Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately fifty percent of BVP-patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard^®-system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3 % and 94.4 % of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.

Background: Pediatric neurological disorders include neurodegenerative disease causing cognitive impairment, vision loss to mention a few. They are one of the important causes of morbidity and mortality in children with diverse etiology. Diagnosis is difficult in spite of genetic work and in only 60% of cases final diagnosis can be achieved. Case presentation: We explore three cases of pediatric neurological diseases, viz. Arthrogryposis, congenital bilateral cataract and Autism by analyzing clinical exomes. In this work, we attempted to understand rare neurological disorders in an Indian pediatric cohort using exome studies. Conclusions: We used our benchmarked CONVEX pipeline for screening consensus variants, wherein EIF2B2 was found to be inherently pathogenic. We map the association of variants and genes, disease correlation to neuroleptic malignant syndrome which is a matching phenotype to the cases.

Purpose: In recent years, there has been an increasing interest in simultaneous hip and knee arthroplasty compared to staged procedures. The aim of this study was to clarify some controversies and show the safety for the patients by comparing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions, and early functional outcome after simultaneous and staged hip and knee arthroplasty. Methods: We conducted a retrospective trial that included all patients who were undergoing primary TKA, THA, and UKA by one single surgeon in a high-volume arthroplasty center between 2017 and 2020 as a simultaneous or staged procedure. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data was acquired through the electronic files at the OCM. For functional outcome, we compared the ability of the patients to walk independently on the ward and the ability to walk a set of stairs alone which was daily recorded by the attending physiotherapist. Results: In total 305 patients were assessed for eligibility and included in this clinical trial. 145 patients were allocated to the staged arthroplasty group. That group was subdivided in a hip and a knee group, whereas the knee group was split in TKA and unicompartmental knee arthroplasty (UKA). The second staged procedure was performed within 12 months of the first procedure.160 patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There is no significant difference in transfusion rate or complication rate. Secondarily: No correlation was found between the Hb-drop and the functional outcome as well as the length of stay (LOS). Walking the stairs showed a significant difference in the knee group. Conclusion: We observed no significant differences in transfusion rate, in-hospital complications, as well as readmission rate. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient and his outcome, in a high-volume center.

Bilateral recurrent nerve damage following total thyroidectomy in thyroid surgery represents severe complications. These complications have almost low incidence thanks also by using the Nerve Intraoperative Monitoring. The aim of this observational retrospective study is to evaluate the inception mode and the recovery time for different clinical laryngeal pictures that arise from this surgery. We enrolled 25 patients with bilateral vocal folds mobility deficit between October 2017 and October 2022, diagnosed in ENT Unit of University of Campania “L. Vanvitelli”, out of a total of 1417 patients undergoing total thyroidectomy. The 25 patients (23F,2M) aged from 24 to 78 years old (average age 51.7) presented a bilateral vocal folds motility deficit (occurring in about 0.1% of cases). All patients underwent 9 months diagnostic/therapeutic process, which started approximately 30 days after thyroid surgery. There are several outcomes of these complications with functional laryngeal defects being mainly related to respiratory and phonatory activities. These clinical manifestations evolve in different ways within a context of a wide range of possibilities, from spontaneous bilateral or monolateral recovery to functional or surgical restoration. This study allowed the acquisition of useful information about prognostic indications and an adequate therapeutic process, based on the specific clinical characteristics.

An ongoing EU Horizon 2020 Project called BionicVEST is investigating the effect of constant electrical stimulation (ES) of the inferior vestibular nerve in patients with bilateral vestibular dysfunction (BVD)[1]. The evidence is that constant ES results in improved postural stability and gait performance and so the question of central importance is how could constant ES of mainly saccular afferents in these BVD patients cause this improved performance? We suggest that the constant ES is substituting for the absent saccular neural input to the vestibular nuclei and the cerebellum in these BVD patients and indirectly via these structures to other structures which have been of great recent interest in motor control. One target area, the anterior midline cerebellum (the uvula) has recently been targeted as a location for deep brain stimulation in human patients to improve postural stability and gait. There are projections from midline cerebellum to basal ganglia including the striatum, structures involved in the initiation of gait. It may be that the effect of this activation of peripheral saccular afferent neurons is analogous to the effect of deep brain stimulation (DBS) by electrodes in basal ganglia acting to help alleviate the symptoms of patients with Parkinson's disease.

The existing PDC(Polycrystalline Diamond Compacts) -cone hybrid bit bearing adopts a unilateral support structure, which is prone to stress concentration in the journal area, resulting in fracture and wear failure of the bearing, thus reducing the service life of the hybrid bit. In this paper, a new type of double supported bearing hybrid bit is proposed. The static strength analysis of unilateral and bilateral support bearing structures is carried out by finite element simulation, and the stress and strain distribution of the two structures under the load of 20KN-100KN is obtained. Experimental devices for unilateral and bilateral support bearing structures are designed and manufactured to complete 50KN-100KN static pressure loading experiments. The results showed that the stress and strain of unilateral and bilateral support bearing increased linearly with the increase of load. Compared with unilateral bearing, when the load was 100KN, the maximum Mises stress of bilateral bearing decreased from 358.80MPa to 211.10MPa, with a decrease of 41.16%. The maximum contact stress decreased from 415.20MPa to 378.10MPa, decreased by 8.94%, and the maximum principal strain decreased from 11.01e-4 to 9.71e-4, decreased by 11.81%. The axial strain in the danger zone was reduced by 14.68% and 17.35%, respectively. It is found that the contact stress of the simulation data is highly correlated with the bearing life, and the service life of the bilateral bearing bit is increased by 8.94%. The simulation data and experimental results provide data support for the production of hybrid bits with bilateral bearing support.

The bilateral trade relationship between PRC and ASEAN is close. As early as 2012, China has been the largest trading partner of ASEAN, and ASEAN has also taken the place of the United States as PRC’s second largest trading partner in 2019.This paper uses the theory of ecological population evolution, selects the total import and export volume of PRC and the ten ASEAN countries from 2000 to 2019 as the data sample, studies the bilateral trade relations between PRC and the ten ASEAN countries, analyzes the competition and symbiotic relationship of bilateral trade between PRC and the ten ASEAN countries and the possibility of trade friction according to the results, and proposes corresponding improvement strategies. According to the results of the population evolution competition model, China has a competitive relationship with Indonesia, Malaysia, the Philippines, Singapore and Thailand, which is most likely to cause trade friction. China has a biased relationship with Brunei, Cambodia, Laos, Myanmar and Vietnam, which is more likely to cause trade friction. On this basis, in order to further strengthen the trade relations between PRC and the ten ASEAN countries, this paper puts forward policy suggestions on improving infrastructure, strengthening independent innovation, seeking cooperation fields and actively investing abroad.

Recently, the medical image processing is extensively used in several areas. In earlier detection and treatment of these diseases is very helpful to find out the abnormality issues in that image. Here there are number of methods available for segmentation to detect the lung nodule of computer tomography (CT) image. The main result of this paper, the earlier detection of lung nodules using Pre-processing techniques of top-hat transform, median and adaptive bilateral filter was compared both filtering methods and proved the adaptive bilateral filter is suitable method for CT images. The proposed segmentation technique uses novel strip method and the image is split into number of strips 3, 4, 5 and 6. A marker- watershed method based on PSO and Fuzzy C-mean Clustering method was proposed method. Firstly, the input image was reduced noise reduction and smoothing and the filter image is using strips method and then the image is segmented by marker watershed method. Secondly, the enhanced PSO technique was used to locate the better accurate value of the clustering centers of Fuzzy C-mean Clustering. Final stage, with the accurate value of centers and the enhanced target function and the small region of the segmented object was clustered by Fuzzy C-mean. In segmentation algorithm presented in this paper gives 95% of accuracy rate to detect lung nodules when strip count is 5.

This paper proposes the application of force-projecting bilateral control to a master-follower teleoperation system with a pneumatic manipulator on the follower side, and evaluates its effectiveness. The proposed method directly projects the operating force on the master side to the driving force on the follower side, eliminating the need for both position control and external force detection on the follower side, thereby solving the problem of low rigidity and response delay of pneumatic manipulators and providing highly stable sensor-less force presentation against variable environments. In this study, dynamic response analyses of a 1-DOF master-follower system were performed by numerical simulation using a linear system model, followed by experimental verification by implementing an actual system with an external force estimator. The results showed that the proposed force-projecting bilateral control has significantly higher positioning rigidity and better force control stability than the conventional force-reflecting bilateral control. A theoretical consideration was also given using equivalent transformation of force transfer functions to provide evidence for the high stability.

Differences are introduced as outputs of linear systems called differencers, being considered two classes: shift and scale-invariant. Several types are presented, namely: nabla and delta, bilateral, tempered, bilinear, stretching, and shrinking. Both continuous and discrete-time are described. ARMA type systems based on differencers are introduced and exemplified. In passing, the incorrectness of the usual delta difference is shown.

This study takes a two-echelon agricultural products supply chain (APSC) composed of an agricultural product processor (processor) and an agricultural product supermarket (supermarket) as the research object. In order to ensure the stable supply of high-quality agricultural products, this paper considers both fairness concern and corporate social responsibility (CSR), and establishes four Stackelberg game models with or without considering fairness concern and CSR, and obtains the influence mechanism of fairness concern and CSR on bilateral quality efforts in APSC through comparative analysis and numerical analysis. Research shows that the supermarket’s fairness concern can take the role of "profit distribution mechanism", but it is not conducive to improving bilateral quality efforts resulting in the inability to improve market demand, and it is not conducive to improving the utility of the supply chain system and consumer surplus; both members of APSC sharing CSR can not only improve the quality of agricultural products and promote the expansion of market demand, but also can achieve Pareto improvement of both profit of all members and supply chain system. Besides, The CSR shared by both members has a greater impact on bilateral quality efforts decision than the supermarket’s fairness concern, and thus the positive effect of CSR can overcome the negative effect of supermarket’s fairness concern.

Background and Objective: There is a paucity of literature comparing unilateral instrumented transforaminal lumbar interbody fusion (UITLIF) with bilateral instrumented TLIF (BITLIF) regarding radiological alignment, including the coronal balance, even though UITLIF might have asymmetric characteristics in the coronal plane. This retrospective study aimed to compare the clinical and long-term radiological outcomes of 1-level UITLIF and BITLIF in lumbar degenerative diseases (LDD). Materials and Methods: Patients who underwent 1-level UITLIF with two rectangular polyetheretherketone (PEEK) cages or BITLIF with ≥ 5 years of follow-up at a single hospital were included. We compared the clinical and radiological outcomes between the UITLIF and BITLIF. Results: In total, 63 and 111 patients who underwent UITLIF and BITLIF, respectively, were enrolled. The median follow-up was 85.55 months (range: 60–130). The UITLIF group had a significantly shorter operation time (185.0 [170.0–210.0] vs. 225.0 [200.0–265.0], p < 0.001) and lower estimated blood loss (300.0 [250.0–500.0] vs. 550.0 [400.0–800.0], p < 0.001) than BITLIF group. Regarding the clinical outcomes, there were no significant differences in the intermittent claudication score (p = 0.495) and Kirkaldy–Willis criteria (p = 0.707) at 1 year postoperatively. The interval changes of the local coronal Cobb angle at the index level, L1-S1 lordotic angle, and coronal off-balance from the immediate postoperative radiograph to the last follow-up were not significantly different (p = 0.687, p = 0.701, and p = 0.367, respectively). Conclusion: UITLIF with two rectangular PEEK cages is a viable option for providing comparable clinical outcomes and radiological longevity to BITLIF in 1-level LDD. In addition, UITLIF has advantages over BITLIF in terms of operative time and blood loss.

This article presents a comprehensive framework for valuing financial instruments subject to credit risk. In particular, we focus on the impact of default dependence on asset pricing, as correlated default risk is one of the most pervasive threats in financial markets. We analyze how swap rates are affected by bilateral counterparty credit risk, and how CDS spreads depend on the trilateral credit risk of the buyer, seller, and reference entity in a contract. Moreover, we study the effect of collateralization on valuation, since the majority of OTC derivatives are collateralized. The model shows that a fully collateralized swap is risk-free, whereas a fully collateralized CDS is not equivalent to a risk-free one.

Objective: To examine the effect of bilateral total lobectomy and unilateral total lobectomy on improving thyroid function in patients with thyroid micropapillary carcinoma treated with euthyrox. Methods: The study was conducted on 68 patients with thyroid micro papillary carcinoma treated with euthyroxwho had been surgically treated with euthyrox in our hospital between January 2018 and December 2019. On the basis of random number grouping, they were divided into control groups (n = 34, bilateral total lobectomy) and observation groups (n = 34, unilateral total lobectomy plus isthmectomy). Thyroid function, free triiodothyronine (FT3), thyroid hormone (TSH), and voice function (VHI score) of the two groups were compared.Results: In comparison to the control group, the observation group had shorter incision lengths, shorter operation times, and shorter hospital stays, as well as less intraoperative bleeding and drainage volume, and the difference was statistically significant (P < 0.05); As compared with the control group, the observation group had higher FT4 and FT3 levels as well as lower TSH levels, a statistically significant difference (P < 0.05).VHI scores of emotions, function, physiology, and other voice functions were significantly lower among the observation group than those of the control group (P < 0.05).Conclusion: A unilateral total lobectomy with adjacent isthmus resection in patients with thyroid micro papillary carcinoma can yield ideal results, accelerate the time taken for surgical rehabilitation, improve thyroid function, thereby improving voice quality, as well as improve the overall prognosis of the patient.

The bilateral tempered fractional derivatives are introduced generalising previous works on the one-sided tempered fractional derivatives and the two-sided fractional derivatives. An analysis of the tempered Riesz potential is done and showed that it cannot be considered as a derivative.

In zebrafish inner ear, hair cell orientation in anterior and posterior maculae of the embryonic otic vesicle is different (about 30–40 degrees): this is rather unusual in planar polarity mechanism of action, instead suggests that kinocilia may be rotationally polarized. In mice node, the innermost monociliated cells generate a left-ward fluid flow sensed by the immotile primary cilia of Left peri-nodal cells: the Nodal signaling pathway is then expressed asymmetrically, in the Left lateral plate mesoderm, breaking symmetry in visceral organs (situs solitus); however, Right peri-nodal cells also, if artificially excited by a right-ward flow, break symmetry and activate the Nodal cascade, though inverting visceral organ asymmetry (situs inversus); surprisingly, peri-nodal cells prove to be adept at distinguishing flow directionality. Recently, in the Kupffer vesicle (the zebrafish laterality organ), chiral primary cilia orientation has been described: primary cilia, in the left and right side, are symmetrically oriented, showing a mirror average divergence of about 15–20 degrees from the midline. This finding, taken together with the mirror behavior of mouse perinodal cells and zebrafish hair cells, champions the idea of primary cilia enantiomerism.

Local binary pattern is one of the visual descriptors and can be used as a powerful feature extractor for texture classification. In this paper, a novel representation for face recognition is proposed, called it Bilateral Line Local Binary Patterns (BL-LBP). This scheme is an extension of Line Local Binary Patterns descriptors in the statistical learning subspace. The present bilateral descriptors are fused with an ensemble learning of calibrated SVM models. The performance of this scheme is evaluated using 5 standard face databases. It is found that it is robust against illumination variation, diverse facial expressions and head pose variations and its recognition accuracy reaches 98 percent, running on a mobile device with a processing speed of 63 ms per face. Results suggest that our proposed method can be very useful for the vision systems that have limited resources where the computational cost is critical.

Low-intensity noisy galvanic vestibular stimulation (nGVS) can improve static and dynamic postural deficits in patients with bilateral vestibular loss (BVL). In this study, we aimed to explore the neurophysiological and neuroanatomical substrates underlying nGVS treatment effects in a rat model of BVL. Regional brain activation patterns and behavioral responses to repeated 30-min nGVS treatment in comparison to sham stimulation were investigated by serial whole-brain [18F]-FDG-PET measurements and quantitative locomotor assessments before and at 9 consecutive time points up to 60 days after chemical bilateral labyrinthectomy (BL). [18F]-FDG-PET revealed a broad nGVS-induced modulation on regional brain activation patterns encompassing biologically plausible brain networks in the brainstem, cerebellum, multisensory cortex and basal ganglia during the entire observation period post-BL. nGVS broadly reversed brain activity adaptions occurring in the natural course post-BL. Parallel behavioral locomotor assessment demonstrated a beneficial treatment effect of nGVS on sensory-ataxic gait alterations, particularly in the early stage of post-BL recovery. Stimulation-induced locomotor improvements were finally linked to nGVS brain activity responses in the brainstem, hemispheric motor and limbic networks. In conclusion, combined [18F]-FDG-PET and locomotor analysis discloses the potential neurophysiological and neuroanatomical substrates that mediate previously observed therapeutic nGVS effects on postural deficits in patients with BVL.

This study investigates resource adequacy and renewable energy integration in the United States, European Union, and Pakistan amid global energy market liberalization and greenhouse gas re-duction efforts. It explores how these regions are adapting to the surge in renewable sources like wind and solar, which, despite their financial and environmental benefits, challenge resource adequacy and the economic viability of traditional energy sources. In the US and EU, significant improvements have been introduced in wholesale electricity markets and capacity accreditation mechanisms, which enhanced the large-scale deployment of renewables. This shift has prompted a reevaluation of resource adequacy, leading to increased deployment of battery storage and demand response. Presently, gas-based generation is largely upholding resource adequacy, however, future trends indicate a move towards greater consumer participation, energy efficiency, and utility-scale storage, with a decline in fossil fuel use. Pakistan aims to adopt a liberalized market structure by balancing competitive markets with legacy contracts. Public pressure is driving a shift from costly fossil-based generation to renewables. Similarly, a trend in the rise of behind-the-meter solar generation can be witnessed. In future, Pakistan may also experience resource adequacy challenges. It will likely need to implement battery storage, demand response, and modern capacity accreditation tools, by drawing lessons from developed markets.

This paper attempts to assess the economic significance and implications of collateralization in different financial markets, which is essentially a matter of theoretical justification and empirical verification. We present a comprehensive theoretical framework that allows for collateralization adhering to bankruptcy laws. As such, the model can back out differences in asset prices due to collateralized counterparty risk. This framework is very useful for pricing outstanding defaultable financial contracts. By using a unique data set, we are able to achieve a clean decomposition of prices into their credit risk factors. We find empirical evidence that counterparty risk is not overly important in credit-related spreads. Only the joint effects of collateralization and credit risk can sufficiently explain unsecured credit costs. This finding suggests that failure to properly account for collateralization may result in significant mispricing of financial contracts. We also analyze the difference between cleared and OTC markets.

Due to the special characteristics of the shooting distance and angle of remote sensing satellites, the pixel area ratio of ship targets is small and the feature expression is insufficient, which leads to unsatisfactory ship detection performance and even situations such as missed detection and false detection. In this study, we propose an improved-YOLOv5 algorithm. The improvement strategies mainly include: (1) Add the Convolutional Block Attention Module (CBAM) into the Backbone to enhance the extraction of target-adaptive optimal features; (2) Introduce cross-layer connection channel and lightweight GSConv structure into the Neck to achieve higher-level multi-scale feature fusion and reduce the number of model parameters; (3) The Wise-IoU loss function is used to cal-culate the localization loss in the Output, and assign reasonable gradient gains to cope with dif-ferences in image quality. In addition, during the preprocessing stage of experimental data, a me-dian and bilateral filter method is used for noise reduction to reduce interference from ripples and waves and highlight the information of ship features. The experimental results show that Im-proved-YOLOv5 has a significant improvement in recognition accuracy compared to various mainstream target detection algorithms; Compared to the original YOLOv5s, the mean Average Precision (mAP) has improved by 3.2% and the Frames Per Second (FPN) has accelerated by 8.7%.