Study design: Technical note. Objectives: To present a novel technique of treatment for patient with basilar invagination. Background : Basilar invagination (BI) is considered a congenital condition and can compress the cervicomedullary junction, causing neurologic deficit. Severe neurological deficit due to BI should be treated surgically. However, there is controversy regarding whether an anterior or posterior approach should be used. Anterior approach is optimal for decompression of cervicomedullary junction, but this approach has high complication rates. Posterior reduction has a high risk of occipital screws backout and/or instrument failure. Materials and Methods : A 15-year-old boy with severe myelopathy was referred to our hospital. He had neck pain, muscle weakness of bilateral upper limbs, gait disturbance appeared 3 months before he visited our hospital, he drops a cup several times recently. In the examination, he had hyperreflexia of upper and lower limbs and muscle weakness of bilateral arms (MMT 4), hypoesthesis was observed bilaterally below elbow and both legs. He also had clumsiness of bilateral hands, mild urinary and bowel incontinence, and spastic gait. His 10 second grip and release test was 16 in both hands. His grip power was 20 kg in right and 17 kg in left. Radiograms showed severe BI and spinal cord was severely compressed with odontoid process.. Results : The patinet underwent posterior surgery with C-arm free technique. All screws including occipital screws were inserted adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year we have these results : Manual muscle testing results and sensory function tests showed almost full recovery, bilateral arms (MMT 5) ,walking smoothly. Cervical Japanese orthopedic association score of the patient has improved from 9/17 to 16/17. Post-operative images showed an excellent spinal cord decompression, and no major or severe complications has occured . Conclusions/Level of Evidence : Basilar invagination with Klippel-Feil syndrome is relatively rare condition. Posterior approach and occipito-cervical fixation for BI treatment with navigation technique is a safe method to treat severe myelopaty with reducible odontoid. This novel navigation technique provides an excellent results for a patient with BI. Level V.

Our image recognition system mainly judges whether the left upper limb in the image is the left upper limb or the right upper limb through our deep learning model in the image. The doctor then could give the correct surgical position. From the experimental results, it could be found that the precision rate and recall rate of the intelligent image recognition system proposed in this paper for preventing the upper limb dislocation surgery could reach 98% and 93%, respectively. It proved that our intelligent image recognition system could indeed assist orthopedic surgeons to prevent the occurrence of left and right dislocation in upper limb surgery. At the same time, this paper also completes the IRB application approval through the prototype experimental results and will conduct the second phase of human trials in the future. It showed that the research results of this paper will be of great benefit and research value to upper limb orthopedic surgery.

The Surgical Complexity Score (SCS) has been widely used to describe the surgical effort during advanced stage epithelial ovarian cancer (EOC) cytoreduction. Referring to a variety of multi-visceral resections, it best combines the numbers with the complexity of the sub-procedures. Nevertheless, not all potential surgical procedures are described by this score. Lately, the European Society for Gynaecological Oncology (ESGO) has established standard outcome quality indicators pertinent to achieving complete cytoreduction (CC0). There is a need to define what weight all these surgical sub-procedures comprising CC0 would be given. Explainable Artificial Intelligence (XAI) could explain the impact of real-time features on the CC0 prediction. We analyzed prospectively collected data from 560 consecutive patients with FIGO-stage III-IV who underwent cytoreductive surgery between Jan 2014 and Dec 2019 at a UK tertiary referral centre. Following adaptation of the structured ESGO ovarian cancer report template, we employed the eXtreme Gradient Boosting (XGBoost) algorithm to model an exhaustive list of surgical sub-procedures. We applied the Shapley Additive explanations (SHAP) framework to provide global (cohort) explainability. We used Cox regression for survival analysis and constructed Kaplan-Meier curves. The XGBoost model predicted CC0 with an acceptable accuracy (area under curve [AUC] = 0.70; 95% confidence interval [CI] = 0.63–0.76). Visual quantification of the feature importance for the prediction of CC0 identified upper abdominal peritonectomy (UAP) as the most important feature, followed by regional lymphadenectomies. The UAP best correlated with bladder peritonectomy and diaphragmatic stripping (Pearson’s correlations > 0.5). Clear inflection points were shown by pelvic and para-aortic lymph node dissection and ileocecal resection/right hemicolectomy, which increased the probability for CC0. When UAP was solely added to a composite model comprising of engineered features, it substantially enhanced its predictive value (AUC = 0.80, CI = 0.75-0.84). The UAP was predictive of poorer progression-free survival (HR=1.76, CI 1.14- 2.70, P:0.01) but not overall survival (HR=1.06, CI 0.56-1.99, P:0.86). The SCS did not have significant survival impact. Machine Learning allows for operational feature selection by weighting the relative importance of those surgical sub-procedures that appear to be more predictive of CC0. Our study identifies UAP as the most important procedural predictor of CC0 in surgically cytoreduced advanced-stage EOC women. The classification model presented here can potentially be trained with a larger number of samples to generate a robust digital surgical reference in high output tertiary centres. The upper abdominal quadrants should be thoroughly inspected to ensure that CC0 is achievable.

Keywords: pelvic ultrasound, follicle number per ovary, FNPO, ovarian volume, PCOM, upper normal limits, referral population

There is a great need to develop research-based models for supporting collaboration between educational institutions. Collaboration models are needed, for example, to assist the transition from lower educational level to higher education or from higher education to work life. In this research, collaboration was conducted through a joint upper-secondary school and university course that addressed global challenges by using a project-based learning approach. There is a shortage of research exploring students’ perceptions of collaboration. Therefore, the main purpose of this qualitative case study is to explore the relevance of the joint course for students and university students. The research was guided by the following research question: What kind of relevance did the students experience in the joint project-based learning course? The data was gathered using questionnaires, interviews, and reflective study reports. The data was analyzed via theory-based content analysis where research-oriented relevance model was used as the analysis framework. The analysis framework enabled categorizing experienced relevance on individual, vocational and societal dimensions. Altogether, the analysis produced 7 relevance categories for upper-secondary students and 9 for university students. According to the analysis, upper-secondary school students felt that the course offered the most on an individual relevance dimension whereas university students experienced the vocational relevance dimension most diverse. As the main conclusion, this research produced new insights on the experienced relevance of upper-secondary level and higher education cooperation from the students’ point of view. The acquired knowledge can be useful for everyone developing new cross-institutional cooperation models.

The challenging issues of Computer Network and Databases are not only the intrusion detection but also the reduction of false positive and increase of detection rate. In any intrusion detection system, anomaly detection mainly focuses on modeling the normal behavior of the users and detecting the deviations from normal behavior which are assumed to be potential intrusions or treat. Several techniques have already been successfully tried for this purpose. However, the normal and suspicious behavior are hard to predict as there is no precise boundary differentiat-ing one from another. Here rough set theory and fuzzy set theory come into the picture. In this article, a hybrid approach based on rough set theory and intuitionistic fuzzy set theory is pro-posed for the detection of anomaly. The proposed approach is a classification approach which takes the advantages of softness properties both rough and fuzzy set theory to deal with uncer-tainty in the dataset. The algorithm classifies the data instances in such a way that they can be expressed using natural language. The experimental results with a real world dataset and a syn-thetic dataset show that the proposed algorithm has normal true positive rates of 91.989% and 96.99% and attack true positive rates of 91.289% and 96.29% respectively

Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. Especially, a location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. The aim of this study was to describe the early and late postoperative clinical course of this highly eloquent tumours. Patients and Methods: This is a single-centre retrospective cohort study. We included 35 patients with IMSCT at levels of craniocervical junction to C4 who underwent surgical treatment between January 2008 and December 2022. The authors analysed the patients' preoperative status, tumour- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included 22 patients with grade II ependymoma (62.9%), 2 low-grade astrocytomas (5.7%), 2 glioblastomas (5.7%), 6 hemangioblastomas (17.1%), 2 metastases (5.7%), and 1 patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column related symptoms and motor deterioration occurred in 64% and 44% of patients, respectively. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients preserved postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively (p=0.0897, α=0.05). Only two out of 35 patients (5.7%) developed new intermittent respiratory dysfunction, of whom two were transient. There were no surgery-related deaths. Conclusions: The surgery of IMSCT of the upper cervical spine could be performed without major procedure-related risk. Roughly a half of the patients develop new neurological deficit in the immediate postoperative period. However, most of the patients still maintain functional independence. The rate of respiratory insufficiency is low and is strongly influenced by the rapid neurological deterioration in high-grade tumours.

We report a diode pumped solid state (DPSS) laser used for intracavity pump-enhanced difference frequency generation (DFG) to create a 3.5 micron laser. Using a 50 mm-long periodically poled lithium niobate (PPLN) crystal inside the cavity of an Nd:YVO4 solid state laser at 1064 nm with 4.5 W pump power at 808 nm, and a 310 mW C-band signal at 1529 nm, up to 31 mW of mid-infrared output power at 3499 nm is obtained. The cavity requires no active stabilization and/or locking, and the entire cavity is <8 cm in length. The obtained output power corresponds to a black box efficiency of 2.20 %W-1, which is the highest value reported to date for continuous wave DFG based on a bulk nonlinear optical crystal with no active stabilization. Potential future applications in free space optical communication are discussed as well.

The presented research article shows a functionally graded lattice as an infill structure in designing a 3D printed mechanical element—a bicycle crank arm. The authors want to answer the fundamental question: whether the functionally graded lattice structures can efficiently improve structural performance and how they can be implemented in real complex components. Intuitively, everyone senses that using such elements must bring profit. A good example might be nature, which commonly reaches for such a solution in the skeletons of animals and humans. Two aspects determine their realisations: the lack of adequate construction and analysis methods and the limitations of existing manufacturing methods. Thus, the authors used relatively simple crank arm design and design exploration methods for structural analysis. The design exploration method enabled us to find the optimum solution efficiently. A developed prototype was created utilising additive manufacturing. One of the 3D printing methods - fused filament fabrication technology for metals, allowed the prototype of a crank arm with the optimised infill to be made. As a result, the authors developed a lightweight and manufacturable crank arm showing the new construction and analysis method implementable in similar 3D printed elements.

The aim of this study was to examine the relationship of the distance between the apex tip of the upper central tooth (U1A) and the anterior nasal spine (ANS) and the nasal floor (NF) with the vertical cephalometric values using cone-beam computerized tomography (CBCT). A total of 122 patients who applied to Department of Orthodontics between January 2011-June 2019 were included. On the CBCT’s, distances between the U1A and the NF and ANS were measured. Statistical significance was considered as p<0.05. Of 122 individuals 73.8% (n=90) were female and 26.2% (n=32) were male with an mean age of 22,8±3,3 years. A statistically significant moderate positive correlation was found between the NF-U1A mean values and the measurements of N-Me, ANS-Me and ANS-Gn, S-Go, and N-ANS measurements (p <0.01). A statistically significant positive correlation was found between the ANS-U1A mean values and Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me and ANS-Gn (p <0.01). In this study, we found that the distance of U1A from ANS and NF points was related to orthodontic vertical direction parameters. It was demonstrated that the ANS-U1A and NF-U1A points can serve as reference points for identifying the orthodontic vertical growth pattern on CBCT scans.

This study empirically analyzes the effectiveness of resource optimization utilizing artificial intelligence (AI) within cloud computing environments. It compares systems that have been transitioned from a Monolithic structure to Microservices Architecture (MSA) with those adopting a simple Rehost strategy, to validate the operational efficiency of two systems whose resource efficiency has been enhanced compared to traditional legacy systems. The research is based on systems that determined resource efficiency post-cloud migration using APM tools. It points out the limitations of traditional heuristic operation methods in resource optimization, which lead to issues such as application performance degradation, resource over-allocation, and increased operational costs. This study aims to overcome the conventional resource optimization standards that depended on the average peak usage of CPU and memory infrastructure, by introducing AI-based optimization tools, and applying on-premise standards to cloud and container environments to achieve resource optimization. The paper emphasizes the importance of resource optimization through AI-based automation tools, exploring the possibilities of resolving real-world application performance issues in cloud environments, reducing unnecessary resource usage costs, and cutting down on labor risks and operational expenses. Through this, it presents strategic directions on how AI technology can offer financial and operational advantages in managing cloud resources.

Pore fluid pressure is very important to the generation, migration and accumulation of petroleum. The previous studies indicate that the Chezhen sag region is typically characterized by pore fluid overpressure (the difference between pore fluid pressure and hydrostatic pressure). To date, the formation mechanism of pore overpressure and the accumulation regularity of “upper source-lower reservoir” type in this region remains unknown. In order to investigate these problems, a 2-D finite element model is established with regards to the fluid-solid coupling in Chegu 25 block of Chezhen depression, fully considering the existing seismic, logging data and regional tectonic stress environment. Meanwhile, we calculate the abnormal overpressure generated at the source rock during hydrocarbon generation and the process of hydrocarbon migration and accumulation along the faults, analyzing the dynamic conditions of hydrocarbon downward accumulation. The results show that overpressure can accelerate migration of hydrocarbon and improve the efficiency of hydrocarbon accumulation. However, when the overpressure is too large, tensile fractures and shear fractures may occur, resulting in hydrocarbon dissipation, and changing the results of oil and gas accumulation. The overpressure at the source rock is mainly caused by hydrocarbon generation, while the overpressure at the reservoir is primarily created by unbalanced compaction. As the dominant channel of hydrocarbon migration, overpressure will change the direction and path of hydrocarbon migration in the fault. Therefore, the “upper source-lower reservoir” hydrocarbon accumulation model is strongly explained by the high permeability of faults and the presence overpressure. In summary, the simulated overpressure results are in good agreement with the mud weight equivalent overpressure and the drill stem tests (DSTs).

The implementation of a progressive rehabilitation training model to promote patients’ motivation efforts can greatly restore the damaged central nervous system function in patients. The patients’ active engagement can be effectively stimulated by assist-as-needed (AAN) robot rehabilitation training. However, its application in robotic therapy has been hindered by a simple determination method of robot assisted torque which focuses on the evaluation only of the affected limb's movement ability. Moreover, the expected effect of assistance depends on the designer, which deviates from the patient's expectations, and its applicability to different patients is deficient. In this study, we propose a control method with personalized treatment features based on the idea of estimating and mapping the stiffness of the patient’s healthy limbs. This control method comprises an interactive control module in the task-oriented space based on the quantitative evaluation of motion needs and an inner loop position control module for the pneumatic swing cylinder in the joint space. An upper limb endpoint stiffness estimation model is constructed and a parameter identification algorithm is designed. The upper limb endpoint stiffness which characterizes the patient's ability to complete training movements is obtained by collecting surface electromyographic (sEMG) signals and human-robot interaction forces during patient movement. Then the motor needs of the affected limb when completing the same movement are quantified based on the performance of the healthy limb. A stiffness mapping algorithm is designed to dynamically adjust the rehabilitation training trajectory and auxiliary force of the robot based on the actual movement ability of the affected limb, achieving AAN control. Experimental studies were conducted on a self-developed pneumatic upper limb rehabilitation robot, and the results showed that the proposed AAN control method can effectively estimate the patient's movement needs and achieve progressive rehabilitation training. The rehabilitation training robot that simulates the movement characteristics of the patient's healthy limbs drives the affected limb, making the intensity of the rehabilitation training task more in line with the patient's pre-morbid limb use habits, and also beneficial for the consistency of bilateral limb movements.

A recent research has identified an inverse amplitude link between obliquity damping and short eccentricity amplification during Mid-Late Pleistocene based on LR04 δ18O and equatorial Pacific Site 846 sea surface temperature records, which is associated with the Earth's long-term cooling. In the present study, new evidence of this anticorrelation is presented from Antarctic D-CO2-CH4 records, global benthic-planktic δ18O, and regional (Atlantic, Pacific, Mediterranean, and Indian) climate-related proxies. Based on a critical review of theoretical constrains (Earth's oblateness changes and ice-volume phase lag in the obliquity band <5.0 kyr), this widespread and symmetric (bipolar) obliquity response damping has been interpreted as an effect of the obliquity-oblateness feedback, which could be the latent physical mechanism at the origin of the Mid-Pleistocene Transition (MPT). Indeed, results and considerations of the present work suggest that fast and positive/negative net variation of the Earth's oblateness in the obliquity band was controlled by dominant glacio-eustatic water mass component and, assuming a rapid response of the ice-volume to surface temperature changes, the mean obliquity lag response is estimated to be <5.0 kyr over the past 800 kyr. These elements may explain the interglacial/glacial damping observed in the obliquity response. The consolidation of the Earth's long-term icy-state in the subtrend IV, culminated with the post-MPT obliquity damping, might have contributed to the strengthening of the short eccentricity response by mitigating the obliquity ‘ice-killing’ during obliquity maxima (interglacials), favouring the obliquity-cycle skipping and a feedback amplified ice-growth in the short eccentricity band (obliquity damping hypothesis). This could suggest a different impact of the climate friction than what is generally believed, which is presumably the latent physical mechanism that triggers transient ‘competitive’ interaction between obliquity and short eccentricity started early during the Piacenzian.

Running is a basic form of human locomotion and one of the most popular sports worldwide. While the leg biomechanics of running have been studied extensively, few studies have focused on the upper-body movement. However, an effective arm swing and longitudinal rotation of the shoulders play an important role in running efficiency as they must compensate for the longitudinal torques generated by the legs. The aim of this study is to assess the upper-body rotation using wearable inertial sensors and to elucidate its relation to energy expenditure. Eighty-six junior elite middle and long-distance runners (37 female, 49 male) performed an incremental treadmill test with sensors attached on both shoulders, tibiae and the sacrum. Mean and total horizontal shoulder and pelvis rotation per stride were derived while energy costs were determined using respiratory gas analysis and blood sampling. Results show that shoulder and pelvis rotation increase with running speed. While shoulder rotation is more pronounced in female than in male runners, there is no sex difference for pelvis rotation. Energy cost of running and upper trunk rotation prove to be slightly negatively correlated. In conclusion, upper body rotation appears to be an individual characteristic influenced by a sex-specific body mass distribution.

Background: Patients undergoing dual antiplatelet therapy (DAPT) may experience recurrent gastrointestinal bleeding (GIB). We investigated the clinical characteristics and risk factors for recurrent non-variceal upper gastrointestinal bleeding (NVUGIB) in patients who had experienced NVUGIB during receiving DAPT. Methods: We enrolled patients diagnosed with NVUGIB during receiving DAPT between 2006 and 2020. Definite bleeding was confirmed by esophagogastroduodenoscopy in all NVUGIB patients. Results: A total of 124 patients were diagnosed with NVUGIB during receiving DAPT. Male was predominant (n = 103, 83.1%), bleeding mostly from the stomach (n = 94, 75.8%) and peptic ulcers (n = 72, 58.1%). After successful hemostasis of NVUGIB, 36 patients (29.0%) experienced at least one episode of recurrent upper GIB, 19 patients (15.3%) died, and 7 (5.6%) patients had a bleeding-related death. Multivariate analysis showed that age was a significant factor for re-bleeding (odds ratio [OR],1.050; 95% confidence interval [CI]:1.001-1.102, P-value:0.047), all-cause mortality (OR,1.096; 95% CI:1.020-1.178, P=0.013), and re-bleeding related mortality (OR,1.187; 95% CI:1.032-1.364, P-value:0.016). In Kaplan-Meier analysis, the cumulative probabilities of re-bleeding, death, and bleeding-related death were significantly higher in patients aged 70 and older (P=0.008, &lt;0.001, and 0.009, respectively). Conclusion: Clinicians should be cautious about re-bleeding and mortality when elderly patients who experienced NVUGIB during receiving DAPT.Keywords: dual antiplatelet therapy; upper gastrointestinal tract; bleeding; mortality

Diversified techniques have been applied in many research papers for the optimization of rehabilitation robotic movements in order to maintain smoothness and accuracy. Smooth and precise control is needed necessarily for upper limb rehabilitation robotic applications having five degree of freedom. The preferred parameters which are used for the controlling were validated by mathematical model and these tuning parameters were optimized. Designing optimization algorithms to control complex physical robots has been a challenging task. In this study, a number of optimization techniques will be analyzed to determine the optimal parameters of a PID controller with a dynamic model of the upper limb rehabilitation system. For determining optimal control parameters for PID, there exists a number of tuning methods such as Zeigler Nichols and fuzzy logic which are classical methods. Swarm intelligence-based optimization algorithms are inspired by the behaviors of living things in nature. Several researchers have reported the optimal design of PID controller parameters using optimization techniques. The proposed control technique has been implemented on a 5-DOF RAX hardware and before any clinical trials, six healthy subjects went for trials under strict protocol. It has been discovered that the proposed control technique rejects the external unwanted disturbances as well as keeps the system stable under extreme perturbed and harsh conditions. In this research paper mathematical models have been validated to determine the PID parameters for the optimization. The comparative study is carried out with four different cost functions since a well-designed objective function leads to better performance of the system and indicates control design expectations. These objective functions are an integral squared error (ISE) and integral absolute error (IAE). In this research work, the effects of different cost functions on optimization techniques for controller parameters were analyzed. The performance of the controller with different cost functions has examined for robustness analysis. The cost function of particle swarm optimization, Firefly, Ant Bee Colony and Ant Colony optimization were developed for the better optimization results.

The paper presents the conceptualization and realization of a novel platform for additive manu-facturing, an industrial robot arm-based system for additive manufacturing applications. Tradi-tional 3D printers, especially those employing fused deposition modelling (FDM) processes, are restricted to depositing material in a single toolpath plane (e.g. x-y plane). The focus of this study was to explore the feasibility of integrating commercial off the shelf (COTS) additive manufac-turing technologies with a six degree of freedom industrial robot arm to yield a 3D additive manufacturing system with the capability to perform free-form six degree of freedom fused deposition modelling. The present paper presents the development of a platform from stage 0, i.e. materials to its use, and finally a printed product with the developed extruder.

The purpose of this scoping review was to comprehensively clarify the methodology of Mental practice (MP) to date by systematically mapping studies that have performed MP on post-stroke paralytic upper extremity function. Specifically, (1) When is the most common timing of MP in-tervention after stroke onset? (2) What is the MP load (intervention time, number of interven-tion days, and intervention period)? (3) What are the most common methods of Motor Imagery (MI) recall and MI tasks during MP? (4) Is MP often used in conjunction with individual rehabili-tative therapies? (5) What is the paralyzed side's upper limb and cognitive function level at the start of MP intervention? Our scoping review was performed ac-cording to PRISMA-ScR to iden-tify research questions. Then, the PubMed, Scopus, Medline, and Cochrane Library databases were used to screen articles published by July 19, 2022. Eligible articles were selected all study designs were included, including studies involving the use of MP for post-stroke paralytic upper extremity function. Selection of eligible papers was done by two or more independent persons. Data were extracted from the eligible papers for items necessary to identify the research ques-tions. English-language articles identified for this study were 694, of which 62 were accepted. The most common intervention time was 30 minutes or less and the duration of the intervention was 5 times a week in MP. The most common method of recalling MI during MP was using an audio guide. In the future, it will be important to conduct accumulation of research to unify the varied widely MP methodologies identified in this study.

We performed urine cytology analysis of a pharmacologically induced diuresis for diagnostics of upper tract urothelial carcinoma. To evaluate the diagnostic value of cytology of pharmacologically forced diuresis, a first cohort of 77 consecutive patients with primary upper tract urothelial carcinoma treated with radical surgery was enrolled. To evaluate pharmacologically forced diuresis cytology as follow-up procedure, a second cohort of 1250 patients who underwent radical cystectomy for bladder cancer was selected. In the first cohort, sensitivity of cytology of pharmacologically forced diuresis in patients with invasive, high-grade, low-grade, and concomitant carcinoma in situ was 8%, 9%, 0% and 14%, respectively. In the second cohort, cytology of pharmacologically forced diuresis was positive in 30/689 (4.3%) of patients, in whom upper urinary tract recurrence was present in 21/30 (70%) and urethral recurrence in 8/30 (26%) of cases. As a follow-up tool, cytology of pharmacologically forced diuresis showed a sensitivity, specificity, and positive and negative predictive value of 60%, 99%, 70% and 98%, respectively. Summarized, as diagnostic tool, sensitivity of cytology of pharmacologically forced diuresis is slightly better in patients with invasive upper tract urothelial carcinoma and concomitant carcinoma in situ. As follow-up method, positive cytology of pharmacologically forced diuresis is strongly related to cancer recurrence and can reveal urethral recurrence. cytology of pharmacologically forced diuresis might be useful in patients with contraindications for imaging or with difficult endoscopic access to the upper urinary tract.

In this paper, two double Jordan-type inequalities are introduced based on the papers [1]-[5]. These inequalities generalize the inequalities obtained in [1]-[5]. As a result, some new upper and lower bounds of the sinc function are obtained. This extension of Jordan’s inequality is enabled by considering the corresponding inequalities through the concept of stratified families of functions elaborated in [6]. Based on this approach, some optimal approximations of the sinc function are derived by determining corresponding minimax approximants, also described in the paper [6].

Keywords: Evanescent field; photonic sensor; optical waveguide; light-matter interaction; absorption; mid-infrared.

The endometrium, the inner mucosal lining of the uterus, undergoes complex molecular and cellular changes across the menstrual cycle in preparation for embryo implantation. Transcrip-tome-wide analyses have mainly been utilized to study the endometrial receptivity, the prerequisite for successful implantation, with most of the studies, so far, comparing the endometrial transcriptomes between (i) secretory versus proliferative endometrium or (ii) mid-secretory versus early-secretory endometrium. In the current study, we provide the complete transcriptome description of the endometrium across the entire menstrual cycle and, for the first time, comprehensively characterize the proliferative phase of the endometrium. Our temporal transcriptome analysis includes five time points: mid-proliferative, late-proliferative (peri-ovulatory phase), early-secretory, mid-secretory, and late-secretory phases. Thus, we exhaustively unveil the transitions between the consecutive proliferative and secretory phases, highlighting their unique gene expression profiles and possible distinct biological functions. Transcriptome analysis reveals many differentially expressed genes (DEGs) across the menstrual cycle, most of which are phase-specific. As an example of the coordinated gene activity, the expression profile of his-tone-encoding genes within the HIST cluster on chromosome 6 showed an increase in cluster activity during the late-proliferative and a decline during the mid-secretory phase. Moreover, numerous DEGs are shared among all phases. In conclusion, in the current study, we delineate the endometrial proliferative phase-centered view of transcriptome dynamics across the menstrual cycle. Data analysis highlights significant transcriptomic and functional changes occurring during the late-proliferative phase – an essential transition point from the proliferative to the secretory phase. Future studies should explore how the biology of the late-proliferative phase endometrium impacts the achievement of mid-secretory endometrial receptivity or contributes to molecular aberrations leading to embryo implantation failure.

Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of thirty years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.

Climate and land use changes are major factors affecting runoff in regional basins. Understanding variation by considering interactions among hydrological components is an important process for water resource management. This study aimed to assess the variation of future runoff in the Upper Chi Basin, Northeastern Thailand. QSWAT hydrological model was integrated to 3 CMIP6 GCMs including ACCESS-CM2, MIROC6, and MPI-ESM1-2-LR under SSP245 and SSP585 scenarios during 2023 – 2100. Land Change Modeler (LCM) was also used for future land use simulation. The results revealed that future average of long-term precipitation and temperature tended to increase while forest land tended to decrease and be replaced by sugarcane plantations. The accuracy assessment of baseline year runoff calculation by QSWAT during 1997 – 2022 showed acceptable result as can be seen from R2, NSE, RSR, and PBIAS indices. This result could lead to temporal and spatial simulation of future runoff. Likewise, runoff of 2 SSPs scenarios tended to increase consecutively, especially in SSP585 scenario. In addition, in case of long-term spatial changes in the subbasins scale, over 90% of the area, from upstream to outlet point, tended to get higher due to 2 major factors including future increased precipitation and changes in cultivation, which would be influential to groundwater and interflow components respectively. Methodology and result of this study can be useful to stakeholders in understanding changes in hydrological system so that they can apply it to develop a strategy for water resource management and handling factors affecting different dimensions properly and sustainably.

This paper presents a numerical study on the vertical (axial) and lateral (flexure) behavior of CFST (Concrete-Filled Steel Tube) columns with active hoop prestress; this transverse prestressing effect is achieved by bolting together two steel half-tubes. This study refers to new construction only (i.e., no retrofit). 12 prototype CFST column specimens (segments) are analyzed. These specimens differ in the prestressing force (3 levels) and in the gravity loading ratio (4 levels); they are selected to represent typical ground columns of mid-rise buildings. The structural behavior of these column specimens is simulated with a nonlinear model implemented in Abaqus; the concrete and steel behavior are described with a damage-plasticity and a plasticity model, respectively. Finally, the interface concrete-steel interaction is represented by a hard (compression-only) surface-to-surface contact model. The calculations involve three consecutive loading steps: (i) transverse prestress, (ii) axial force, and (iii) lateral loading (shear force and bending moment). The structural behavior of the CFST columns is deeply examined and discussed; the results show that their axial-flexural capacity is adequate. Noticeably, it is concluded that the overall benefits of prestressing the columns are only modest. Preliminary studies on the aforementioned mid-rise buildings equipped with the CFST columns show that their gravity and wind capacities are largely enough; conversely, their seismic capacity is sufficient for moderate seismic ground motions only.

Study design: Technical note. Objectives: To present a new technique of treatment for a patient with thoracolumbar focal kyphosis due to osteoporotic verte-bral fracture (OVFs). Background : OVFs are common among the elderly population. Following a severe wedged fracture, patients often experience low back pain and disruptions in activities of daily living. Reconstruction surgeries, such as corpectomy, are among the treatment options for this condition. However, corpectomy requires longer surgical times and involves a significant amount of blood loss. Materials and Methods : An 80-year-old woman presented to our hospital with severe low back pain and gait disturbance. She had experienced an L2 OVF six years prior. Although she had no neurological deficit, she could not walk more than 200m due to pain. Preoperative spinal radiographs revealed severe sagittal malalignment, with the L2 vertebra collapsed and focal kyphosis of L1-3 measuring 34 degrees. Results: The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm free technique. The surgical time was 133 minutes with an estimated blood loss of 100 ml. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws (PPS) were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only. Post-operative images showed excellent spinal alignment, with local kyphosis reduced from 34 to 14 degrees, and no major or severe complications occurred. At one-year follow-up, the patient was able to walk smoothly, with her visual analogue scale for low back pain improving from 73mm to 13mm, and her Oswestry Disability Index improving from 53.3% to 13.3%. Conclusions/Level of Evidence : The simultaneous use of hyperlordotic cages and PPS is an effective and innovative navigation technique that yields promising outcomes for thoracolumbar focal kyphosis resulting from OVFs. This approach not only reduces surgical time but also minimizes intraoperative blood loss. Level V.

In the field of robotics education, introductory courses would ideally utilize heavy industrial arms for hands-on learning. This would provide students with valuable experience in joint programming, which involves direct control of each joint motor in the arm to accomplish desired path planning and differential movements. This practice requires consideration of the physical dynamics of the arm. However, the use of heavy industrial arms has several drawbacks. They are large and expensive, require specialized maintenance, can pose safety risks, and they typically do not allow for direct control of the joint motors. One solution is to use a small, lightweight, toy-like arm. While these are cost-effective and provide direct access to the joint motors without posing safety risks, their lightweight construction means they exhibit minimal dynamic behavior, which limits their educational value. Another solution involves a robotic arm simulator that uses a virtual arm. However, a virtual arm doesn't offer the same level of hands-on engagement and excitement as a physical arm. We propose a hybrid solution that combines a small physical arm with a virtual arm. This approach provides students with the experience of working with an industrial arm, but without the associated difficulties. We demonstrate how this approach successfully improved the completion rate of joint programming assignments, offering a promising solution for practical robotics education.

Certain micronutrients exhibit immunomodulatory effects. However, no intervention has yet investigated the effect of an individualized supplementation on the severity of upper respiratory tract infections (URI). Therefore, we investigated whether a personalized supplementation moderates the incidence and severity of URI. Selenium, zinc, and vitamin D was measured from 59 healthy participants ) in dried blood spots. Accordingly, a personalized supplement was provided with or without the respective micronutrients. We used WURSS-21 questionnaires to assess the disease status. The blood values converged during the intervention and micronutrients no longer differed at the end of the intervention period between treated and untreated volunteers. The incidence and severity of the illness did not significantly differ between the groups. However, when analyzing the WURSS-21 score by the intention to treat, the initially randomized treatment arm revealed a significantly higher score than the placebo arm. Upon acute administration, individualized combination of selenium, zinc and vitamin D does not reduce the number or contribute to a milder course of URIs. Therefore, supplementation in acute infectious situations seems questionable. Further studies must address the habitual diet in more detail to better understand the impact of individual micronutrient status on the prevention of URI.

MAD is the gold standard therapy for mild/moderate OSA and is a second-choice treatment in patients with severe OSA not responding to CPAP. The aim of this study was to analyze the upper airway characteristics of OSA patients and the morphological changes in the upper airway, inducted by four different types of mandibular advancement devices, using CBCT 3D imaging. Twenty-two patients were recruited after OSA diagnosis with polysomnography. Four different customized and titratable MAD were used and an initial CBCT scan was obtained for each patient. After 6 months to the end of the MAD titration phase, all the subjects showed an AHI of &lt; 5 or a decrease of 50% in AHI with MAD when compared with initial AHI and a second CBCT scan with MAD in situ was performed. An important improvement of the airway was observed (+33.76%) and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (respectively +42.77% and + 41.63%). MAD therapy is effective to treat mild/severe OSA with increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.

A concept of ensemble averaged stellar reactors is developed to study the dynamics of processes occurring in stars, allocated in the ~ 200 pc solar neighborhood. According to the effective temperature value, four stellar classes are identified, for which the correlation coefficients and standard deviation are counted. The theory of the buoyancy terrestrial elements is generalized to stellar systems. It was suggested that stars are over-heated due to the shift parameters of the nuclear processes occurring inside the stars, which leads to the synthesis of transuranium elements until the achievement of a critical nuclear mass and star explosion. The heavy transuranium elements sink downward and are concentrated in the stellar depth layers. The physical explanation of the existence of the critical Chandrasekhar star limit has been offered. Based on the spatial analysis of overheated stars, it was suggested that the withdrawal of the stellar reactor from the equilibrium state is a consequence of extragalactic compression inside the galaxy arm due to the arm spirality (not to be confused with the spirality of the galaxy itself).

In the last decade, robotic-mediated rehabilitation has emerged as a potential solution to improve repetitive task training. Each device in this field has a unique development history shaped by engineers’ expertise in specific programming languages or platforms. In this work we adopt an approach that tries to abstract from the final implementation with the aim to make control logic more shareable and understandable. The authors will present the outcomes of the application of a Rapid Control Prototyping strategy to an upper-limb robotic exoskeleton. A model-based design approach implemented on a real-time target machine is presented. This modern design approach was explored with several control strategies and was used to test the exoskeleton’s performances. The proposed method highlights how it is possible to develop the entire control architecture in a single programming environment.

Study design :Technical note. Objectives : To present a new unilateral biportal endoscopic technique for lumbar disc herniation without C-arm . Background : Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. Our study introduces the use of standard intraoperative navigation in unilateral biportal endoscopy (UBE) to reduce radiation exposure and increase surgical acuracy. Materials and Methods : A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had have conservative treatment for 12 months in another hospital before admission. However, the conservative treatment did not work for him. He had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle waekness of bilateral legs (Manual muscle testing ;MMT of extensor hullusis longs 4 4), and numbness of bilateral lower leg. Preoperative lumbar MRI showed L4/5 large central disc herniation. Results: He underwent C-arm free unilateral biportal endoscopic discectomy under the guidance of O-arm navigation. The patient was successfully treated surgically. Postoperative lumbar MRI showed good decompression of dural sac and bilateral L5 nerve roots. MMT and sensory function of both leg had recovered fully on final follow-up at one year. Conclusions/Level of Evidence: The new unilateral biportal endoscopic technique under navigation guidance is useful technique for lumbar disc herniation. This innovative technique proved to be safe, accurate, and minimized radiation exposure for surgeons for the treatment of lumbar intervertebral disc herniation. Level V.

The composition and pattern of ecosystems are important factors determining the overall status and spatial differences of ecosystem service functions. However, under the background of differential land policies and ecological protection policies, research on the trend of ecological system pattern changes in the Fenhe River Basin is insufficient. Taking the upper and middle reaches of the Fenhe River Basin as the study area, based on long-term NDVI index and multi-period LUCC remote sensing images, this study used spatial statistics and time trend analysis methods to analyze the spatio-temporal dynamic changes of vegetation, land use, landscape pattern, and explored the impact of major driving factors on ecosystem changes. The results show that: (1) From 2010 to 2020, the vegetation cover in the upper and middle reaches of the Fenhe River Basin increased, with an annual NDVI increment of 0.003 (P<0.001). NDVI showed an increasing trend spatially, with significant statistics (P<0.001) and significant changes (P<0.05) in vegetation in high-altitude mountain areas, and the vegetation cover was mostly forests or grasslands. There was no significant change in vegetation cover in the low-lying urban agglomeration area. (2) From 2010 to 2020, the area of water bodies or wetlands in the study area significantly decreased, with 51.3% converted to arable land and 33.9% transferred to construction land, while only 2.2% remained as water bodies or wetlands. From 2015 to 2020, the trend of water body changes slowed down, with the proportions of conversion to arable land and construction land being 44.0% and 18.4% respectively, while the area of wetlands or water bodies remained at 16.3%. During the period of 2015-2020, the area of water bodies or wetlands converted to other land types increased by more than 14% compared to 2010-2015. This proportion reached more than 30% compared to the 13th Five-year Plan Period. (3) From 2010 to 2020, the spatial changes of landscape diversity (SHDI) and evenness (SHEI) of LUCC showed heterogeneous characteristics. In the high-altitude areas near the river basin boundary, the values of SHDI and SHEI were below 1.0. While in the low-altitude plain areas and urban areas with relatively frequent human activities, the values of SHDI and SHEI were above 1.0, and the values in urban areas could reach above 1.5. The evolution of ecosystem patterns in the upper and middle reaches of the Fenhe River Basin in the past decade has been clarified, providing a scientific basis for the construction and management of ecological environment governance and restoration projects in the Fenhe River Basin, and providing practical references for ecological protection and high-quality development practice in the Yellow River Basin.

This paper proposes an upper bound for mine productivity and also a simple truck dispatch rule that demonstrates how tight the upper bound can be using simulation. It also proposes a greedy search to approximate the productivity upper bound, which is faster and often exact. Uncertainty is added to the simulation in order to verify how the productivity responds to it. Typically, the productivity upper bound is less tight close to its saturation point as a function of the number of trucks, where adding more trucks only increases queues. Furthermore, more uncertainty in the model typically leads to a less tight upper bound. The results are conducted using real data from an open pit mine in Brazil.

Nonlinear properties of zinc germanium diphosphide (ZGP) crystals enable their ap-plications in powerful mid-IR optical parametric oscillators and second-harmonic generators. This paper summarizes mechanisms of the laser induced damage (LID) in high-purity ZGP crystals under periodically pulsed nanosecond irradiation by a Ho3+:YAG laser at 2.1 μm. The ZGP samples were manufactured by “LOC” Ent., Tomsk, Russia, or Harbin Institute of Technology, China. The impact of processing techniques and the post-growing methods for polishing and anti-reflection coating on the LID threshold are discussed. The importance of the defect structure of the crystal lattice and the parameters of transparent coatings for increasing the LID threshold is discussed. The impact of the test laser parameters on the LID threshold is analyzed. The transient area near the LID threshold obtained using digital holography is ana-lyzed. Influence of the pre-damage processes on the optical parametric oscillations is reported. Prospects for improving ZGP crystals to further increase the LID threshold are discussed.

In order to deal with imprecision, ambiguity, and uncertainty in data analysis, Pawlak introduced rough set theory in 1982. This paper aims to expand the scope of basic set theory developed by presenting the notions of δP-upper and δP-lower approximations, that are based on the notion of δP-open sets, we additionally examine a few of their fundamental characteristics.

We compare the well known Rayleigh-Ritz variational method (RRVM) with a recently proposed approach based on supersymmetric quantum mechanics and the Gram-Schmidt orthogonalization method (SSQMGS). We apply both procedures to a particular class of double-well harmonic oscillators that had been conveniently chosen for the application of the latter approach. The RRVM eigenvalues converge smoothly from above providing much more accurate results with less computational effort. Present results show that the unproved SSQMGS upper bounds do not hold.

This paper examines the response of the ionosphere to the impact of two moderate geomagnetic storms observed in January 17 and 26-27, 2013 under conditions of strong sudden stratospheric warming. The study uses data from ground-based ionosonde measurements at the Alma-Ata ionospheric station (43.25 N, 76.92 E) combined with optical observation data (The Spectral Airglow Temperature Imager (SATI)). Ionosonde data showed that the geomagnetic storms under consideration do not generate ionospheric storms, but demonstrate some unusual types of diurnal foF2 variations with large (up to 60%) deviations of foF2 from median values observed during the night/morning periods on 13-15 and 20-23 January which do not have any relation to solar or geomagnetic activity. Wave-like disturbances in foF2, h’F and daily averaged foF2 values with quasi-period of 5-8 days and peak-to-peak amplitude from about 1MHz to 2 MHz (from 20% to 40%) and ~40 km are observed during the 9-28 January, after registration the occurrence of the major SSW event on 6-7 January. The observed variations in the OH emission rate are found to be quite similar to those observed in the ionosheric parameters that assume a community of processes in the stratosphere/mesosphere/ionosphere system. The study shows that the F-region of the ionosphere is influenced by processes in the lower ionosphere, in this case by processes associated with sudden stratospheric warming SSW-2013, which led to modification of the structure of the ionosphere and compensation of processes associated with the development of the ionospheric storms.

So far, scientific studies on high frequency welding (HF) have observed the three main parameters: anode current, welding time and pressure of upper electrode. Some authors have also observed and studied the welding frequency, the power, and the values of the dielectric constants of the materials or the angle of dielectric losses. Due to the complex effects that the parameters have on the quality of the welded joint, it is necessary to extend the research and study the mutual relationships between a large numbers of process parameters on the welded joint in order to achieve satisfactory strength of the welded joint. In this research, the number of considered parameters is increased to 17, each of which is relevant to the processes of HF welding, and their mathematical equations are presented. The research is carried out on a HF welding machine improved with a linear pneumatic actuator for lowering the upper electrode and regulating the compressive force, and a measuring machine with the appropriate measuring method for determining the breaking forces with a tension gage and performing the „T“ test is made. Numerous researches were carried out on the functional changes of the process parameters of the percentage share of the values of the coupling capacitor, the anode current and the welding time on the values of the breaking forces of the welded joints. Based on the conducted research, it was concluded that the optimization of the process parameters of HF machine must be performed before the welding process, which is determined by a certain amount of energy that must be introduced into the material. These parameters are the capacity of the output capacitor, i.e., the value of the electric current flowing through the material and the time for the development of the operating power to produce welded joints with a certain strength and quality of welded joints for a specific material used in the process.

The current work reports the upper bound of the state variable of the of the Pointwise Steady Fluid Flow Approximation (PSFFA) model of non-stationary M/Ek/1 queueing system.

At present paper, we aim to study the long-time behavior of a stochastic semi-linear degenerate parabolic equation on bounded or unbounded domain and driven by a nonlinear noise and defined. Since the theory of pathwise random dynamical systems can not be applied directly to the equation with nonlinear noise, first, we establish the existence of weak pullback mean random attractors for the equation by applying the theory of mean-square random dynamical systems; then, we prove the existence of (pathwise) pullback random attractors for the Wong-Zakai approximate system of the equation. In addition, we establish the upper semicontinuity of pullback random attractors for the Wong-Zakai approximate system of the equation under consideration driven by a linear multiplicative noise.

This paper introduces a novel method for accurately calculating the upper biomass of single trees using Light Detection And Ranging (LiDAR) point cloud data. The proposed algorithm involves classifying the tree point cloud into two distinct ones: the trunk point cloud and the crown point cloud. Each part is then processed using specific techniques to create a 3D model and determine its volume. The trunk point cloud is segmented based on individual stems, with each stem further divided into slices that are modeled as cylinders. On the other hand, the crown point cloud is analyzed by calculating its footprint and gravity center. The footprint is further divided into angular sectors, with each being used to create a rotating surface around the vertical line passing through the gravity center. All models are represented in a matrix format, simplifying the process of minimizing and calculating the tree’s upper biomass, consisting of crown biomass and trunk biomass. To validate the proposed approach, both terrestrial and airborne datasets are utilized. A comparison with existing algorithms in the literature confirms the effectiveness of the new method. The study shows that the proposed algorithm achieves an average fit between 0.01 m and 0.49 m for individual trees.

To reduce the cost of small wind turbines, a prototype of a butterfly wind turbine (6.92 m in diameter), a small vertical-axis type, was developed with many parts made of extruded aluminum suitable for mass production. An over-speed control system with movable arms that operated using centrifugal and aerodynamic forces was installed for further cost reduction. Introducing this mechanism eliminates the need for large active brakes and expands the operating wind speed range of the wind turbine. However, although the mechanism involving the use of only bearings is simple, the violent movement of the movable arms can be a challenge. To address this in the present study, dampers were introduced on the movable arm rotation axes to improve the movement of the movable arms. To predict the behavior of a movable arm and the performance of the wind turbine with the mechanism, a simulation method was developed based on the blade element momentum theory and the equation of motion of the movable arm system. Comparison of experiments and predictions with and without dampers demonstrated qualitative agreement. In the case with dampers, measurements confirmed the predicted increase in the rotor rotational speed when the shorter ailerons installed perpendicularly to the movable arms were used to achieve the inclination. The movable arm system with dampers is expected to be a useful device for vertical-axis wind turbines that are difficult to control.

Accurate and reliable mid-long runoff prediction (MLTRP) is of great importance in water re-sources management. However the MLTRP is not suitable in each basin and how to evaluate the applicability of MLTRP is still a question. Therefore, the total mutual information (TMI) index is developed in this study based on the predictor selection method using mutual information (MI) and partial MI (PMI). The relationship between the TMI and the predictive performance of five models is analyzed by applying five models in 222 forecasting scenarios in Australia. The results over 222 forecasting scenarios demonstrate that, compared with the MI, the developed TMI index can better represent the available information in the predictors, and has more significant negative correlation with the RRMSE with the correlation coefficient between -0.62 and -0.85. This means the model's predictive performance will become better along with the increase of TMI, and there-fore the developed TMI index can be used to evaluate the applicability of MLTRP. When TMI is more than 0.1, the available information in the predictors can support the construction of MLTRP models. In addition, the TMI is used to partly explain the difference of predictive performance among five models. In general, the complex models, which can better utilize the contained infor-mation, are more sensitive to the TMI, and have more significant improvement in terms of predic-tive performance along with the increase of TMI. This research can provide support for the study of MLTRP.

High average power narrow-linewidth tunable solid-state lasers in the wavelength region between 2 to 3 μm are attractive light sources for many applications. This paper reports a narrow-linewidth widely-tunable laser system based on the polycrystalline Cr2+:ZnSe elements pumped by the repetitively-pulsed 2.1 µm Ho3+:YAG laser operating at the tens of kilohertz pulse rate. An advanced procedure of ZnSe-element doping and surface improvement was applied to increase the laser-induced damage threshold, which resulted in an increase of the output power of the Cr2+:ZnSe laser system. The high-average-power laser system comprised double master-oscillators and power amplifiers: Ho3+:YAG and Cr2+:ZnSe laser oscillators, and Ho3+:YAG and Cr2+:ZnSe power amplifiers. The output wavelength was widely tuned within 2.3-2.7 µm by an acousto-optical tunable filter inside the Cr2+:ZnSe master oscillator cavity. The narrow-linewidth operation at the pulse repetition rate of 20-40 kHz in a high-quality beam with the average output power up to 9.7 W was demonstrated.

(1) Background: The lateral arm flap has been the very useful choice in the reconstruction of small- to medium-sized defects like hand, extremity, oral head and neck area reconstructions. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but the reconstructive potential in facial subunit after tumor ablative procedures has never been reported. In this study, we aimed to utilize the advantages of the flap to treat facial temple subunit defect reconstruction. (2) Methods: Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after malignant tumor wide excision. There were 7 women and 5 men, and the mean patient age was 60.6 years old. Among the patients with cancer, 6 had squamous cell carcinoma, 5 had basal cell carcinoma and 1 had myxofibrosarcoma. All the flaps were elevated under general anesthesia. Aloprostadil(PGE1, Eglandin®) were administered postoperatively. (3) Results: All the flap types were fasciocutaneous type with varied sizes from 3 × 4 to 5 × 7 cm (Average size of flap 22.7cm2) were utilized. The average pedicle length was 6.1cm. The versatility of the lateral arm flap enabled successful coverage of all cases with no specific complications. Good functional outcome and range of motion in the recipient arm were obtained after surgery. (4) Conclusion: The authors successfully verified the advantages of lateral arm flaps in the treatment of medium sized facial subunt temple defect reconstruction.