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BACKGROUND: Reconstruction of forefoot defects often necessitates free tissue transfer due to the limited availability of local tissue. Microsurgical reconstruction of the forefoot remains challenging as it requires durable yet thin, soft tissue coverage for functional restoration. This study aimed to evaluate the efficacy of free thin perforator flaps for forefoot reconstruction, with a focus on functional outcomes. METHODS: Patients who underwent microsurgical forefoot reconstruction between March 2020 and September 2023 were reviewed...

INTRODUCTION: Poison centers provide free expert recommendations on the treatment of a wide variety of toxicological emergencies. Prior studies have called attention to the increasing complexity of cases reported to poison centers. We aimed first, to evaluate the trends in medical outcome severity, over a 15-year period in both the adult and pediatric populations. Second, we described the most frequently reported substances associated with major effect or death. METHODS: This is a retrospective review of exposures reported to the National Poison Data System from 1 January 2007 through 31 December 2021...

As fossil fuels continue to deplete, the development of sustainable and green energy sources has become crucial for human societal advancement. Among the various renewable energies, solar energy stands out as a promising substitute for conventional fossil fuels, offering widespread availability and a pollution-free solution. Solar cells, as devices that convert solar energy, are garnering significant focus. However, the intermittent nature of solar energy results in a high dependence on weather conditions of solar cells...

BACKGROUND: In recent years, novel therapies targeting specific molecular pathways and immunotherapies have exhibited promising outcomes for treating human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Our work aimed to assess the effectiveness and safety of these emerging treatment regimens for this disease. MATERIAL AND METHODS: We systematically searched databases including PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials their inception to August 2023 to identify relevant randomized controlled trials (RCTs)...

Autosomal dominant hereditary paraganglioma-pheochromocytoma syndrome (HPPS) is a rare genetic disorder characterized by neuroendocrine tumor development associated with pathogenic variants in succinate dehydrogenase (SDH) enzyme complex genes. Particularly, HPPS linked to SDHB mutation poses a significant clinical challenge due to its association with aggressive tumor features and a high risk of malignancy. Our report underscores the diversity in the presentation of patients with SDHB-mutated paraganglioma and the feasibility of managing it with a minimally invasive surgical approach...

OBJECTIVE: To present an alternative technique called pseudo-flap for reconstructing long ureteral defects as an alternative to Boari flap. Despite being used for more than 70 years by urologists for tension-free reconstruction of distal and mid-ureteral defects, the Boari flap exhibits high complication rates, with an average of 27% (range 5.5%-30.4%). These complications arise from compromised blood supply, attributed to incisions made on all three sides of the flap and dependence on the flap base as the sole source of blood supply...

IMPORTANCE: Large language models (LLMs) possess a range of capabilities which may be applied to the clinical domain, including text summarization. As ambient artificial intelligence scribes and other LLM-based tools begin to be deployed within healthcare settings, rigorous evaluations of the accuracy of these technologies are urgently needed. OBJECTIVE: To investigate the performance of GPT-4 and GPT-3.5-turbo in generating Emergency Department (ED) discharge summaries and evaluate the prevalence and type of errors across each section of the discharge summary...

Leishmaniasis is a vector-borne disease caused by the protozoan parasite of Leishmania genus and is a complex disease affecting mostly tropical regions of the world. Unfortunately, despite the extensive effort made, there is no vaccine available for human use. Undoubtedly, a comprehensive understanding of the host-vector-parasite interaction is substantial for developing an effective prophylactic vaccine. Recently the role of sandfly saliva on disease progression has been uncovered which can make a substantial contribution in vaccine design...

Due to high proliferative capacity, multipotent differentiation, immunomodulatory abilities, and lack of ethical concerns, dental pulp stem cells (DPSCs) are promising candidates for clinical application. Currently, clinical research on DPSCs is in its early stages. The reason for the failure to obtain clinically effective results may be problems with the production process of DPSCs. Due to the different preparation methods and reagent formulations of DPSCs, cell characteristics may be affected and lead to inconsistent experimental results...

INTRODUCTION: The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site. METHODS: A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed...

INTRODUCTION: Despite the Veterans Health Administration (VA) efforts to become a learning health system (LHS) and high-reliability organization (HRO), interventions to build supportive learning environments within teams are not reliably implemented, contributing to high levels of burnout, turnover, and variation in care. Supportive learning environments build capabilities for teaching and learning, empower teams to safely trial and adapt new things, and adopt highly reliable work practices (eg, debriefs)...

Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) accounts for the majority of extra-nodal DLBCL. Even so, literature is lacking on early, localised presentations. We studied a cohort of patients with stage I disease, diagnosed between 2006 and 2018, from six centres between Australia, Canada and Denmark. Our goal was to characterise outcomes, review treatment and investigate the role of interim positron emission tomography (iPET). Thirty-seven eligible patients were identified. The median duration of follow-up was 42...

We study a nonequilibrium ferromagnetic mean-field spin model exhibiting a phase with spontaneous temporal oscillations of the magnetization, on top of the usual paramagnetic and ferromagnetic phases. This behavior is obtained by introducing dynamic field variables coupled to the spins through nonreciprocal couplings. We determine a nonequilibrium generalization of the Landau free energy in terms of the large deviation function of the magnetization and of an appropriately defined smoothed stochastic time derivative of the magnetization...

Resetting is a renewal mechanism in which a process is intermittently repeated after a random or fixed time. This simple act of stop and repeat profoundly influences the behavior of a system as exemplified by the emergence of nonequilibrium properties and expedition of search processes. Herein we explore the ramifications of stochastic resetting in the context of a single-file system called random average process (RAP) in one dimension. In particular, we focus on the dynamics of tracer particles and analytically compute the variance, equal time correlation, autocorrelation, and unequal time correlation between the positions of different tracer particles...

Molecular motors fulfill critical functions within all living beings. Understanding their underlying working principles is therefore of great interest. Here we develop a simple model inspired by the two-component biomolecular motor F_{o}-F_{1} ATP synthase. We analyze its energetics and characterize information flows between the machine's components. At maximum output power we find that information transduction plays a minor role for free-energy transduction. However, when the two components are coupled to different environments (e...

The statistics of the diffusive motion of particles often serve as an experimental proxy for their interaction with the environment. However, inferring the physical properties from the observed trajectories is challenging. Inspired by a recent experiment, here we analyze the problem of particles undergoing two-dimensional Brownian motion with transient tethering to the surface. We model the problem as a hidden Markov model where the physical position is observed and the tethering state is hidden. We develop an alternating maximization algorithm to infer the hidden state of the particle and estimate the physical parameters of the system...

Systems featuring hard-core-soft-shell repulsive pair potentials can form ordered phases, where particles organize themselves in aggregates with nontrivial geometries. The dimer crystal formed by one such potential, namely, the hard-core plus generalized exponential model of order 4, has been recently investigated, revealing a low-temperature structural phase transition, with the onset of nematic ordering of the dimers. In the present work, we aim to characterize this phase transition via a mean-field theory, by which a detailed analysis of the low-temperature properties of the system is carried out under quadrupole approximation...

It is expected that the energy-diffusion propagator in a one-dimensional nonlinear lattice with three conserved quantities: energy, momentum, and stretch, consists of a central heat mode and two sound modes. The heat mode follows a Lévy distribution. Consequently, the heat diffusion is super, i.e., the second moment of the diffusion propagator diverges as t^{β} with β>1; and the heat conduction is anomalous, i.e., the heat conductivity is size dependent and diverges with size N by N^{α}, with α>0...

We study collective dynamics of networks of mutually coupled identical Lorenz oscillators near a subcritical Hopf bifurcation. Such systems exhibit induced multistable behavior with interesting spatiotemporal dynamics including synchronization, desynchronization, and chimera states. For analysis, we first consider a ring topology with nearest-neighbor coupling and find that the system may exhibit intermittent behavior due to the complex basin structures and dynamical frustration, where temporal dynamics of the oscillators in the ensemble switches between different attractors...

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php)...