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Due to concentrated conflicts, on-ramp merging is an important scenario in the study of new hybrid traffic control. Current research mainly focuses on optimizing the vehicle passage sequence of ramp vehicles merging with mainline vehicles in single-lane scenarios, neglecting the coordination problem of vehicles in multiple mainline lanes. Therefore, an Improved Dueling Double DQN (D3QN) On-ramp Merging Strategy (IDS stands for the initials of Improved, D3QN, and Strategy) combined with a sine function is proposed, establishing a Vehicle Coordination System (VCS) to guide the merging of vehicles in multi-lane mainline traffic. This strategy uses the improved D3QN algorithm combined with the excellent smoothness of the sine function to evaluate driving safety, helping vehicles find suitable gaps in traffic flow. An action masking mechanism was deployed during the strategy exploration phase to prevent unsafe actions. The proposed VCS + IDS strategy was tested in SUMO simulations of on-ramp merging under different density of vehicle flow. Under a traffic flow of 1200 vehicles per lane per hour, the on-ramp merging completion rate of VCS + IDS reached 98.62%, and the task completion rate was 98.11%, which increased by 11.08% and 10.79% compared to traditional D3QN, respectively, validating the effectiveness of this method.

Battered Sensory Nerve Syndrome (BSNS) is a condition characterized by persistent, long-term mechanical compression of the sensory roots, dorsal root ganglia (DRG), and sensory fibers of the spinal nerve roots. This leads to symptoms such as hyperalgesia or allodynia, paresthesia, and radicular pain-like syndromes where pain worsens with weight-bearing or physical activity. High-voltage DRG pulsed radiofrequency (PRF) is effective for BSNS, but optimal treatment parameters for the best clinical efficacy remain undefined. This study aims to compare the clinical outcomes of various PRF temperatures and durations in patients with BSNS. Patients with BSNS were randomized to one of four high-voltage (80 V) PRF parameter groups: 42℃/3min, 42℃/12min, 55℃/3min, and 55℃/12min. The primary outcome measures included the Numerical Rating Scale (NRS) and the Oswestry Disability Index (ODI). The secondary outcome measures included the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Pittsburgh Sleep Quality Index (PSQI) scores, the effective rate of pain relief, the proportion of patients with a ≥ 50% reduction in ODI score, and medication usage. These were evaluated before PRF and within 12 months after surgery. All patients included in our study had a mean age over 60, with the majority being female. Four patient groups showed significant reductions in NRS, ODI, HAMA, HAMD scores ( P  < 0.05) and decreased medication use within 12 months post-PRF, with no statistically significant differences between the groups ( P  > 0.05). The PSQI scores decreased significantly only in the 42 °C/3min group at 1 month,3 and 6 months ( P  < 0.05), also without intergroup significance ( P  > 0.05). The subgroup analysis by time and temperature revealed that NRS scores ( P  = 0.009), the number of patients with effective pain relief ( P  = 0.039) and ODI reduction ≥ 50% ( P  = 0.045) 1 month after PRF in the 55℃ group were significantly better than those in the 42℃ group, while no statistically significant difference was found between 3-min and 12-min durations ( P  > 0.05). High-voltage DRG PRF effectively treats BSNS patients within a treatment duration range of 3 to 12 min. Treatment at 55 °C offers superior pain relief and physical function improvement without neuropathic complications.

Background How to treat the posterior cruciate ligament (PCL) tibial insertion small and comminuted avulsion fracture is still challenging. Our study evaluated the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion fractures through the inverted L-shaped postero-medial approach using a homemade pin-hook. Methods Between January 2009 and December 2020, twenty-four patients with isolated PCL tibial insertion bony avulsion were enrolled. There were 16 males and 8 females. The age range was 18-48 (32.5 ± 9.3) years. The time from injury to surgery was 1-10 (4.4 ± 2.8) days. There were 11 cases in the left knee and 13 cases in the right knee. The patients received anticoagulant therapy to prevent thrombosis. Preoperative standard X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. According to the Meyers-McKeever classification, there were 8 cases of type II and 16 cases of type III. Results The operation time was 60-120 (89.6 ± 19.8) min. Postoperative follow-up ranged from 3 to 18 months. The average follow-up was 11.4 ± 4.3 months. In all patients, one or two homemade pin-hooks were used to fix different sizes of fracture segments. X-ray or CT scans taken after surgery revealed fracture union. The fractures healed in 9-16 (11.8 ± 1.7) weeks. At the last follow-up, the patients were able to fully straighten. The ROM (132.6° ± 3.9°), the Tegner-Lysholm score (96.2 ± 2.3) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5° ± 13.1°, 46.8 ± 8.9, 36.2 ± 7.9). The posterior drawer test was negative. The gastrocnemius muscle strength did not diminish. No internal fixation migration was observed during the follow-up. No neurovascular bundle- or hardware-related complications were reported. Conclusions The inverted L-shaped postero-medial approach with homemade pin-hook fixation for the treatment of PCL avulsion fractures produces acceptable clinical and radiological results. Moreover, the homemade pin-hook made of K-wires is affordable and reduces patient costs. It is a practical application and worth recommending, especially for community hospitals.

Pulsed radiofrequency (PRF) has demonstrated therapeutic potential for neuropathic pain, yet its efficacy in alleviating pain induced by chronic dorsal root ganglion (DRG) compression remains unclear. This study evaluated the analgesic effects of DRG-targeted PRF in a chronic compression of DRG (CCD) rat model. Adult male Sprague Dawley rats were divided into four groups: sham, CCD, CCD+PRF, and CCD+freePRF. CCD was induced by inserting stainless-steel rods into the intervertebral foramen to compress L4/L5 DRGs. Pain behaviors, including spontaneous pain, mechanical/cold allodynia, and heat hypersensitivity, were assessed pre- and post-PRF treatment. On day 14 post-CCD, DRG ultrastructural changes and myelin basic protein (MBP) expression were analyzed via transmission electron microscopy and immunofluorescence. Compared to sham rats, CCD animals exhibited significant pain behaviors (P < .0001). PRF treatment in CCD+PRF rats significantly attenuated these behaviors (P < .01). Ultrastructural analysis revealed intact myelin sheaths in sham DRGs, whereas CCD DRGs showed myelin damage and reduced MBP expression (P < .01). Notably, PRF repaired myelin structural integrity and restored MBP levels. These findings demonstrate that DRG PRF alleviates neuropathic pain by reversing ultrastructural damage caused by chronic compression, providing mechanistic insights into PRF's analgesic effects and supporting its therapeutic value for neuropathic pain management.

Purpose In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators. Methods The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients ( N  = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound. Results The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound ( P  < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred. Conclusion Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.

Background Management the Sanders type II-III displaced intra-articular calcaneus fractures (DIACF) combined with compromised soft-tissue condition is full of challenges. The aim of this study was to validating the clinical efficacy and merits of the closed reduction and sequential frame screw technique for managing Sanders type II-III DIACF in conjunction with compromised soft-tissue conditions. Methods We conducted a retrospective analysis on 13 patients with Sanders type II-III DIACF accompanied by compromised soft-tissue conditions between March 2022 and October 2023, while assessing postoperative complications as well as functional and radiographic outcomes. Results The fractures healed uneventfully in a single stage (8–12 weeks postoperatively), with no occurrences of infection, impaired wound healing, or necrosis of the skin and soft tissues during the postoperative period and at the last follow-up. The AOFAS score at the final follow-up was 88.38 ± 7.75, with 7 cases rated as excellent, 5 cases rated as good, and 1 case rated as fair, resulting in an overall excellent or good rate of 92.30%. Additionally, the mean VAS score at the final follow-up was recorded at 1.46 points (ranging from 0 to 3 points). The imaging measurements revealed a statistically significant improvement in the postoperative Gissane angle, Bohler angle, and calcaneal height when compared to preoperative values ( P <0.05). Furthermore, no significant differences were found between the postoperative measurements and those recorded at the final follow-up ( P >0.05). No cases of obvious varus deformity were observed, and although calcaneal width showed improvement at both postoperative and final follow-up assessments compared to preoperative measurements, these changes were not statistically significant ( P >0.05). Conclusions The closed reduction technique utilizing Kirschner wire lever and sequential frame screw technique has demonstrated efficacy in the management of Sanders type II-III DIACF accompanied by compromised soft-tissue conditions.

Autologous chondrocyte implantation (ACI) is a procedure used to treat articular cartilage injuries and prevent the onset of post-traumatic osteoarthritis. In vitro expansion of chondrocytes, a necessary step in ACI, results in the generation of senescent cells that adversely affect the quality and quantity of newly formed cartilage. Recently, a senolytic peptide, fork head box O transcription factor 4-D-Retro-Inverso (FOXO4-DRI), was reported to selectively kill the senescent fibroblasts. In this study, we hypothesized that FOXO4-DRI treatment could remove the senescent cells in the expanded chondrocytes, thus enhancing their potential in generating high-quality cartilage. To simulate the in vitro expansion for ACI, chondrocytes isolated from healthy donors were expanded to population doubling level (PDL) 9, representing chondrocytes ready for implantation. Cells at PDL3 were also used to serve as the minimally expanded control. Results showed that the treatment of FOXO4-DRI removed more than half of the cells in PDL9 but did not significantly affect the cell number of PDL3 chondrocytes. Compared to the untreated control, the senescence level in FOXO4-DRI treated PDL9 chondrocytes was significantly reduced. Based on the result from standard pellet culture, FOXO4-DRI pre-treatment did not enhance the chondrogenic potential of PDL9 chondrocytes. However, the cartilage tissue generated from FOXO4-DRI pretreated PDL9 cells displayed lower expression of senescence-relevant secretory factors than that from the untreated control group. Taken together, FOXO4-DRI is able to remove the senescent cells in PDL9 chondrocytes, but its utility in promoting cartilage formation from the in vitro expanded chondrocytes needs further investigation.

Understanding the mechanical behavior of implanted neural electrode arrays is crucial for BCI development, which is the foundation for ensuring surgical safety, implantation precision, and evaluating electrode efficacy and long-term stability. Therefore, a reliable FE models are effective in reducing animal experiments and are essential for a deeper understanding of the mechanics of the implantation process. This study established a novel finite element model to simulate neural electrode implantation into brain tissue, specifically characterizing the nonlinear mechanical responses of brain tissue. Synchronized electrode implantation experiments were conducted using ex vivo porcine brain tissue. The results demonstrate that the model accurately reproduces the dynamics of the electrode implantation process. Quantitative analysis reveals that the implantation force exhibits a positive correlation with insertion depth, the average implantation force per electrode within a multi-electrode array decreases with increasing electrode number, and elevation in electrode size, shank spacing, and insertion speed each contribute to a systematic increase in insertion force. This study provides a reliable simulation tool and in-depth mechanistic analysis for predicting the implantation forces of high-density neural electrode arrays and offer theoretical guidance for optimizing BCI implantation device design.

Background. Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective. To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design. A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method. A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results. Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with −4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions. Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.