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关键词： cervical artery dissection   chiropractic manipulation   STOP-CAD registry   ischemic stroke   neck pain  

摘要： Objectives: Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults. Nearly 100 million annual chiropractic cervical manipulations are performed in the United States. The relationship between manipulation and CeAD remains controversial. Methods: We analyzed patients in the multicenter STOP-CAD registry (n=4023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between manipulation-associated and nonmanipulation-associated cases using chi 2 and t tests. Multivariable logistic regression identified key factors associated with manipulation-related CeAD. Results: About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P=0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P=0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P=0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P<0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P<0.001). Recurrent ischemic stroke rates were similar between groups. Conclusions: Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.

关键词： artificial intelligence   fractional flow reserve   coronary artery disease   coronary CT angiography   transcatheter aortic valve replacement  

摘要： Objectives:To explore the diagnostic accuracy and robustness of artificial intelligence (AI)-based fully automated CT-derived fractional flow reserve (CT-FFR) in detecting significant coronary artery disease (CAD) in patients with transcatheter aortic valve replacement (TAVR).Methods:This single-center retrospective study included consecutive patients who underwent TAVR between January 2020 and June 2023. All patients received preoperative coronary CT angiography (CCTA) and invasive coronary angiography (ICA). CT-FFR was evaluated with a fully automated AI-based software. The diagnostic performance of CCTA and CT-FFR for the identification of significant CAD was compared using ICA (>= 70% diameter stenosis) as the reference standard. Patients who underwent post-TAVR CCTA within 3 months were used to calculate CT-FFR values. The post-TAVR CT-FFR calculations were compared with pre-TAVR CT-FFR to evaluate the robustness of the AI-based ***:A total of 77 pre-TAVR patients and 164 vessels were included. Significant CAD was identified by ICA in 18 patients (23.4%). In per-patient analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 44.4%, 91.5%, 61.5%, 84.4%, and 80.5% for CCTA and 94.4%, 83.1%, 64.0%, 98.0%, and 85.7% for CT-FFR. The area under the receiver operating characteristic curve of CT-FFR was superior to CCTA (0.83 vs. 0.63, P = 0.001). Thirty-five (45.5%) patients underwent CT-FFR calculations before and after TAVR. There was good agreement between pre- and post-TAVR of CT-FFR values (intraclass correlation coefficient 0.85).Conclusions:AI-based fully automated CT-FFR enables to improve the diagnostic performance of CCTA for the detection of significant CAD pre-TAVR and demonstrates robust stability post-TAVR.

关键词： ACS   CAD   SYNTAX   CYP2C19  

摘要： Background Coronary angiography is the gold standard for assessing coronary artery disease (CAD), while the SYNTAX score (SxS) quantifies lesion complexity. Its prognostic value across clinical settings remains uncertain. This study compared angiographic findings in stable angina and acute coronary syndrome (ACS) using the SxS. Methods A prospective study was conducted at Shaikh Zayed Hospital, Lahore, over 12 months, including 156 patients undergoing coronary angiography: stable angina (n = 78) and ACS (n = 78). Patients aged 18-80 years undergoing primary PCI or elective angiography were included, excluding prior PCI or CABG. Demographic and clinical data were collected, and SxS was applied post-angiography. Data were analyzed using SPSS v.25, with p <= 0.05 considered significant. Results A total of 156 patients were enrolled (71.2% male;mean age 59.2 +/- 10.6 years, BMI 27.2 +/- 3.5 kg/m(2)), equally divided into stable angina (n = 78) and ACS (n = 78). The overall mean SxS was 26.1 +/- 11.3. Comparison between groups showed no significant differences in age, BMI, sex distribution, smoking, hypertension, or diabetes (all p > 0.05). However, dyslipidemia was more prevalent in ACS patients (p < 0.05), and the mean SxS was significantly higher in ACS versus stable angina (28.2 +/- 9.9 vs. 23.8 +/- 12.4;p = 0.01), indicating greater angiographic complexity. Discussion The higher SxS in ACS patients indicated greater angiographic complexity, consistent with prior studies. Scores were also significantly elevated in patients with diabetes and hypertension, supporting the score's prognostic value in CAD stratification. However, the absence of clinical variables limits risk prediction. The single-center design, small sample size, lack of adjusted analyses, and absence of long-term outcomes further constrain generalizability, warranting validation in larger multicenter cohorts. Conclusion The SxS was significantly higher in ACS than stable angina, supporting its role in g

摘要： Purpose: To compare retention and occlusal force distribution between a conventional technique and two 3D-printed CAD/CAM duplication techniques for refitted maxillary complete dentures. Materials and Methods: In total, 20 completely edentulous individuals with preexisting complete dentures participated in this within-subject controlled clinical trial. Dentures were duplicated using three methods: Group I (conventional duplication), Group II (3D printing to create a separate base made of pink polymethyl methacrylate [PMMA] and teeth made of tooth-colored PMMA dentures), and Group III (3D printing of a single-unit denture with a veneered base made of pink photocurable resin). Occlusal force distribution was measured for the reference denture before duplication. Retention and occlusal force distribution were measured at the time of denture delivery. One-way ANOVA was used for group comparisons, and Bonferroni's post hoc test was used for multiple comparisons. Results: The highest mean retention was observed in Group II (36.53 +/- 3.75), followed by Group III (35.01 +/- 3.41) and Group I (27.95 +/- 4.32), with a statistically significant difference between Group I and the other two groups. For occlusal force distribution, the highest mean difference was recorded in Group I (14.35 +/- 3.25), followed by Group II (7.60 +/- 1.84) and Group III (3.82 +/- 0.91), compared to the reference denture with a statistically significant difference (P = .001). Conclusions: Within the study's limitations, 3D-printed dentures showed superior retention and more balanced occlusal force distribution compared to conventional dentures. These findings imply that 3D-printing technology may improve prosthodontists, ability to construct duplicate dentures. Intl Prosthodont 2026;39:183-192. doi: 10.11607/O.9274

关键词： Aeonium   Canary Islands   Crassulaceae   crassulacean acid metabolism   cuticle   functional traits   minimum conductance   succulence  

摘要： Discovering functional and evolutionary interdependencies of hydraulic traits and crassulacean acid metabolism (CAM) is crucial to understand CAM phenotype diversity and convergence. In complex traits such as CAM, the co-option of associated traits strongly impacts the evolutionary outcome. Here we study Aeonium (Crassulaceae), a diverse Macaronesian genus that exhibits a broad array of CAM expression, focusing on two CAM-associated traits, minimum conductance (gmin) and succulence. At the heart of the study, there are two experiments: a comparative cultivation experiment to monitor nocturnal acidification (Delta H+) under drought and heat treatments and a leaf-drying curve experiment to quantify gmin. Our study group was comprehensively sampled to cover its phylogenetic and ecological diversity. We found a consistently negative correlation of gmin and Delta H+, indicating a critical role for the cuticle in the function of CAM. Although Delta H+ and succulence were overall not positively correlated, we found evidence that more succulent species remain in the CAM mode when stress is relaxed. We conclude that there is a tight evolutionary link between cuticular transpiration barrier properties and CAM performance. Thereby, the stronger CAM plants express diurnal stomatal closure typical of CAM, the more they may optimise water-use efficiency through reduced gmin.

关键词： narrow-gap welding technique   TC4 titanium alloy   thermal cycling   microstructure   mechanical property  

摘要： Thermal cycling has a significant impact on the microstructure and properties of narrow-gap welded joints in titanium alloy thick plates. In this study, a 60 mm-thick TC4 titanium alloy welded joint was fabricated using oscillating-wire magnetic-controlled arc narrow-gap welding technique. The evolution of the microstructure (alpha phase, beta phase, and grain boundary alpha(GB)), as well as changes in microhardness and its tensile properties under typical thermal cycling conditions were investigated through numerical simulation. The results show that high-temperature thermal cycling induces a complete alpha ->beta transformation, promoting the preferential growth of the alpha phase and forming coarse and uniformly-oriented alpha colonies. In contrast, subsequent low-temperature thermal cycling causes an incomplete alpha ->beta transformation, where lower cooling rate and temperature gradient weaken the preferential orientation, leading to the refinement of lamellar alpha phase. After the entire thermal cycling process, the thickness of lamellar alpha phase increases from 0.91 +/- 0.09 mu m to 1.02 +/- 0.18 mu m, and the proportion of residual beta phase increases from 0.02% to 1.89%. The weld root layer exhibits the highest microhardness, attributed to grain refinement strengthening. The root layer also demonstrates the highest tensile strength, while the cap layer shows the highest elongation. The joints exhibit ductile fracture behavior overall.

关键词： femoroacetabular impingement   sacroiliac joint   cam resection   finite elemental analysis  

摘要： Background: Patients with femoroacetabular impingement (FAI) frequently experience sacroiliac joint (SIJ) pain. Patients with concomitant lower back symptoms may be at risk for poor patient-reported outcomes after cam resection. Purpose: To investigate whether SIJ stress in patients with FAI changes depending on posture or cam resection. Study Design: Descriptive laboratory study. Methods: Preoperative and postoperative computed tomography (CT) scans were analyzed in 31 patients with FAI who underwent cam resection. We created CT models of the lumbar spine, pelvis, and hip joints, including the SIJ cartilage and surrounding ligaments. For both pre- and postoperative conditions, we constructed models of standing, sitting, and sitting with 10 degrees posterior pelvic tilt positions and measured the equivalent stress in the anterior, superior-posterior, and inferior-posterior regions of the SIJ under a 600-N load. Results: Preoperatively, the equivalent stress in the posterior-inferior SIJ region was generally higher in the sitting than in the standing position (up to 2.87-fold, P < .0001), whereas there was no significant difference between standing and sitting with a 10 degrees posterior pelvic tilt position. After cam resection, the equivalent stress in the lower portion of the SIJ during sitting generally decreased (P < .0001). A positive correlation was observed between the preoperative posterior-inferior SIJ equivalent stress in the sitting position and preoperative alpha angle (r = 0.40;95% CI, 0.04-0.66). Conclusion: In patients with FAI, the equivalent stress in the lower portion of the SIJ generally increased in the sitting posture. Cam resection decreased the equivalent stress in the posterior-inferior SIJ region in the sitting posture to a level similar to that observed with a 10 degrees posterior pelvic tilt before surgery. Clinical Relevance: These findings suggest that optimizing pelvic posture and appropriate cam resection may help mitigate SIJ-related

关键词： colorectal cancer screening   artificial intelligence   real-time characterization   colonic polyp  

摘要： INTRODUCTION:Polypectomy-related costs could potentially be reduced through optical diagnosis strategies, such as "diagnose-and-leave" and "resect-and-discard." Artificial intelligence, using computer-aided diagnosis (CAD), may provide a reproducible optical diagnosis of colorectal lesions. This study aimed to assess the performance of the CAD-EYE system in the real-time characterization of colonic polyps.
METHODS:We conducted a cross-sectional, multicenter study evaluating the CAD-EYE system in patients undergoing screening colonoscopies at 5 French centers. CAD-EYE predictions and assessments by endoscopists (hyperplastic vs neoplastic) were compared with histopathology results. The primary outcome was the sensitivity of CAD-EYE for predicting neoplastic polyps, compared with the predefined threshold of 85%. The secondary outcomes were the specificity, positive predictive value, negative predictive value, endoscopists' performance, and polyp detection rates.
RESULTS:Of 398 polyps analyzed, 343 were included in the primary analysis. CAD-EYE characterization was feasible in 96% of cases. The sensitivity was 0.80 (95% confidence interval, 0.74-0.85), which failed to achieve the predefined threshold of 85% (P = 0.064). The specificity, negative predictive value, and positive predictive value were 0.79, 0.64, and 0.90, respectively. Performance was higher for diminutive rectosigmoid polyps (DRSPs). Endoscopists showed higher sensitivity than CAD-EYE (0.90 vs 0.80, P = 0.001). CAD-EYE-assisted colonoscopies detected more polyps per procedure (3.3 vs 2.3, P < 0.001) than endoscopists alone.
DISCUSSION:The performance of CAD-EYE was insufficient for the characterization of neoplastic colonic polyps. CAD-EYE performed better for DRSPs. AI seems to be beneficial for polyp detection.