Search Results (8,947)

Background/Objectives: Chronic wounds are a major source of morbidity in patients with paraplegia, often resulting in repeated treatment, prolonged hospitalization, and reduced quality of life. Reconstruction becomes particularly challenging when a wound arises in a scarred trunk region and is further complicated by deep infection, osteomyelitis, or enteric fistula. We describe the staged management of a complex left flank wound in a paraplegic patient, initially reconstructed with a quadrilateral pinwheel flap and later requiring multidisciplinary salvage for recurrence associated with rib osteomyelitis and a colocutaneous fistula. Methods: A paraplegic man in his 50s presented with a chronic left flank wound after repeated full-thickness skin graft failure and persistent Pseudomonas aeruginosa infection. After wide debridement, the approximately 7 × 7 cm defect was reconstructed with a quadrilateral pinwheel flap composed of four Limberg-style rhomboid fasciocutaneous flaps positioned at the 12, 3, 6, and 9 o’clock orientations, elevated at the level of the deep fascia, and transposed into the central defect, with adjunctive negative-pressure wound therapy (NPWT). Approximately 1 year later, recurrence with rib osteomyelitis required rib resection. During NPWT, feculent drainage led to the diagnosis of a colocutaneous fistula. Subsequent multidisciplinary treatment included fistula tract resection, colonic repair with omental patching, transposition of vascularized omentum into the chest wall cavity to obliterate dead space, continued NPWT, and delayed primary closure. Results: Initial local flap reconstruction achieved wound coverage, and immediate postoperative clinical assessment, including pinprick and refill testing, confirmed satisfactory flap perfusion; however, delayed recurrence developed in association with rib osteomyelitis. After definitive fistula surgery, dead-space management with vascularized omentum, wound conditioning with staged NPWT, and delayed primary closure, the wound healed completely. At 6 months after delayed closure, no recurrence of fistula, osteomyelitis, wound dehiscence, or soft-tissue breakdown was observed, and the patient’s daily comfort and functional independence were improved compared with the preoperative condition. Conclusions: A quadrilateral pinwheel flap may provide an effective tension-dispersing local fasciocutaneous option for selected scarred trunk defects in high-risk patients. However, when chronic wounds are compounded by deep infection and enteric fistula, durable healing depends not on flap design alone but on staged multidisciplinary management incorporating definitive source control, vascularized tissue transfer for dead-space elimination, NPWT, and appropriately timed closure. Full article

To improve the efficiency and output power of the twin-screw expander used in natural gas pressure energy recovery, a hybrid NGO-SDERIME algorithm is proposed for structural optimization, with the structural parameters of the male and female rotors selected as the optimization design variables. First, the enhanced Rime Ice Optimization (RIME) algorithm is adopted to perform hybrid improvement on the Northern Goshawk Optimization (NGO) algorithm; then, the stability and superiority of the proposed hybrid algorithm are verified by using a suite of benchmark test functions; finally, the algorithm is applied to the structural optimization of the twin-screw expander, followed by numerical simulation and experimental verification. The results indicate that, compared with other existing algorithms, the proposed NGO-SDERIME hybrid algorithm shows excellent convergence and strong optimization performance. After optimization using this algorithm, the output power of the screw expander increases by 5.5%, the high-speed leakage area is significantly reduced, the isentropic efficiency improves from 75.1% to 78.1%, and the average mass flow rate increases from 18.42 t/h to 18.72 t/h. Full article

Surgical resection remains a cornerstone in the multidisciplinary management of central nervous system (CNS) tumors, particularly diffuse gliomas. Traditionally, the role of surgery has been evaluated primarily through quantitative metrics such as extent of resection and its association with survival outcomes. However, despite maximal and radiologically complete resections, recurrence remains nearly universal in malignant CNS tumors, suggesting that surgical cytoreduction alone does not fully account for post-surgical disease dynamics. Emerging biological and molecular evidence indicates that surgery represents not merely a technical intervention, but a biologically active event that profoundly reshapes tumor evolution and treatment response. In this review, we propose a conceptual framework that redefines surgery as a key biological driver in CNS tumor progression. We synthesize evidence demonstrating that surgical trauma induces inflammation, hypoxia, vascular remodeling, immune modulation, and extracellular matrix reorganization, collectively reprogramming the residual tumor microenvironment. These changes create selective pressures that favor the survival and expansion of adaptive tumor cell subpopulations, including invasive and stem-like phenotypes. From an evolutionary perspective, surgical resection functions as an acute selective bottleneck acting on heterogeneous tumor ecosystems, contributing to clonal selection and molecular divergence at recurrence. We further examine the dissociation between surgical (anatomical) margins and molecular (biological) margins, highlighting how biologically active tumor cells infiltrate beyond radiologically defined boundaries. This discrepancy provides a biological explanation for marginal and distant recurrences and challenges anatomy-based paradigms of surgical completeness. Importantly, we discuss how surgery-induced biological changes influence postoperative radiotherapy and systemic therapies, affecting radiosensitivity, target delineation, and therapeutic vulnerability. Finally, we outline future directions toward surgery-integrated precision neuro-oncology, emphasizing the potential of spatial profiling, liquid biopsy, advanced imaging, and artificial intelligence to capture perioperative tumor evolution. By reframing surgery as a biological inflection point rather than a neutral prelude to adjuvant treatment, this review advocates for a dynamic, biology-driven continuum of care aimed at anticipating tumor adaptation and improving long-term disease control in CNS tumors. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent disorder in adults, characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, sympathetic activation, and sleep fragmentation. It is linked to significant cardiovascular, metabolic, neurocognitive, and psychosocial morbidity. There is increasing evidence that continuous positive airway pressure (CPAP) adherence remains suboptimal in many patients, and in those patients, surgery is often indicated. Methods: This protocol report presents an updated and protocol-driven surgical approach grounded in clinical evidence and experience, highlighting the role of drug-induced sleep endoscopy (DISE) and personalized multi-level interventions for adult patients with OSA. The integration of anatomical phenotyping and DISE-directed planning enables precise surgical targeting. The protocol emphasizes patient selection, individualized treatment based on obstruction patterns, and perioperative optimization. This surgical algorithm improves the success rates and long-term outcomes in patients who are intolerant of CPAP therapy. Results: A DISE-guided and multi-level surgical approach includes uvulopalatoplasty, septoplasty, tongue base reduction, palatoplasty, and maxillomandibular advancement (MMA). Preoperative assessments include BMI and the STOP-BANG and Epworth Sleepiness scales, while postoperative care emphasizes follow-up polysomnography and adjunctive therapies only when necessary. Regional experiences in Saudi Arabia and Canada underscore the importance of standardized evidence-based surgical care. Conclusions: The purpose of this article is to establish a clear protocol for managing patients diagnosed with OSA, drawing on a review of the existing literature and the insights of experienced surgeons in the field of sleep apnea, and to update current protocols with modern evidence. Full article

External leakage from valve stem packings is a critical safety and reliability issue in high-pressure hydrogen systems. This work aims to quantify how packing geometry and polymer selection influence stem sealing in a PN650 needle valve (316L body and stem). Two geometries were compared: a conical V-ring (chevron style) stack and a flat three-disc stack. Two polymer material sets were assessed: Vespel^® polyimide (SP-1/SP-21) and a glass-filled PTFE sealing element combined with a virgin PEEK back-up ring. Four assemblies (one per geometry/material combination) were first screened by hydrostatic pressure hold testing up to 1500 bar and by helium mass spectrometer leak measurements under vacuum. All assemblies sustained the hydrostatic overpressure hold with negligible decay. Vacuum helium screening produced leak rates between 3.7 × 10⁻¹⁰ and 9.5 × 10⁻¹⁰ mbar·l·s⁻¹, with the conical V-ring geometry consistently outperforming the disc stack. A more demanding helium test at 700 bar with external vacuum yielded leak rates of 3.6–3.7 × 10⁻⁸ mbar·l·s⁻¹, for conical assemblies. Based on the screening results and practical industrial considerations, the PTFE/PEEK conical configuration was selected for endurance testing and completed 2500 open/close cycles in 650 bar hydrogen without gland readjustment. Post-cycling checks confirmed continued tightness, including a qualitative helium pressure hold result near 700 bar and 0 bubbles in 10 min in the seat tightness test. Microscopy/EDX revealed limited wear with minor metallic transfer. The proposed multi-stage workflow provides a pragmatic route for the early qualification of stem packings for high-pressure hydrogen valves. Full article

Metal additive manufacturing (AM) offers unprecedented opportunities to fabricate complex, lightweight metallic components, yet its practical deployment remains fundamentally constrained by defects arising from rapid melting and solidification. Cyclic thermal transients generate cracks, pores, residual stresses, and lack-of-fusion regions, undermining mechanical performance and reliability. Ultrasonic field-assisted laser-based additive manufacturing (UF-LBAM) has emerged as a powerful approach to manipulate melt pool dynamics and suppress defect formation. Nevertheless, the governing physical mechanisms remain poorly understood, particularly under highly non-equilibrium ultrasonic excitation, where acoustic pressure oscillations, melt convection, cavitation, and solidification are intricately coupled across multiple temporal and spatial scales. Here, we provide a systematic review of X-ray based fundamental studies in UF-LBAM and the diverse applications of machine learning (ML), detailing the literature selection criteria and methodology. We highlight advances spanning synchrotron X-ray revealed physical phenomena, ML-driven real-time monitoring and defect prediction, and pathways toward industrial implementation. Critical challenges persist, including fundamental physics gaps, transferability of ML models across alloy systems, and real-time control limitations. We further identify promising directions for the field, such as physics-informed models, multimodal diagnostics, and closed-loop control, which together promise to unlock the full potential of UF-LBAM for high-performance metal component fabrication. Full article

Next-generation sequencing (NGS) has impacted the treatment landscape for mCRC, leading to improved outcomes through the use of molecularly targeted and immune checkpoint inhibitor therapies. The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) recommend, at a minimum, initial testing to assess RAS, BRAF, HER2, and microsatellite instability (MSI)/mismatch repair (MMR) status, as these results determine therapeutic eligibility. Broader testing to identify the eligibility for tumor-agnostic therapy for a tumor mutation burden (TMB), NTRK gene fusions, and RET fusions is encouraged for all patients with advanced solid tumors. Patients with metastatic disease may develop progressive disease, often as a result of adaptive resistance mechanisms and selective therapeutic pressure on disease heterogeneity. Repeat biomarker testing at progression has the potential to define these resistance mechanisms and to guide the next therapy or clinical trial enrollment. While these practices have become more commonplace, unified guidelines have yet to be established. In this review of the literature, we evaluate the advantages and pitfalls of sequential biomarker testing during disease progression in patients with mCRC. Full article

Understanding wind–structure interaction (WSI) in low-rise buildings remains a significant challenge in wind and structural engineering, particularly under highly turbulent and non-stationary wind phenomena such as downbursts and tornado-like vortices. While Computational Fluid Dynamics (CFD) has become a widely adopted tool for predicting wind-induced loads, validation efforts remain predominantly limited to aerodynamic quantities—such as pressure and velocity fields—with insufficient consideration of structural response. This study presents a structured review of contemporary research in wind engineering, encompassing field measurements, wind tunnel experiments, and CFD modeling approaches. Particular attention is paid to turbulence model selection, methodological limitations of conventional validation strategies, and the often-overlooked necessity of incorporating structural response assessment into the validation process. Based on a synthesis of existing research, the paper outlines a multi-level validation perspective in which aerodynamic and structural validation are treated as interconnected components rather than independent procedures. The review identifies a prevailing focus on aerodynamic coefficients and flow field agreement, often lacking systematic integration of structural-scale verification. The proposed perspective emphasizes the need for a transparent and reproducible link between CFD-derived aerodynamic loads and structural response assessment. By bridging computational wind engineering and structural mechanics, this study supports a more reliable evaluation of wind-induced effects on building components and contributes to the development of robust, wind-resilient design methodologies for low-rise structures. Full article

Right ventricular pressure overloading [RVPO] with secondary maladaptive RV remodeling and progressive myocardial dysfunction in patients with pulmonary hypertension associated with left-sided heart diseases [PH-LHDs] and in those with pulmonary arterial hypertension [PAH] still remains one of the most complex challenges in cardio-pulmonary medicine. Despite the advances in the optimization of diagnostic tools and the expansion of treatment options, there is still a great need for further research to gain a better understanding of the major pathophysiological mechanisms involved in both the RV responses to PO and to find new possibilities to stop the progression of the alterations inside the pulmonary arterial circulation [PAC]. This article summarizes current knowledge about the particularities of the RV structural and functional responses to abnormal PO and also provides an overview of the benefits and limitations of the currently available tools for clinical evaluations of the RV adaptability to high afterload. A major focus of this review relates to the possibilities for obtaining evidence about the existence of a still remaining adaptability to a normal afterload in an over-burdened RV, in case of abolition of the pathological PO and, in this regard, to also evaluate the clinical usefulness of the RV adaptability estimation for certain critical therapeutic decisions. Among the most important conclusions of this updated overview are: 1. Whereas single parameters are insufficiently reliable for the evaluation of RV dysfunction and for predictions of its prognostic relevance across the whole spectrum of RVPO, properly selected and integrated multiparametric approaches had meanwhile unequivocally proved that they can usually become sufficiently reliable. 2. Multiparametric approaches can substantially improve the prediction of a preserved RV responsiveness to the abolition of its steady PO by reversal of RV maladaptive remodeling and by the normalization of RV pump function. Such a prediction, which can be decisive for therapeutic decision-making especially in candidates for ventricular assist device [LVAD] implantation or thoracic organ transplantation, can have a crucial impact on patient survival. 3. The complex and temporally highly variable interactions between certain structural and functional changes in both the PAC and in the hemodynamic overloaded right-sided heart, as well as between the two ventricles, can often hamper the interpretation of certain changes in the measured parameters and even relevantly alter their reliability. Additionally, the progressive aggravation of a secondary tricuspid regurgitation [TR] has a particularly high negative (often also misleading) impact on the diagnostic and prognostic relevance of RVPO evaluations. Full article

Photocatalytic CO₂ reduction to high-value-added C₂+ products is a practical route from an economic viewpoint for advancing the industrialization of CO₂ conversion. Despite significant progress in catalyst modification in recent years (such as defect engineering, heterostructure construction, and single-atom modification), the generation of C₂+ products still faces challenges due to the slow kinetics of multi-electron reactions and the high thermodynamic barrier for C-C coupling. Moreover, the severely imbalanced molar ratio of CO₂ to H₂O in the traditional liquid-phase reaction systems exacerbated the challenge to the unfavorable situation. This article summarizes various strategies to improve the yield of C₂+ products through the regulation of reaction environments, including: (1) increasing the partial pressure of CO₂ to enhance its solubility; (2) using alternative solvents like ionic liquids to reduce water content; (3) transitioning the reaction system from liquid phase to gas phase; (4) designing a three-phase (gas–liquid–solid) interface or floating photocatalysts to optimize reactant transfer and local concentration; (5) utilizing photothermal synergistic effects to enhance the reaction temperature and efficiency under concentrated light. It also discusses the role of different reactor designs in improving the reaction environment. Finally, it emphasizes that future research should pay more attention to the optimization of the reaction environment engineering in addition to catalyst design, providing new perspectives for achieving efficient and highly selective C₂+ products in CO₂ photoreduction. Full article

Municipal solid waste (MSW) management faces increasing pressure due to rapid urbanization and the need for low-emission energy systems. This study investigates the thermogravimetric gasification behavior of Chinese MSW under CO₂, mixed air-CO₂, and SrMnO₃ (SMO) oxygen-carrier atmospheres to identify pathways for producing clean and higher-quality syngas. Using TGA-QMS, the gasification stages were monitored qualitatively and quantitatively over the temperature range of 750–1000 °C, while complementary FTIR, XRD, SEM-EDS, and ICP-OES analyses were employed to characterize the fresh waste and ash samples. Results show that CO₂ gasification is strongly dependent on temperature and concentration, producing CO via Boudouard reaction, resulting in a gas composition of 73% CO and 27% CO₂. An air-CO₂ mixture as a gasification agent shifted conversion toward combustion, producing high CO during oxidation but suppressing gasification, yielding syngas dominated by 90% CO and 10% CO₂. Introducing SMO significantly altered the reaction pathway via lattice-oxygen transfer: 7–56.75 mg SMO produced up to 97% CO and 3% CO₂, without external oxidants, demonstrating superior per-unit oxidizing capacity compared to CO₂. A mild synergistic effect was observed in the mixed CO₂-SMO investigation, where CO formation exceeded that obtained with CO₂ alone but remained lower than that in SMO-only gasification. In general, SMO-enabled oxygen donation provides a promising low-dilution, high-selectivity route for MSW gasification within thermogravimetric regimes. Full article

Hemp (Cannabis sativa L.) is an important crop, yet little is known about how herbivory and soil microbial communities interact to influence plant performance. In this study, two hemp cultivars, BaOx and Cherry Citrus, were grown under identical greenhouse conditions and exposed to naturally occurring background populations of the two-spotted spider mite (Tetranychus urticae). Plant traits were measured, and rhizosphere soil was sampled for 16S rRNA gene sequencing to compare bacterial community composition and diversity between cultivars. Spider mite injury was assessed using a standardized 0–5 visual damage scale commonly applied in integrated pest management studies. Although the cultivars did not differ significantly in growth traits, Cherry Citrus experienced significantly less spider mite damage than BaOx, suggesting greater tolerance or resistance to herbivory under shared conditions. Rhizosphere bacterial communities differed markedly between cultivars despite identical soil and environmental conditions. BaOx rhizospheres were enriched in Actinobacteria, including taxa associated with decomposition and antimicrobial compound production, whereas Cherry Citrus rhizospheres were enriched in Alphaproteobacteria, particularly nitrogen-cycling and root-associated taxa such as Rhizobium and Reyranella. Alpha diversity metrics did not differ between cultivars; however, beta diversity analyses revealed significant cultivar-level separation, particularly in phylogenetic community structure. Because herbivore pressure and microbial communities were not experimentally manipulated, this observational study identifies ecological associations rather than direct causal relationships. Nevertheless, the results demonstrate that hemp cultivar identity is associated with distinct rhizosphere microbiomes and differential susceptibility to spider mite damage. These findings highlight the potential for integrating cultivar selection and microbiome-informed strategies into sustainable pest management programs for hemp. Full article

Given the rising demand for phosphate, a critical mineral for many countries due to its essential role in fertilizer production and global food security, reprocessing waste generated during phosphate mining has become increasingly important to mitigate demand pressures and reduce the environmental impact of the mining industry. This study aims to develop a sustainable hydrometallurgical process to recover residual phosphate from a lithology present in mining waste rock. To this end, a thermodynamic analysis was first performed to assess reaction feasibility during leaching and precipitation. A two-step process was then proposed: the first step involves leaching carbonates (mainly calcite) using acetic acid, optimized through response surface methodology based on a Box–Behnken design; the second step consists of precipitating calcium with phosphoric acid to produce a value-added by-product (brushite) while simultaneously regenerating the acetic acid. A preliminary economic assessment was conducted to evaluate process feasibility. The results show that acetic acid is highly selective for carbonates, yielding a phosphate concentrate containing 30% P₂O₅ with complete phosphate recovery under the following conditions: 3.4 molL⁻¹ acid concentration, 28 °C reaction temperature, a liquid-to-solid ratio of 6 mLg⁻¹ (14.2% solids), and a reaction time of 49 min. In the precipitation step, a calcium recovery of 97% was achieved under optimal conditions (20 °C, 15 min, 500 rpm stirring, and a P:Ca ratio of 1). Furthermore, the preliminary economic assessment indicates that the developed process, based on the use of an organic acid and its recycling, generates a net profit, confirming its economic viability and its contribution to environmentally sustainable phosphate processing. Full article

Addressing the thermal management challenges of prismatic aluminum shell lithium battery modules in electric vehicles under high-rate charge–discharge conditions, this study proposes a multi-objective optimization design method for integrated biomimetic liquid cooling plates. By integrating various highly efficient heat transfer structures from nature, including fractal-tree-like networks, leaf vein branching systems, and spider web radial distribution, a novel biomimetic liquid cooling plate topology was constructed. A multi-physics coupled numerical model considering electrochemical heat generation, thermal conduction, convective heat transfer, and thermal stress deformation was established. The NSGA-II algorithm was employed to globally optimize 12 design variables including channel geometric parameters, operating conditions, and structural dimensions, achieving collaborative optimization objectives of maximum temperature minimization, temperature uniformity maximization, pressure drop minimization, and structural lightweighting. The weight coefficients for the four optimization objectives were determined through the Analytic Hierarchy Process (AHP) with verified consistency (CR = 0.02 < 0.10), ensuring rational priority allocation aligned with automotive safety standards. The optimization results demonstrated that compared to the initial design, the optimal solution reduced the maximum temperature under 3C discharge conditions by 9.9% to 34.7 °C, decreased the temperature difference by 31.3% to 3.3 °C, lowered the pressure drop by 24.6% to 2150 Pa, reduced structural mass by 4.0%, and decreased maximum stress by 16.7%. Quantitative comparison with single biomimetic structures under identical boundary conditions showed that the integrated design achieved a 3.3% lower maximum temperature and 25.7% better flow uniformity than the best-performing single structure, demonstrating the synergistic advantages of multi-biomimetic integration. These synergistic performance improvements can be attributed to the hierarchical multi-scale architecture where fractal networks provide macro-scale flow distribution, leaf vein branches ensure meso-scale coverage, and spider web radials achieve micro-scale thermal matching. Long-term cycling tests conducted at 1C/1C rate with 25 ± 1 °C ambient temperature showed that the optimized design maintained a capacity retention rate of 92.3% after 1000 charge–discharge cycles, demonstrating excellent durability. The complex biomimetic channel structure can be fabricated using selective laser melting technology with minimum feature sizes below 0.3 mm, indicating promising manufacturing feasibility. The research findings provide theoretical guidance and technical support for the engineering design of high-performance battery thermal management systems. Full article

With the increasing emphasis and protection on forest resources worldwide, the development of non-wood plant fiber raw materials has become a key path to promote the green and sustainable development of China’s pulp and paper industry. In this study, Super-Arundo donax, a new non-wood fiber raw material, was systematically investigated for its applicability in the bleaching process. Firstly, by adjusting key bleaching technical variables such as alkali dosage, time, oxygen pressure and temperature, the oxygen delignification process of the Super-Arundo donax kraft pulp was optimized. The data revealed that under the experimental conditions of 3.0% alkali dosage, 60 min bleaching time, 100 °C bleaching temperature, 0.6 MPa oxygen pressure and 0.6% MgSO₄ dosage, the bleached pulp yield reached 91.58%, the brightness was 42.04% ISO, and its tensile index was 60.92 N·m/g, bursting index was 4.16 kPa·m²/g, and tear index was 5.45 mN·m²/g, respectively. To further enhance the bleaching effect, the study introduced the H₂O₂ enhanced oxygen delignification process. The alkali dosage, bleaching temperature and H₂O₂ dosage were selected as the process parameters, with the pulp yield and brightness as the response indicators. A central composite design was adopted to construct a response surface model, and the interaction effects among various factors were analyzed. The optimized optimal process conditions are as follows: pulp concentration 10%, alkali dosage 2.84%, bleaching temperature 105 °C, H₂O₂ dosage 4.85%, bleaching time 60 min, MgSO₄ dosage 0.6%. Under these conditions, the pulp yield was 89.76% and the brightness reached 53.85% ISO. Therefore, Super-Arundo donax possesses excellent pulp-making and papermaking properties, and is expected to serve as a high-quality non-wood fiber raw material to alleviate the pressure on traditional papermaking raw materials and contribute to the green, sustainable and low-carbon transformation of the pulp and paper industry. Full article