Search Results (342)

Severe coronary artery calcification (CAC) remains a major challenge in percutaneous coronary intervention (PCI), driving stent under-expansion and higher rates of restenosis and adverse events. Balloon-based calcium modification remains central to lesion preparation, with the available tools ranging from high-pressure non-compliant balloons and ultra-high-pressure balloons to cutting, scoring, and intravascular lithotripsy (IVL) balloons. While traditional IVL has advanced the field by permitting circumferential fracture of deep calcium through acoustic shockwaves, important drawbacks persist, including problems in deliverability, energy distribution, and questionable efficacy in nodular or eccentric calcium. This review examines all contemporary balloon-based modification strategies and introduces the novel Hertz-contact IVL (HC-IVL), a new technology designed to transmit mechanical energy through direct contact rather than shockwave propagation. Based on Hertzian mechanics, this device may facilitate more focused energy delivery, improved lesion crossing, and enhanced calcium fracture in complex morphologies. A detailed comparison between HC-IVL and standard IVL is provided, along with a proposed algorithm for device selection. Taking into consideration the limitations of current tools, HC-IVL represents a promising mechanistic innovation in balloon-based calcium modification, warranting further validation in randomized, imaging-guided clinical studies. Full article

Background: Rotator cuff tendinopathy is a major cause of shoulder pain and disability. Focused extracorporeal shockwave therapy (ESWT) is an established conservative treatment option; however, the predictive factors influencing the treatment response remain poorly characterized. Objectives: To identify clinical, demographic, and metabolic predictors of pain reduction and functional improvement at four months following focused ESWT in patients with supraspinatus tendinopathy, with the goal of informing individualized treatment planning and early prognostic counseling. Methods: This retrospective cohort study analyzed patients with supraspinatus tendinopathy (calcific and non-calcific) treated with focused ESWT at a university rehabilitation center between June 2020 and December 2025. Outcomes were assessed at baseline and 4-month follow-up using the Visual Analog Scale (VAS), Roles and Maudsley, and Constant–Murley scores. Change score analysis with covariate adjustment and backward stepwise selection were performed to identify predictors of clinical improvement. Results: A total of 239 patients (97 males [40.6%], 142 females [59.4%]; mean age 60.2 ± 11.5 years; mean BMI 25.5 ± 4.0 kg/m²) were included, of whom 101 (42.3%) had calcific tendinopathy. Significant improvements were observed in all outcomes: VAS decreased from 6.50 ± 1.35 to 3.96 ± 2.09 (p < 0.001; Cohen’s d = 1.24), and Constant–Murley score increased from 60.38 ± 14.53 to 75.88 ± 15.52 (p < 0.001; Cohen’s d = 1.07). Patient-reported satisfaction (Roles and Maudsley score) showed a 91.2% success rate (excellent or good outcomes). Regression analysis identified baseline severity as the strongest predictor of improvement in all models. BMI emerged as a significant predictor of functional recovery (β = −0.95, p < 0.001 for Constant–Murley change), with each 1 kg/m² increase associated with approximately 1-point less improvement. Conclusions: Baseline clinical severity and body mass index were consistent predictors of ESWT effectiveness in rotator cuff tendinopathy. A lower BMI was associated with greater functional improvement, highlighting a potentially modifiable factor for treatment optimization. These findings support personalized treatment planning and early prognostic counseling in clinical practices. Full article

Coordinated control of ramp metering, variable speed limits, and intersection signals is critical for mitigating congestion and enhancing efficiency at urban expressway–arterial interfaces. Existing strategies often operate in isolation, leading to fragmented responses and limited adaptability under heterogeneous traffic demands. This study develops a multi-agent reinforcement learning framework based on MADDPG to achieve cooperative decision-making across heterogeneous controllers. An asynchronous control cycle mechanism is designed to accommodate different temporal requirements of ramp meters, speed limits, and signal controllers, ensuring practical feasibility in real-time operations. A conflict-aware reward design further embeds density regulation, speed harmonization, and spillback prevention to stabilize flow dynamics. Simulation experiments on a calibrated urban network demonstrate that the proposed framework delays congestion onset, reduces shockwave propagation, and improves throughput compared with classical benchmarks. In particular, at the mainline merge, average travel time is reduced to 13.56 s (62.4% of VSL-only); at the ramp, occupancy is lowered to 6.4% (40.6% of ALINEA); and at the signalized approach, average delay decreases to 85.71 s (62.7% of actuated control). These results highlight the scalability and deployment potential of the proposed cooperative control approach for system-level traffic management in mixed traffic environments. Full article

Background/Objectives: Insertional Achilles tendinopathy (IAT) is frequently associated with posterior calcaneal spurs; however, the prognostic significance of spur morphology for patient-centered treatment outcomes remains unquantified. This study aimed to establish treatment-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds after extracorporeal shockwave therapy (ESWT) and to determine whether quantitative spur morphology independently predicts achievement of these patient-centered endpoints. Methods: In this retrospective cohort study, 201 patients with IAT and radiographically confirmed posterior calcaneal spurs received standardized ESWT (three weekly sessions, 0.20 mJ/mm², 8 Hz). Spur length and angle were measured on calibrated weight-bearing lateral radiographs. MCID and PASS thresholds for VISA-A, AOFAS, and VAS scores were determined using anchor-based receiver operating characteristic (ROC) analyses. Optimal spur morphology thresholds were derived from ROC curves using PASS achievement as the outcome criterion and the Youden index for cut-off selection. Multivariable logistic regression analyses, adjusted for age, sex, and body mass index, were performed to assess the independent prognostic value of spur morphology. Results: MCID thresholds were: ΔVISA-A ≥ 16.5 (AUC = 0.886), ΔAOFAS ≥ 11.5 (AUC = 0.830), and ΔVAS ≥ 2.5 (AUC = 0.897). PASS thresholds were: VISA-A ≥ 70.5 (AUC = 0.712), AOFAS ≥ 72.5 (AUC = 0.842), and VAS ≤ 3.5 (AUC = 0.753). While significant mean improvements occurred (all p < 0.001), only 36.8–43.3% of patients achieved MCID and 38.3–53.2% achieved PASS. ROC analysis identified spur length > 8.7 mm (AUC = 0.713) and spur angle > 16° (AUC = 0.738) as optimal thresholds predictive of PASS failure. In multivariable analysis, increased spur length (adjusted OR = 0.23–0.24, p < 0.001) and angle (adjusted OR = 0.16–0.23, p < 0.001) independently reduced the likelihood of achieving both MCID and PASS. Conclusions: This study provides the first anchor-based MCID and PASS thresholds for ESWT in IAT and demonstrates that posterior calcaneal spur morphology—specifically length > 8.7 mm and angle > 16°—independently predicts patient-defined treatment success. These findings support the integration of quantitative spur assessment into clinical decision-making for personalized management of IAT. Full article

Introduction: Extracorporeal shockwave therapy (ESWT) is used as an adjunctive treatment for canine osteoarthritis (OA), but its effects in dogs with treatment-refractory advanced disease remain unclear. This study compared the efficacy of one versus two sessions of focused ESWT administered approximately 28 days apart in dogs with refractory elbow or stifle OA. Methods: In this randomized, double-blinded clinical trial, twenty-four client-owned dogs with treatment-refractory elbow (n = 12) or stifle (n = 12) osteoarthritis received ESWT using an identical per-session protocol (X-Trode, 1000 pulses at 0.14 mJ/mm²; PulseVet-Zomedica, Ann Arbor, MI, USA), once (Group L) or twice (Group E). Orthopedic examination, goniometric and limb circumference measurements, and kinetic gait analysis (peak vertical pressure [PVP], vertical impulse [VI]) were performed on days 0, 28, and 56. Owner questionnaires (Canine Brief Pain Inventory [CBPI], Client Specific Outcome Measures [CSOM]) were collected on days 0, 28, 56, and 84. Data were analyzed using chi-squared tests, t-tests, and mixed effects models in R. Results: Age, weight, BCS, and radiographic osteoarthritis severity did not differ between groups at baseline. Improvement was small and limited to selected parameters. Vertical impulse and limb circumference increased more consistently in Group E, whereas peak vertical pressure increased in both groups, including before ESWT in Group L. No sustained or treatment-associated improvement was detected in symmetry variables or joint range of motion. Owner-reported outcomes showed variable patterns without consistent treatment effects. ESWT was well tolerated, and no major adverse events occurred. Conclusion: ESWT produced modest, inconsistent improvements in dogs with treatment-refractory OA, with slightly more consistent effects following two sessions. Therapeutic efficacy appeared limited in this end-stage population. Full article

Background: The traditional A1-centric paradigm for trigger finger (TF) management does not fully capture heterogeneous pathology spanning isolated pulley stenosis, tendon degeneration, and impaired tendon–sheath gliding. Methods: A comprehensive literature synthesis (2010–2025) integrating anatomy, biomechanics, and ultrasound-guided interventions was performed to develop a testable, phenotype-driven framework. Results: A continuum model is proposed emphasizing (i) origin-to-insertion assessment of the flexor apparatus, (ii) pragmatic ultrasound phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise, phenotype-matched management pathway incorporating conservative care, ultrasound-guided injection, selected adjuncts (e.g., hydrodissection, prolotherapy, ESWT) for tendon-dominant or mixed presentations, and percutaneous or open release when an A1 bottleneck is confirmed. Conclusions: This framework is presented as a hypothesis to guide standardized reporting, reliability testing, and phenotype-stratified comparative trials, rather than as a validated clinical guideline. This article proposes a novel, phenotype-driven clinical framework to address this limitation. Contemporary evidence is integrated to construct a model emphasizing (i) a whole-length, origin-to-insertion assessment of the flexor apparatus, (ii) sonographic phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise treatment algorithm integrating conservative care, ultrasound-guided injections, ultrasound-guided percutaneous release, and selected adjunctive approaches such as hydrodissection (HD), prolotherapy (Prolo), and extracorporeal shockwave therapy (ESWT). While evidence supports individual modalities, the framework’s primary innovation lies in matching interventions to phenotype. This sonographic phenotyping system is presented not as a validated tool, but as a testable hypothesis designed to guide future validation studies. The proposed framework establishes research priorities, including standardized criteria, reliability testing, and comparative effectiveness research for phenotype-stratified management. Full article

Colloidal solutions containing silica-coated silver nanoparticles (Ag@SiO₂) were synthesized through a two-step process integrating physical and chemical mechanisms. In the first step, laser ablation of a silicon target submerged in deionized water generated an H₂O–SiO₂ colloid, termed the as-cast colloid. This contained nanometric SiO₂ particles alongside micrometer-sized or larger silicon fragments produced by laser shockwave-induced target surface fragmentation. To refine particle size distribution and elevate nanometric SiO₂ concentration, the as-cast colloid underwent secondary laser irradiation, effectively fragmenting larger particles. The second step involved adding ionic silver to both as-cast and irradiated colloids, yielding Ag@SiO₂ nanoparticles. Structural properties were probed via XRD and TEM; optical characteristics via UV–Vis spectroscopy; and electrophoretic mobility via zeta potential measurements, both pre- and post-silver incorporation, to elucidate irradiation’s influence on synthesis. For controlled agglomeration, AlCl₃ was used to modify surface charge, neutralizing silanol groups on the silica shell and minimizing electrostatic repulsion through aluminum ion interactions. These findings demonstrate tunable Ag@SiO₂ colloids with precise surface properties for future development of advanced nanomaterials suitable for microbicidal applications. Full article

The Kuramoto–Sivashinsky (KS) equation and its fractional generalizations (FKSs) arise as canonical models for a wide class of nonlinear dissipative–dispersive systems, including thin-film flows, combustion fronts, drift–wave turbulence in plasmas, and chemically reacting media, where shock-like and strongly localized structures play a central role in the dynamics. Despite their apparent simplicity, KS-type models become analytically intractable once higher-order dissipation, geometric effects, and memory (fractional) operators are incorporated, and standard perturbative or transform-based schemes often lead to cumbersome recursive structures, slow convergence, or severe restrictions on the initial data. In this work, a novel direct approximation procedure, referred to as the Tantawy Technique (TT), is developed and implemented to solve and analyze planar fractional KS-type equations and their Burgers-type reductions in a systematic manner. The central difficulty is to construct, for a given physically motivated initial profile, a rapidly convergent series in fractional time that remains stable for a broad range of the fractional order and transport coefficients, while still retaining a clear link to the underlying shock-wave physics. To overcome this, the TT combines (i) a Tanh-based exact shock solution of the planar integer-order KS equation, obtained first as a reference via the standard Tanh method, with (ii) a carefully designed fractional-time ansatz in powers of $t^{\rho }$, where the spatial coefficients are determined recursively from the governing equation in the Caputo sense. This construction yields closed-form expressions for the first few terms in the approximation hierarchy and allows one to monitor convergence through residual and absolute error measures. Full article

Anterior Cruciate Ligament (ACL) injuries are among the most common knee injuries sustained during sport. Following injury, only 65% of patients may return to their previous level of sport. Individuals who have suffered ACL injury are far more likely to develop post-traumatic osteoarthritis of the knee (PTOA). This suggests an unmet need for strategies to help advance return to play, reduce risk of PTOA, and provide additional options for pain management after ACL injury. Extracorporeal shockwave therapy (ESWT) and radial pressure waves (RPW) are non-invasive treatment options that have been shown effective for treatment of a variety of orthopedic injuries. This perspective proposes the use of ESWT and RPW as treatment options during the peri-operative and post-operative management of ACL injuries, with the goal of modifying risk for PTOA. The available literature indicates that ESWT may have chondroprotective effects after ACL injury, and numerous clinical trials demonstrate the effectiveness of ESWT and RPW for orthopedic conditions including tendinopathy or bone marrow edema. Limited data and a lack of consensus on standardized rehabilitation protocols present gaps in the literature and emphasize the need for research leading to evidence-based recommendations for the use of ESWT and RPW to modify risk for the onset of PTOA after ACL injuries. Full article

In response to the challenge of achieving highly reliable interface fabrication in the fields of microelectronics and micro-electromechanical system (MEMS) packaging, this study harnesses the superior characteristics of solid-state bonding inherent in explosive welding (EXW) technology. This study investigates the precise EXW of milligram-scale metallic foils by employing focused laser energy to control the explosion behavior of liquid energetic materials, thereby generating shockwaves that induce high-velocity oblique collisions between metallic foils and base plates. Laser-focused energy was utilized to regulate energetic materials for conducting precision EXW experiments on Al/Cu couples. The technical feasibility and interfacial quality of this method for fabricating Al/Cu bonding interfaces were systematically evaluated through in situ observation of the dynamic welding process, comprehensive analysis of interfacial microstructures, and numerical simulations. The results reveal distinct Al/Cu elemental diffusion at the bonding interface, confirming the technical viability of the approach. However, an unloading rebound phenomenon is observed at the interface, which is inherently associated with the dynamic impact process, indicating the need for further optimization in the precise control of impact loading. Full article

Purpose: In this systematic review, we compare the effectiveness of high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) in treating lateral elbow tendinopathy (LET). Methods: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was conducted from database inception to 23 June 2025 to identify randomized controlled trials (RCTs) comparing the two interventions. The primary outcome was pain intensity (visual analog scale or numeric rating scale). Secondary outcomes included upper-limb disability (qDASH), grip strength (pain-free or maximal), ultrasound-measured common extensor tendon thickness, and safety (adverse events and withdrawals). Two reviewers independently extracted data and assessed methodological quality using the Physiotherapy Evidence Database (PEDro) scale; the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effects were synthesized as SMD (95% CI) using random- or fixed-effects models based on heterogeneity (I²). Significance was set at p < 0.05. Results: Four RCTs met the inclusion criteria and 169 participants were included. Methodological quality was moderate, with moderate-quality evidence indicating a significant improvement in short-term and medium-term upper-limb function in favor of HILT (SMD = −0.42; 95% CI: −0.73 to −0.12 and SMD = −0.50; 95% CI: −0.94 to −0.06, respectively). Evidence ranging from low to moderate quality showed no significant differences between the HILT and ESWT groups in terms of short-term or medium-term resting pain (SMD = −0.50; 95% CI: −1.15 to 0.16 and SMD = −0.42; 95% CI: −1.06 to 0.22, respectively), short-term or medium-term activity pain (SMD = −0.38; 95% CI: −1.05 to 0.29 and SMD = −0.73; 95% CI: −1.65 to 0.19, respectively), short-term or medium-term grip strength (SMD = 0.24; 95% CI: −0.20 to 0.67 and SMD = 0.20; 95% CI: −0.16 to 0.55, respectively), or short-term or medium-term common extensor tendon thickness (SMD = 0.04; 95% CI: −0.50 to 0.59 and SMD = −0.00; 95% CI: −0.55 to 0.55, respectively). Conclusions: HILT appears to offer significant benefits in improving upper-limb function at short-term (<1 month) and medium-term (1–3 months) follow-up. Regarding pain, grip strength, and tendon thickness, the pooled effects did not show clear between-group differences. Evidence certainty ranged from low to moderate, demonstrating that trials with a follow-up period beyond 3 months are needed to evaluate long-term efficacy. Systematic review registration number: PROSPERO: CRD420251026387. Full article

Long underground expressways have emerged as an alternative to surface highways in densely urbanized areas; however, their enclosed geometry, extended length, and steep longitudinal gradients introduce traffic-flow dynamics distinct from those of surface roads. This study investigates the combined and interaction effects of traffic volume, heavy-vehicle ratio, longitudinal gradient, lane number, and lane-changing policy on traffic performance in long underground expressways using microscopic traffic simulation. A hypothetical 20 km underground expressway network was evaluated under 72 systematically designed scenarios. Weighted average speed and throughput were analyzed using nonparametric statistics, generalized linear models with interaction terms, and machine learning-based sensitivity analysis. While traffic volume and heavy-vehicle ratio were confirmed as dominant determinants of performance, a key contribution of this study is the identification of the density-dependent role of lane-changing policies. Under moderate traffic density, permissive lane-changing improves efficiency by enabling vehicles to bypass localized disturbances caused by heavy vehicles and longitudinal gradients, thereby enhancing capacity utilization. In contrast, under high-density conditions, permissive lane-changing amplifies lane-change conflicts and shockwave propagation within the confined underground environment, accelerating traffic instability and performance breakdown. These adverse effects are further intensified by steep uphill gradients. The findings demonstrate that lane-changing policies on long underground expressways should be designed in a context-sensitive manner, balancing efficiency and stability across traffic states. Full article

Traffic state estimation (TSE) is a core task in intelligent transportation systems (ITSs) that seeks to infer key operational parameters—such as speed, flow, and density—from limited observational data. Existing methods often face challenges in practical deployment, including limited estimation accuracy, insufficient physical consistency, and weak generalization capability. To address these issues, this paper proposes a hybrid estimation framework that integrates multi-agent reinforcement learning (MARL) with the Lighthill–Whitham–Richards (LWR) traffic flow model. In this framework, each roadside detector is modeled as an agent that adaptively learns fundamental diagram (FD) parameters—the free-flow speed and jam density—by fusing local detector measurements with global CAV trajectory sequences via an interactive attention mechanism. The learned parameters are then passed to an LWR solver to perform sequential (rolling) prediction of traffic states across the entire road segment. We design a reward function that jointly penalizes estimation error and violations of physical constraints, enabling the agents to learn accurate and physically consistent dynamic traffic state estimates through interaction with the physics-based LWR environment. Experiments on simulated and real-world datasets demonstrate that the proposed method outperforms existing models in estimation accuracy, real-time performance, and cross-scenario generalization. It faithfully reproduces dynamic traffic phenomena, such as shockwaves and queue waves, demonstrating robustness and practical potential for deployment in complex traffic environments. Full article

In terminal flight trajectory, significant dispersion poses a challenge for accurate localization, as the velocity vector of a supersonic flying object increasingly deviates from the normal vector of the measurement plane under gravitational and aerodynamic effects. Therefore, in this study, an impact point localization method, utilizing a dual-rectangular-ring linear optical microphone array based on apparent shock-wave velocity, was developed. A shock-wave measurement array was developed using a dual rectangular ring composed of linear optical microphone arrays. A time-equivalent model, derived from shock-wave propagation, was introduced to analyze the apparent velocity of the shock-wave within the measurement plane. The time difference in the shock-wave arrivals at the dual rectangular ring, combined with the distances between the inner and outer rectangular rings, was used to calculate the non-uniform apparent shock-wave velocity, thereby enabling the localization of supersonic flying objects. The method’s constraints were examined, and its measurement errors were evaluated. The simulation and experimental results showed that the error was less than 0.5 mm. The proposed novel and cost-effective method for impact point localization aids in the effective dispersion assessment of flying objects. Full article

The present study systematically investigates, for the first time, the combined influences of detonator position (top-edge and bottom-edge initiations) and anvil material (steel and sand) on the interfacial microstructure and mechanical performance of explosively welded A1050/AZ31 dissimilar joints. When welding was conducted using a steel anvil with the detonator positioned at the top edge, significant cracking occurred both at the surface and along the weld interface. In contrast, placing the detonator at the bottom edge noticeably reduced these defects. Moreover, the use of a sand anvil nullified these defects by damping the reflecting shockwaves and minimizing vibrations. Hardness measurements revealed substantial increase at the interface under all the conditions, with the highest value observed with the steel anvil. Welds subjected to top-edge detonation showed higher hardness values compared to those of welds subjected to bottom-edge detonation. Overall, the results suggest that sand anvils with bottom-edge detonation provide the optimal weld quality. The rigid steel anvil reflects the shockwave, generating high pressure and velocity at the interface, whereas the sand anvil absorbs a part of the shock energy, suppressing high-magnitude reflections. The position of the detonator influences the propagation dynamics of the detonation wave and the resulting collision velocity, which in turn, affect the interfacial morphology and overall quality of the weld. Full article