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.

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 < 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.

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.

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 artificial intelligent image recognition system, AIIRS, 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.

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 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.

Abstract: Hox gene clusters are crucial in Embryogenesis. It was observed that some Hox genes were located in order along the telomeric to centromeric direction of the DNA sequence: Hox1, Hox2, Hox3…. These genes were expressed in the same order in the ontogenetic units of the Drosophila embryo along the Anterior-Posterior axis. The two entities (genome and embryo) differ significantly in linear size and in-between distance. This strange phenomenon was named Spatial Collinearity (SP). Later, it was observed that, particularly in the Vertebrates, a Temporal Collinearity (TC) coexists: first is Hox1 expressed, later Hox2 and even later Hox3,…,. Hox clusters are irreversibly elongated along the force direction. According to a Biophysical Model (BM), pulling forces act at the anterior end of the cluster while a cluster fastening applies at the posterior end. During Evolution, the elongated Hox clusters are broken at variable lengths thus split clusters may be created. An Empirical Rule was formulated distinguishing development due to a complete Hox cluster from development due to split Hox clusters. BM can explain this Empirical Rule. In an accidental mutation where the cluster fastening is dismantled, a minimal pulling force can automatically shift the cluster inside the Hox activation domain. This cluster translocation can probably explain the absence of temporal collinearity in Drosophila.

Objective: To evaluate the clinical efficacy of antibiotic bone cement plus lateral bone repositioning for severe diabetic foot and its impact on wound healing rate. Methods: Sixty patients with hemodialysis anemia admitted to the endocrinology department of our hospital from July 2020 to July 2021 were included and randomly assigned to receive antibiotic bone cement plus lateral bone repositioning (observation group) or vacuum sealing drainage (VSD) (control group). Outcome measures included skin temperature of the affected limb, ankle-brachial index, sensory threshold, foot wound healing, dorsalis pedis artery hemodynamics, lower limb function and clinical efficacy. Results: Antibiotic bone cement plus lateral bone repositioning resulted in significantly higher treatment efficiency and transcutaneous partial pressure of oxygen, smaller wound, and lower trauma pH versus VSD, suggesting that antibiotic bone cement plus lateral bone repositioning contributes to potentiating the treatment efficacy and reducing the foot ulcer trauma, thereby facilitating rapid recovery. Patients given antibiotic bone cement plus lateral bone repositioning had larger vascular internal diameter and blood flow and better sensory conduction velocity of the common peroneal nerve and the motor conduction velocity of the tibial nerve versus those given VSD, indicating its vascular and neurological benefits. Conclusion: Antibiotic bone cement plus lateral bone repositioning enhances the treatment efficiency, boosts trauma healing, and promotes postoperative functional recovery of patients.

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.

Upper mesophilic temperature acclimation of halophilic, hydrogen-producing bacteria from salt fields was investigated in this study, along with the changes in microbial abundance during an-aerobic digestion (AD) process. Genomic approaches such as PCR-denaturing gradient gel elec-trophoresis (DGGE) and next-generation sequencing (NGS) were performed to profile the mi-crobial communities. During AD, there was a significant abundance of Halanaerobacter lacunarum at 48°C followed by the increase in hydrogen yield, signifying potential contribution from the halophile in the hydrogen production. A decrease in the dominance of H. lacunarum and Halan-aerobium fermentans at 42°C, likely due to an increase in other bacterial species, was noted but their dominance significantly increased at temperatures of 45°C and 48°C. This investigation provides valuable insights in highlighting the potential of Halanaerobium sp. and the other halo-philic bacteria to adapt under upper mesophilic temperature conditions and synthesizing hy-drogen. The findings in the present study also underscore the importance of optimizing temper-ature and pH conditions to maximize hydrogen yield during high-salt anaerobic digestion.

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.

Background: Arm elevation plays an important role in simple and complex daily tasks. Muscles that stabilize the shoulder girdle also function as respiratory accessory muscles. Dual demand on these muscles, particularly in patients with chronic respiratory conditions, leads to dyspnea and fatigue of the upper limb, making simple daily activities difficult. Various tests, including Grocery Shelving Task (GST), are designed to assess functional performance during upper limb activities. The aim of the study is to derive reference values for GST among the population of the United Arab Emirates Methods: This cross-sectional study was conducted with 220 healthy individuals of both genders between the ages of 20 and 69. Duration required to complete GST was recorded. The correlation between duration and age, height, body mass and body mass index (BMI) were also assessed. Results: Reference values for duration (in seconds) in females for age groups 20-29, 30-39, 40-49, 50-59 and 60-69 are 43.5±5.5, 43.1±8.08, 48.1±6.7, 44.9±7.1, 46.7±6.5 respectively. Values for males of age groups 20-29, 30-39, 40-49, 50-59 and 60-69 are 45.7±6.7, 44.8±8.9, 42.5±10.01, 53.4±4.2, and 53.9±5.4 respectively. Conclusion: Reference values for GST duration were obtained. Weak correlations were found between duration and age, height, body mass, BMI of the participants.

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.

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.

Background: The present study investigated the outcomes and possible predictive factors of autologous bone marrow cells (BMCs) therapy in patients with „no-option“ critical limb ischaemia (CLI). It was focused on exploring the clinical background and prior statin and renin-angiotensin system (RAS)-acting agent’s pharmacotherapy related to the therapeutic efficacy of BMCs treatment. Methods: In the present study, we have reviewed thirty-three patients (mean age 64.9 ± 10 years; 31 males) with advanced CLI after failed or impossible revascularisation, who were treated with 40 ml of autologous BMCs by local intramuscular application. Patients with limb salvage and wound healing (n=22) were considered responders to BMCs therapy, and patients with limb salvage and complete ischemic wound healing (n=13) were defined as super-responders. Logistic regression models were used to screen and identify the prognostic factors, and a receiver operating characteristics (ROC) curve, a linear regression and a survival curve were drawn to determine the predictive accuracy, the correlation between the candidate predictors and the risk of major amputation. Results: Based on the univariate regression analysis, baseline C-reactive protein (CRP) and transcutaneous oxygen pressure (TcPO2) values were identified as prognostic factors of the responders, while CRP value, ankle-brachial index (ABI) and bone marrow-derived mononuclear cells (BM-MNCs) concentration were identified as prognostic factors of the super-responders. An area under the ROC curve of 0.768 indicated good discrimination for CRP ˃ 8.1 mg/L before transplantation as a predictive factor for negative clinical response. Linear regression analysis revealed a significant dependence between the levels of baseline CRP and the concentration of BM-MNCs in transplanted bone marrow. Patients taking atorvastatin before BMCs treatment (n=22) had significantly improved TcPO2 and reduced pain scale after BMCs transplant, compared to the non-atorvastatin group. Statin treatment was associated with reduced risk for major amputation. However, the difference was not statistically significant. Statin use was also associated with a significantly higher concentration of BM-MNCs in the transplanted bone marrow compared to patients without statin treatment. Patients treated with RAS-acting agents (n=20) had significantly reduced pain scale after BMCs transplant, compared to the NON-RAS group. Similar results, reduced pain scale and improved TcPO2, were achieved in patients treated with atorvastatin and RAS-acting agents (n=17) before BMCs treatment. Results of the Spearman correlation showed a significant positive correlation between CLI regression, responders, and previous therapy before BMCs transplant with RAS-acting agents alone or with atorvastatin. Conclusions: CRP and TcPO2 were prognostic factors of the responders, while CRP value, ABI and BM-MNCs concentration were identified as predictive factors of the super-responders. Atorvastatin treatment was associated with a significantly increased concentration of BM-MNCs in bone marrow concentrate and higher TcPO2 and lower pain scale after BMCs treatment in CLI patients. Similarly, reduced pain scales and improved TcPO2 were achieved in patients treated with atorvastatin and RAS-acting agents before BMCs treatment. Positive correlations between responder and previous treatment before BMCs transplant with RAS-acting agents alone or atorvastatin were significant.

This study aimed to introduce a novel machine learning (ML) model designed to predict the need of interventions during endoscopy in patients with upper gastrointestinal bleeding (UGIB). The risk stratification tools in current use, such as the Glasgow Blatchford Score (GBS) and pre-endoscopic Rockall score, have limitations in accurately predicting the need for endoscopic interventions. All patients diagnosed with UGIB from January 2013 to October 2023 who underwent endoscopy were included in the study. Variables extracted included demographics, social history ,clinical history, clinical presentation and symptoms, drug history, management prior to endoscopy, findings during endoscopy, laboratory variables and vitals, and post-endoscopic results. Three machine learning models including Random Forest Classifier (RFC), Gradient Boosting Classifier (GBC), and AdaBoost Classifier were used to evaluate the need for intervention during endoscopy in our study. A total of 1372 patients were included from three major hospitals in Jordan, of whom 242 underwent endoscopic intervention. The GBC outperformed all other models and pre-endoscopic scores in predicting the need for endoscopic intervention with an area under the curve of 0.861. Findings during endoscopy, platelet count, pulse rate and systolic blood pressure during admission were the most contributing features in predicting the need for the need of endoscopic intervention. This study highlights the potential of machine learning models in enhancing decision making for UGIB management.

Hox gene clusters are crucial in Embryogenesis. It was observed that some Hox genes are located in order along the telomeric to centromeric direction of the DNA sequence: Hox1, Hox2, Hox3…. These genes are expressed in the same order in the ontogenetic units of the Drosophila embryo along the Anterior-Posterior axis. The two entities (genome and embryo) differ significantly in linear size and in-between distance. This strange phenomenon was named Spatial Collinearity (SP). Later, it was observed that, particularly in the Vertebrates, a Temporal Collinearity (TC) coexists: first is Hox1 expressed, later Hox2 and even later Hox3,…,. According to a Biophysical Model (BM), pulling forces act at the anterior end of the cluster while a cluster fastening applies at the posterior end. Hox clusters are irreversibly elongated along the force direction. During Evolution, the elongated Hox clusters are broken at variable lengths thus split clusters may be created. An Empirical Rule was formulated distinguishing development due to a complete Hox cluster from development due to split Hox clusters. BM can ‘explain’ this Empirical Rule. In a spontaneous mutation where the cluster fastening is dismantled, a weak pulling force automatically shifts the cluster inside the Hox activation domain. This cluster translocation can probably explain the absence of Temporal Collinearity in Drosophila.

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.

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.

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.

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].

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.

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.

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.

Limb-salvage surgery is the first choice for treatment of primary or metastatic bone tumors when possible to perform. Rehabilitation plays a major role after surgery, with the aim of improving function and maintaining the highest possible quality of life. Megaprostheses are currently the most frequent type of limb reconstruction used to treat the bone defect after tumor resection and The Modular Universal Tumor And Revision System (MUTARS®)is currently among the most used tumor and revision systems. Several studies have evaluated the causes and rate of failure of this system, but only few studies investigated the rehabilitative outcomes in terms of function and quality of daily life. The aim of this narrative review is to explore the correlations between functional outcomes and quality of life after implant of MUTARS® prostheses surgery in patients with bone tumor of the lower extremities. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: “MUTARS”, “Megaprosthesis”, “bone”, “tumors”, “metastasis”, “lower limb”, “rehabilitation”, “outcome”, “quality of life”, and 12 studies were included. The most frequent oncological pathology was found to be primitive bone tumors treated with modular prosthesis. Outcome measures used were Henderson et al classification, HHS, MSTS, VAS, ROM,LSR, KPS and quality of life questionnaire. Reconstruction of the lower limbs with the MUTARS® system seemed to be a valid treatment option after bone tumor resection. Rehabilitation after MUTARS® surgery is very relevant, but currently, functional and rehabilitative outcomes are inadequately represented in the literature. Therefore, further studies are needed to define best rehabilitation protocols in clinical practice after oncological orthopedic surgery.

Patients with Peripheral-artery-disease (PAD) are prone to risks of major-adverse-limb-events (MALE), and major-adverse-cardiovascular-events (MACE). CHA2DS2-VASc is a prognostic score for Atrial fibrillation stroke risk, however, no study exists that evaluated its predictability for MALE and MACE in PAD patients. In this study, patients with PAD were stratified into four risk groups based on CHA2DS2-VASc score. Cox-proportional hazards models,10-fold cross-validation and Receiver operating characteristic (ROC) analyses were utilized to evaluate the predictability of CHA2DS2-VASc for predicting MALE, MACE, and MALE+MACE. Kaplan-Meier analysis estimated the survival-probability of risk-groups. CHA2DS2-VASc was found to be a significant predictor of MACE (hazard ratio (95% confidence interval; P) = 3.47 (0.99 - 12.18; 0.052), 4.12 (1.19 - 14.14; 0.024), and 5.06 (1.48 – 17.28; 0.009), for moderate-, high- and very-high-risk groups, respectively, while for MALE and MALE+MACE significance was achieved only for high-risk group. MACE demonstrated AUC > 0.8, good-discrimination (c-index > 0.8) and good-calibration. However, MALE and MALE+MACE models failed to achieve good performances. Based on all findings, CHA2DS2-VASc could potentially serve as a risk stratification score for predicting MACE in patients with PAD but failed to qualify as a good predictor for MALE.