demonstrated clinical improvement or neurological stability at three-month follow-up, while one out of seven patients (14%) who presented with severe preoperative neurological deficits had persisting neurological deterioration postoperatively. The technical aspects of the microsurgical approach were critical to minimizing risk. Conclusions: The transpedicular–transdural approach is a viable and effective surgical option for select cases of central or centrolateral calcified thoracic disc herniation. When executed with a precise microsurgical technique, it offers safe decompression with favourable short-term outcomes. Full article

Background/Objectives: Diabetic retinopathy (DR) segmentation faces critical challenges from domain shift and false positives caused by heterogeneous retinal backgrounds. Recent transformer-based studies have shown that existing approaches do not comprehensively integrate the anatomical context, particularly training datasets combining blood vessels with DR lesions. Methods: These limitations were addressed by deploying a DeepLabV3+ framework enhanced with more comprehensive anatomical contexts, rather than more complex architectures. The approach produced the first training dataset that systematically integrates DR lesions with complete retinal anatomical structures (optic disc, fovea, blood vessels, retinal boundaries) as contextual background classes. An innovative illumination-based data augmentation simulated diverse camera characteristics using color constancy principles. Two-stage training (cross-entropy and Tversky loss) managed class imbalance effectively. Results: An extensive evaluation of the IDRiD, DDR, and TJDR datasets demonstrated significant improvements. The model achieved competitive performances (AUC-PR: 0.7715, IoU: 0.6651, F1: 0.7930) compared with state-of-the-art methods, including transformer approaches, while showing promising generalization on some unseen datasets, though performance varied across different domains. False-positive returns were reduced through anatomical context awareness. Conclusions: The framework demonstrates that comprehensive anatomical context integration is more critical than architectural complexity for DR segmentation. By combining systematic anatomical annotation with effective data augmentation, conventional network performances can be improved while maintaining computational efficiency and clinical interpretability, establishing a new paradigm for medical image segmentation. Full article

Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications. Full article

The global rise of antimicrobial resistance represents a critical challenge to public health, with Escherichia coli emerging as one of the most significant contributors due to its high adaptability and prevalence of extended-spectrum β-lactamase (ESBL) production. Outer membrane vesicles (OMVs), nanoscale structures released by Gram-negative bacteria, have recently been implicated in the dissemination of resistance determinants and direct antibiotic inactivation. This study investigated the role of OMVs derived from ESBL-producing E. coli in mediating resistance to ampicillin. Clinical strains harboring CTX-M-15 resistance genes were cultured under selective pressure, and OMVs were purified via size-exclusion chromatography. Characterization using tunable resistive pulse sensing (TRPS) and cryo-transmission electron microscopy confirmed vesicle integrity, with sizes ranging from 80 to 150 nm. DNA quantification and PCR analysis revealed the presence of CTX-M-15 genes within vesicles, which remained protected from DNase digestion, confirming encapsulation. Functional assays demonstrated β-lactamase activity within OMVs, with proteinase K treatment indicating localization primarily within vesicles rather than on their surface. Importantly, OMVs inactivated ampicillin in a dose-dependent manner, significantly reducing its efficacy against susceptible E. coli. Disc diffusion and microtiter plate assays confirmed that β-lactamase-positive OMVs protected susceptible strains from antibiotic killing, promoting bacterial survival and growth. This study uniquely demonstrates that OMVs from CTX-M-15–producing Escherichia coli carry both resistance genes and active β-lactamase enzymes, thereby facilitating both genetic dissemination and direct antibiotic inactivation. Targeting OMV biogenesis may represent a novel strategy to combat antimicrobial resistance. Full article

As a functional coating, the wear-resistant Cr coating is of considerable importance in metal plating. In the present paper, S235 steel samples were electrodeposited with 5 µm thick Cr coating at current densities of 15, 27 and 40 A dm⁻². Nanoindentation was performed to measure the hardness of samples with electroplated Cr coating. Under the defined electroplating process conditions, the Cr coating hardness varied as a function of current density: the minimum average H_IT value of 11.4 GPa was measured at a current density of 15 A dm⁻² and the maximum average H_IT value of 12.9 GPa was measured at 40 A dm⁻². Tribological characteristics of coated samples were determined using the ball-on-disc tribo-method with surface evaluation of tribo-track on the confocal and electron microscope. The Cr coating deposited at 15 A dm⁻² had the lowest wear resistance with a wear rate of 12.76 × 10⁻¹⁵ m³ (Nm)⁻¹. The Cr coating deposited at 40 A dm⁻² had the highest wear resistance on the sample with a wear rate of 3.84 × 10⁻¹⁵ m³ (Nm)⁻¹. Full article

Organic–inorganic compound fertilizer application technology is a key technology for chemical fertilizer efficiency improvement, and stable grain yield increase. However, current agricultural machinery is unable to achieve uniform application of both organic and inorganic fertilisers. This study has compared two modeling methods and optimally selected the EDEM-Fluent coupled method. It aims to investigate the mechanism by which four factors—namely inorganic fertilizer drop location (Polar angle: −80° to 80°, polar radius: 60 mm to 180 mm), organic fertilizer flow rate (875–3500 g·s⁻¹), inorganic fertilizer proportion (10–50%), and fertilizer spreading disc rotational speed (300–700 r·min⁻¹)—influence inorganic fertilizer uniformity. A Box–Behnken test was designed with the pole angle and pole diameter of the drop location, organic fertiliser flow rate, spreading disc rotational speed, and coefficient of variation in the uniformity of the inorganic fertilisers as indexes. The Box–Behnken test divided the fertiliser drop location into left and right parts and established a mathematical model of fertiliser drop location, rotational speed, and organic fertiliser flow rate. Finally, the predictive performance of the model was verified in the field by testing four scenarios: low speed–low flow rate, low speed–high flow rate, high speed–low flow rate, and high speed–high flow rate. The root mean square error (RMSE) between the EDEM-Fluent coupled test and the bench test is 1.53, which is better than the RMSE (2.55) between the EDEM test and the bench test. Before optimization, the coefficients of variationof inorganic fertilizer (ICV) under four operating conditions were 28.93%, 32.43%, 38.17%, and 29.32% respectively. After optimization, the corresponding values were 19.34%, 23.78%, 21.45%, and 23.10% respectively. Compared with the pre-optimization results, the organic fertilizer coefficient of variation (OCV) remained stable, while the inorganic fertilizer coefficient of variation (ICV) decreased by an average of 10.29%. This study greatly improved the uniformity of inorganic fertiliser in the organic–inorganic spreader and provides a basis for subsequent intelligent spreaders. Full article

NADESs represent a modern class of extraction media that align with the principles of green chemistry. They are considered non-toxic and biodegradable, but relatively little is known about their biological activity. This study investigated the antioxidant, antibacterial, and antifungal properties of 40 NADESs. The systems were developed from primary (PRIM) based on choline chloride (ChCl), and specialized (HEVO) plant-derived metabolites, particularly based on thymol and menthol. Their antioxidant activity was evaluated using spectrophotometric tests. The antimicrobial activity was evaluated by the disk diffusion method. The data obtained were analyzed using principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). NADESs based on PRIM exhibited negligible antioxidant activity and relatively low antimicrobial activity. By contrast, NADESs containing HEVO, particularly thymol-based systems, indicated significant antioxidant activity, with stronger activity observed at higher molar proportions of thymol. In the 1,8-cineole:thymol system, ABTS activity ranged from 167.37 ± 24.17 to 861.25 ± 33.03 mg Trolox equivalents/mL NADES (molar ratios 9:1 and 1:9, respectively). The 1,8-cineole:thymol system (1:9) also showed strong antimicrobial activity, with a maximum inhibition zone of 39.33 ± 2.52 mm against Staphylococcus aureus. In summary, NADESs based on HEVO exhibit significantly stronger biological activity than those containing only PRIM. Full article

Background: The distal oblique bundle (DOB) of the interosseous membrane (IOM) has been recognized as an important stabilizer of the distal radioulnar joint (DRUJ). However, its prevalence, morphology, and distal attachments—particularly its relationship to the articular disc and the extensor carpi ulnaris (ECU) tendon sheath—remain inconsistently described. Clarifying these anatomical details is essential for understanding DRUJ stability and guiding surgical reconstruction. Methods: The distal IOM was examined in 48 specimens from 24 embalmed Korean cadavers. In 46 dissected specimens, the presence, morphology, and attachment sites of distal interosseous structures were documented, and attachment levels were measured. In 38 specimens, attachment to the articular disc was assessed. In addition, serial transverse sections from one cadaver were analyzed to confirm three-dimensional relationships. Results: Two morphological patterns were identified: a distinct DOB (21/46, 45.7%) and, when absent, a membranous thickening of the distal IOM (25/46, 54.3%). The mean attachment level was 39.1 ± 9.7 mm for the DOB and 25.4 ± 4.8 mm for the membranous thickening. Both structures assumed an oblique orientation, fanning palmarly toward the capsule and articular disc and dorsally toward the ECU tendon sheath and dorsal septum. In 26 of 38 specimens (68.4%), these structures attached to the proximal palmar portion of the articular disc. Serial transverse sections confirmed this oblique configuration, linking palmar and dorsal stabilizers of the DRUJ. Conclusions: The distal IOM consistently forms specialized structures—either a DOB or a membranous thickening—that integrate with the triangular fibrocartilage complex. By bridging palmar and dorsal stabilizers, these structures contribute to joint congruency and load transfer during forearm rotation. A refined anatomical understanding of these patterns provides clinically relevant insights for surgical preservation or reconstruction, with the potential to improve outcomes in patients with chronic DRUJ instability. Full article

The findings of this study are connected with geometric function theory and were acquired using subordination-based techniques in conjunction with the Hurwitz–Lerch Zeta function. We used the Hurwitz–Lerch Zeta function to investigate certain properties of multivalent meromorphic functions. The primary objective of this study is to provide an investigation on the argument properties of multivalent meromorphic functions in a punctured open unit disc and to obtain some results for its subclass. Full article

Introduction: Currently, static interbody cages are the gold standard for achieving solid arthrodesis in the spine, enhancing segmental stability, obtaining neuroforaminal decompression, and improving as well as maintaining segmental lordosis. It is well known that restoring sagittal balance and segmental lordosis is crucial for long-term outcomes in lumbar spine fusion. For some cases, expandable interbody cages are emerging as an alternative to static cages. This study aims to evaluate the radiographic outcomes and complications of standard open transforaminal lumbar interbody fusion (TLIF). Methods: A standard open TLIF procedure using expandable cages was performed at 1 to 3 levels in 71 patients (129 levels in total), with a follow-up of two years. All patients underwent radiological assessments preoperatively, immediately postoperatively, and at one and two years postoperatively. Radiological evaluation was conducted using standing lateral X-rays. Results: Segmental lordosis (SL) increased significantly from the preoperative value (9.0° ± 3.6°) to 24 months postoperatively (15.4° ± 3.0°), with improvements maintained throughout the 24-month follow-up period (p < 0.001). Similarly, anterior disc height (ADH), posterior disc height (PDH), and foraminal height (FH) each increased significantly from preoperative to immediate postoperative measurements, and these gains were maintained over the two-year follow-up (p < 0.001 each). Lumbar lordosis increased significantly from the preoperative value (41.9° ± 10.5°) to the immediate postoperative period (45.7° ± 10.8°); however, this improvement decreased slightly at the one- and two-year follow-ups. No revisions were required for cage-related complications. One patient experienced a surgical site infection, and two patients had mechanical complications (screw loosening and proximal junctional kyphosis). Conclusions: Expandable interbody cages enable excellent restoration and maintenance of disc height and segmental lordosis in a standard open TLIF procedures at two-year. Achieving these outcomes depends on several factors, including proper preparation of the vertebral endplates, accurate cage placement and expansion, posterior facet osteotomy, and the application of posterior compression prior to final fixation. These steps are essential to fully maximize the potential of expandable cage technology. Full article

Knee–spine interactions suggest that limited knee extension may elevate spinal loading during ambulation in older adults. This study aimed to estimate lumbar intervertebral disc loads during walking in patients with knee extension limitations using a 3D musculoskeletal model and examine their relationship with sagittal alignment. Seventeen adults with radiographic knee osteoarthritis (Kellgren–Lawrence ≥ 2) underwent whole-spine lateral radiography and 3D gait analysis with force plates. A patient-scaled AnyBody model was used to compute intervertebral disc compression forces (T12/L1–L5/S1). Participants were categorized into two groups based on knee extension angle (KEA): a limitation cohort (deficit ≥ 10°) and a non-limitation cohort (<10°). Peak compression force (PCF) and mean compression force were normalized to body weight. The limitation group showed a smaller pelvic incidence and a larger sagittal vertical axis. PCF was significantly increased at the thoracolumbar and upper lumbar levels (T12/L1, L1/2, L2/3, and L3/4), whereas the mean forces remained unchanged. Knee extension limitation is associated with higher peak upper lumbar disc loading during gait, supporting the targeted management of knee extension in older adults at risk of spinal degeneration. Full article

Mitochondria play a central role in cellular bioenergetics. They contribute significantly to ATP production, which is essential for maintaining cells. They are also key mediators of various types of cell death, including apoptosis, necroptosis, and ferroptosis. Additionally, they are one of the main regulators of autophagy. This brief review focuses on BID, a molecule of the BCL-2 family that is often overlooked. The importance of the cardiolipin/caspase-8/BID-FL platform, which is located on the surface of the outer mitochondrial membrane and generates tBID, will be emphasized. tBID is responsible for BAX/BAK delocalization and oligomerization, as well as the transmission of death signals. New insights into the regulation of caspase-8 and BID have emerged, and this review will highlight their originality in the context of activation and function. The focus will be on results from biophysical studies of artificial membranes, such as lipid-supported monolayers and giant unilamellar vesicles containing cardiolipin. We will present the destabilization of mitochondrial bioenergetics caused by the insertion of tBID at the mitochondrial contact site, as well as the marginal but additive role of the MTCH2 protein, not forgetting the new players. Full article