Malicious Vehicle Detection Using Layer-Based Paradigm and the Internet of Things.

Deep learning algorithms have a wide range of applications, including cancer diagnosis, face and speech recognition, object recognition, etc. It is critical to protect these models since any changes to them can result in serious losses in a variety of ways. This article proposes the consortium blockchain-enabled conventional neural network (CBCNN), a four-layered paradigm for detecting malicious vehicles. Layer-1 is a convolutional neural network-enabled Internet-of-Things (IoT) model for the vehicle; Layer-2 is a spatial pyramid polling layer for the vehicle; Layer-3 is a fully connected layer for the vehicle; and Layer-4 is a consortium blockchain for the vehicle. The first three layers accurately identify the vehicles, while the final layer prevents any malicious attempts. The primary goal of the four-layered paradigm is to successfully identify malicious vehicles and mitigate the potential risks they pose using multi-label classification. Furthermore, the proposed CBCNN approach is employed to ensure tamper-proof protection against a parameter manipulation attack. The consortium blockchain employs a proof-of-luck mechanism, allowing vehicles to save energy while delivering accurate information about the vehicle's nature to the "vehicle management system." C++ coding is employed to implement the approach, and the ns-3.34 platform is used for simulation. The ns3-ai module is specifically utilized to detect anomalies in the Internet of Vehicles (IoVs). Finally, a comparative analysis is conducted between the proposed CBCNN approach and state-of-the-art methods. The results confirm that the proposed CBCNN approach outperforms competing methods in terms of malicious label detection, average accuracy, loss ratio, and cost reduction.

Efficient Internet-of-Things Cyberattack Depletion Using Blockchain-Enabled Software-Defined Networking and 6G Network Technology.

Low-speed internet can negatively impact incident response by causing delayed detection, ineffective response, poor collaboration, inaccurate analysis, and increased risk. Slow internet speeds can delay the receipt and analysis of data, making it difficult for security teams to access the relevant information and take action, leading to a fragmented and inadequate response. All of these factors can increase the risk of data breaches and other security incidents and their impact on IoT-enabled communication. This study combines virtual network function (VNF) technology with software -defined networking (SDN) called virtual network function software-defined networking (VNFSDN). The adoption of the VNFSDN approach has the potential to enhance network security and efficiency while reducing the risk of cyberattacks. This approach supports IoT devices that can analyze large volumes of data in real time. The proposed VNFSDN can dynamically adapt to changing security requirements and network conditions for IoT devices. VNFSDN uses threat filtration and threat-capturing and decision-driven algorithms to minimize cyber risks for IoT devices and enhance network performance. Additionally, the integrity of IoT devices is safeguarded by addressing the three risk categories of data manipulation, insertion, and deletion. Furthermore, the prioritized delegated proof of stake (PDPoS) consensus variant is integrated with VNFSDN to combat attacks. This variant addresses the scalability issue of blockchain technology by providing a safe and adaptable environment for IoT devices that can quickly be scaled up and down to pull together the changing demands of the organization, allowing IoT devices to efficiently utilize resources. The PDPoS variant provides flexibility to IoT devices to proactively respond to potential security threats, preventing or mitigating the impact of cyberattacks. The proposed VNFSDN dynamically adapts to the changing security requirements and network conditions, improving network resiliency and enabling proactive threat detection. Finally, we compare the proposed VNFSDN to existing state-of-the-art approaches. According to the results, the proposed VNFSDN has a 0.08 ms minimum response time, a 2% packet loss rate, 99.5% network availability, a 99.36% threat detection rate, and a 99.77% detection accuracy with 1% malicious nodes.

Reconstruction of the coracoclavicular ligament with palmaris longus tendon and Mersilene tape for acromioclavicular dislocations.

BACKGROUND: Acromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up. METHODS: This retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24-66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed. RESULTS: The mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p <  0.001, p <  0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. The final follow-up CC and AC distances were 9.29 ± 2.72 mm and 5.30 ± 2.09 mm, respectively (p <  0.001, p <  0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up. CONCLUSION: The CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations.

Reinforcement Learning Based Multipath QUIC Scheduler for Multimedia Streaming.

With the recent advances in computing devices such as smartphones and laptops, most devices are equipped with multiple network interfaces such as cellular, Wi-Fi, and Ethernet. Multipath TCP (MPTCP) has been the de facto standard for utilizing multipaths, and Multipath QUIC (MPQUIC), which is an extension of the Quick UDP Internet Connections (QUIC) protocol, has become a promising replacement due to its various advantages. The multipath scheduler, which determines the path to which each packet should be transmitted, is a key function that affects the multipath transport performance. For example, the default minRTT scheduler typically achieves good throughput, while the redundant scheduler gains low latency. While the legacy schedulers may generally give a desirable performance in some environments, however, each application renders different requirements. For example, Web applications target low latency, while video streaming applications require low jitter and high video quality. In this paper, we propose a novel MPQUIC scheduler based on deep reinforcement learning using the Deep Q-Network (DQN) that enhances the quality of multimedia streaming. Our proposal first takes into account both delay and throughput as a reward for reinforcement learning to achieve a low video chunk download time. Second, we propose a chunk manager that informs the scheduler of the video chunk information, and we also tune the learning parameters to explore new random actions adequately. Finally, we implement our new scheduler on the Linux kernel and give results using the Mininet experiments. The evaluation results show that our proposal outperforms legacy schedulers by at least 20%.

Towards Latency Bypass and Scalability Maintain in Digital Substation Communication Domain with IEC 62439-3 Based Network Architecture.

Parallel redundancy protocol (PRP) and high-availability redundancy protocol (HSR) are widely adopted protocols based on IEC 61850 standard to support zero recovery communication networks for time-critical and reliable interactions in power system substations. However, hiring these protocols comes with technical and economic constraints that impact the size of the substation network arrangement. Therefore, we will undertake a theoretical analysis of HSR, PRP, and their combinations to reach a maximum number of nodes in different substation communication architectures regarding IEC 61850 standard message time constraint requirements and IEC 62439-3 standard regulations. We will validate our findings through a simulation in the OPNET Modeler environment. In addition, we considered bandwidth efficiency by prohibiting the extra circulation of packets in the redundancy Box (RedBox) and QuadBox implementation as interfaces for HSR and PRP connection and HSR rings interconnection, respectively, which represent the main hindrance in utilizing the combination of these protocols.

Weigh-in-Motion: Lightweight Real-Time Identification of Gbps Wireless Traffic.

Distinguishing between wireless and wired traffic in a network middlebox is an essential ingredient for numerous applications including security monitoring and quality-of-service (QoS) provisioning. The majority of existing approaches have exploited the greater delay statistics, such as round-trip-time and inter-packet arrival time, observed in wireless traffic to infer whether the traffic is originated from Ethernet (i.e., wired) or Wi-Fi (i.e., wireless) based on the assumption that the capacity of the wireless link is much slower than that of the wired link. However, this underlying assumption is no longer valid due to increases in wireless data rates over Gbps enabled by recent Wi-Fi technologies such as 802.11ac/ax. In this paper, we revisit the problem of identifying Wi-Fi traffic in network middleboxes as the wireless link capacity approaches the capacity of the wired. We present Weigh-in-Motion, a lightweight online detection scheme, that analyzes the traffic patterns observed at the middleboxes and infers whether the traffic is originated from high-speed Wi-Fi devices. To this end, we introduce the concept of ACKBunch that captures the unique characteristics of high-speed Wi-Fi, which is further utilized to distinguish whether the observed traffic is originated from a wired or wireless device. The effectiveness of the proposed scheme is evaluated via extensive real experiments, demonstrating its capability of accurately identifying wireless traffic from/to Gigabit 802.11 devices.

A High-Power 3P3T Cross Antenna Switch with Low Harmonic Distortion and Enhanced Isolation Using T-Type Pull-Down Path for Cellular Mobile Devices.

This paper presents a radio frequency (RF) triple pole triple throw 3P3T cross antenna switch for cellular mobile devices. The negative biasing scheme was applied to improve the power-handling capability and linearity of the switch by increasing the maximum tolerable voltage drop across the drain and source and reverse biasing the parasitic junction diodes. To avoid signal reflection through the antenna in off-state, all the antenna ports were equipped with 50-ohm termination to provide the pull-down path. Considering the simultaneous operation of antenna ports in different switch cases, the presented T-type pull-down path demonstrated improvement of isolation by over 15 dB. Using stacked switches, the 3P3T handled the input power level of over 35 dBm. The chip was manufactured in 65 nm complementary metal oxide semiconductor (CMOS) silicon on insulator (SOI) technology with a die size of 790 × 730 µm. The proposed structure achieved insertion loss, isolation, and voltage standing wave ratio (VSWR) of less than -0.9 dB, -40 dB, and 1.6, respectively, when the input signal was 3.8 GHz. The measured results prove the implemented switch shows the second and third harmonic distortion performances of less than -60 dBm when the input power level and frequency are 25 dBm and 3.8 GHz, respectively.

A Configurable and Fully Synthesizable RTL-Based Convolutional Neural Network for Biosensor Applications.

This paper presents a register-transistor level (RTL) based convolutional neural network (CNN) for biosensor applications. Biosensor-based diseases detection by DNA identification using biosensors is currently needed. We proposed a synthesizable RTL-based CNN architecture for this purpose. The adopted technique of parallel computation of multiplication and accumulation (MAC) approach optimizes the hardware overhead by significantly reducing the arithmetic calculation and achieves instant results. While multiplier bank sharing throughout the convolutional operation with fully connected operation significantly reduces the implementation area. The CNN model is trained in MATLAB® on MNIST® handwritten dataset. For validation, the image pixel array from MNIST® handwritten dataset is applied on proposed RTL-based CNN architecture for biosensor applications in ModelSim®. The consistency is checked with multiple test samples and 92% accuracy is achieved. The proposed idea is implemented in 28 nm CMOS technology. It occupies 9.986 mm2 of the total area. The power requirement is 2.93 W from 1.8 V supply. The total time taken is 8.6538 ms.

A Highly Efficient RF-DC Converter for Energy Harvesting Applications Using a Threshold Voltage Cancellation Scheme.

In this paper, a self-threshold voltage (Vth) compensated Radio Frequency to Direct Current (RF-DC) converter operating at 900 MHz and 2.4 GHz is proposed for RF energy harvesting applications. The threshold voltage of the rectifying devices is compensated by the bias voltage generated by the auxiliary transistors and output DC voltage. The auxiliary transistors compensate the threshold voltage (Vth) of the PMOS rectifying device while the threshold voltage (Vth) of the NMOS rectifying device is compensated by the output DC voltage. The proposed RF-DC converter was implemented in 180 nm Complementary Metal-Oxide Semiconductor (CMOS) technology. The experimental results show that the proposed design achieves better performance at both 900 MHz and 2.4 GHz frequencies in terms of PCE, output voltage, sensitivity, and effective area. The peak power conversion efficiency (PCE) of 38.5% at -12 dBm across a 1 MΩ load for 900 MHz frequency was achieved. Similarly, for 2.4 GHz frequency, the proposed circuit achieves a peak PCE of 26.5% at -6 dBm across a 1 MΩ load. The proposed RF-DC converter circuit shows a sensitivity of -20 dBm across a 1 MΩ load and produces a 1 V output DC voltage.

T/R RF Switch with 150 ns Switching Time and over 100 dBc IMD for Wideband Mobile Applications in Thick Oxide SOI Process.

This paper presents a fast-switching Transmit/Receive (T/R) Single-Pole-Double-Throw (SPDT) Radio Frequency (RF) switch. Thorough analyses have been conducted to choose the optimum number of stacks, transistor sizes, gate and body voltages, to satisfy the required specifications. This switch applies six stacks of series and shunt transistors as big as 3.9 mm/160 nm and 0.75 mm/160 nm, respectively. A negative charge pump and a voltage booster generate the negative and boosted control voltages to improve the harmonics and to keep Inter-Modulation Distortion (IMD) performance of the switch over 100 dBc. A Low Drop-Out (LDO) regulator limits the boosted voltage in Absolute Maximum Rating (AMR) conditions and improves the switch performance for Process, Voltage and Temperature (PVT) variations. To reduce the size, a dense custom-made capacitor consisting of different types of capacitors has been presented where they have been placed over each other in layout considering the Design Rule Checks (DRC) and applied in negative charge pump, voltage booster and LDO. This switch has been fabricated and tested in a 90 nm Silicon-on-Insulator (SOI) process. The second and third IMD for all specified blockers remain over 100 dBc and the switching time as fast as 150 ns has been achieved. The Insertion Loss (IL) and isolation at 2.7 GHz are -0.17 dB and -33 dB, respectively. This design consumes 145 uA from supply voltage range of 1.65 V to 1.95 V and occupies 440 × 472 µm2 of die area.

A 0.617-2.7 GHz Highly Linear High-Power Dual Port 15 Throws Antenna Switch Module (DP15T-ASM) with Branched-Antenna Technique and Termination Mode.

This paper presents a Dual-Port-15-Throw (DP15T) antenna switch module (ASM) Radio Frequency (RF) switch implemented by a branched antenna technique which has a high linearity for wireless communications and various frequency bands, including a low- frequency band of 617-960 MHz, a mid-frequency band of 1.4-2.2 GHz, and a high-frequency band of 2.3-2.7 GHz. To obtain an acceptable Insertion Loss (IL) and provide a consistent input for each throw, a branched antenna technique is proposed that distributes a unified magnetic field at the inputs of the throws. The other role of the proposed antenna is to increase the inductance effects for the closer ports to the antenna pad in order to decrease IL at higher frequencies. The module is enhanced by two termination modes for each antenna path to terminate the antenna when the switch is not operating. The module is fabricated in the silicon-on-insulator CMOS process. The measurement results show a maximum IMD2 and IMD3 of -100 dBm, while for the second and third harmonics the maximum value is -89 dBc. The module operates with a maximum power handling of 35 dBm. Experimental results show a maximum IL of 0.34 and 0.92 dB and a minimum isolation of 49 dB and 35.5 dB at 0.617 GHz and 2.7 GHz frequencies, respectively. The module is implemented in a compact way to occupy an area of 0.74 mm2. The termination modes show a second harmonic of 75 dBc, which is desirable.

Primary radial nerve palsy associated with humeral shaft fractures according to injury mechanism: is early exploration needed?

BACKGROUND: Radial nerve palsy is a common complication associated with humeral shaft fractures. The purposes of this study were (1) to evaluate the status of primary radial nerve palsy in patients with humeral shaft fracture according to injury mechanism, (2) to estimate the risk factors of primary RNP, and (3) to evaluate whether early exploration is helpful for radial nerve recovery. METHODS: This study analyzed 162 patients with humeral shaft fractures from January 2014 to December 2019. All patients were surgically treated in our hospital. Of these, 109 high-energy injuries were identified and compared with 53 low-energy injuries. The risk factors of radial nerve palsy were analyzed, and the prevalence of radial nerve palsy and status of radial nerve exploration according to injury mechanism were evaluated. Nerve recovery rate according to early nerve exploration was investigated. RESULTS: There were 31 cases of radial nerve palsy among 162 patients: 27 in the high-energy humeral shaft fracture group and 4 in the low-energy humeral shaft fracture group. Logistic regression analysis for risk factors showed that the injury mechanism was significantly associated with primary radial nerve palsy. Among 31 radial nerve palsy patients, 21 radial nerves were explored and 19 radial nerves recovered completely (80.6%). In the high-energy humeral shaft fracture group, 18 radial nerves were explored during surgery among 27 radial nerve palsy cases, and 16 cases recovered (88.9%). The other 9 radial nerves were not explored, and only 5 cases recovered (55.6%). CONCLUSIONS: This study confirmed that the incidence of radial nerve paralysis was higher in high-energy humeral shaft fractures than in low-energy fractures. The more common fracture patterns were oblique, transverse, wedge, and comminuted in high-energy humeral shaft fracture. This study suggests that these patterns are not directly associated with radial nerve palsy, but that high-energy injury is associated with a specific fracture pattern. Early nerve exploration during surgical treatment in patients with radial nerve palsy associated with humeral shaft fracture was helpful especially after high-energy injury.

A Low-Band Multi-Gain LNA Design for Diversity Receive Module with 1.2 dB NF.

This paper presents and discusses a Low-Band (LB) Low Noise Amplifier (LNA) design for a diversity receive module where the application is for multi-mode cellular handsets. The LB LNA covers the frequency range between 617 MHz to 960 MHz in 5 different frequency bands and a 5 Pole Single Throw (5PST) switch selects the different frequency bands where two of them are for the main and three for the auxiliary bands. The presented structure covers the gain modes from -12 to 18 dB with 6 dB gain steps where each gain mode has a different current consumption. In order to achieve the Noise Figure (NF) specifications in high gain modes, we have adopted a cascode Common-Source (CS) with inductive source degeneration structure for this design. To achieve the S11 parameters and current consumption specifications, the core and cascode transistors for high gain modes (18 dB, 12 dB, and 6 dB) and low gain modes (0 dB, -6 dB, and -12 dB) have been separated. Nevertheless, to keep the area low and keep the phase discontinuity within ±10∘, we have shared the degeneration and load inductors between two cores. To compensate the performance for Process, Voltage, and Temperature (PVT) variations, the structure applies a Low Drop-Out (LDO) regulator and a corner case voltage compensator. The design has been proceeded in a 65-nm RSB process design kit and the supply voltage is 1 V. For 18 dB and -12 dB gain modes as two examples, the NF, current consumption, and Input Third Order Intercept Point (IIP3) values are 1.2 dB and 16 dB, 10.8 mA and 1.2 mA, and -6 dBm and 8 dBm, respectively.

The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion.

PURPOSE: To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS: Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss. RESULTS: A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50 years, workers' compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110 min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain. CONCLUSION: The results of this study suggest that younger age, workers' compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed. These slides can be retrieved under Electronic Supplementary Material. (paragraph). Then process the ppt slide as graphical image.

A Memory-Efficient Transmission Scheme for Multi-Homed Internet-of-Things (IoT) Devices.

Internet-of-things (IoT) is a wide spreading technique that enables intelligence to the everyday objects, however, IoT devices are limited in computation and memory space due to their small physical sizes. As a result, IoT applications generally connect to the remote cloud that provides high computation and large storage. To enhance this communication, some IoT devices are equipped with multiple networks, e.g., cellular or Wi-Fi, by using Multipath TCP (MPTCP). However, MPTCP requires large buffer memory space compared to the legacy TCP, which is problematic for low-memory IoT devices. This paper proposes a new MPTCP scheme that leverages the multi-homed feature of low-memory IoT devices. Our design utilizes an application-level distributor that transmits packets to each MPTCP socket at each endpoint of the data. This scheme cleverly avoids the buffer blocking problem, while still maintaining the benefits of multi-homing. The main contribution of our paper is three-fold. First, our proposal achieves the benefits of multipath while avoiding buffer blocking due to out-of-order packets. Second, since our scheme utilizes the original MPTCP and modifies only the application level, it can be deployed more easily to the legacy systems. Finally, our experimental results, conducted on a Linux testbed and real-world cellular/Wi-Fi, show that the proposed scheme requires only half or less memory to achieve the performance of MPTCP.

The Vascular Anatomy of the Capitate: New Discoveries Using Micro-Computed Tomography Imaging.

PURPOSE: To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (µCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. METHODS: Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a µCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points. RESULTS: The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. CONCLUSIONS: This µCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. CLINICAL RELEVANCE: This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.

Capitate Fractures: A Review of 53 Patients.

PURPOSE: To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution. METHODS: We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients' demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed. RESULTS: Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults. CONCLUSIONS: This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting.

BACKGROUND: The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume. OBJECTIVES: The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction. METHODS: A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer. RESULTS: Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting. CONCLUSIONS: The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic.

Condylar-stabilizing tibial inserts do not restore anteroposterior stability after total knee arthroplasty.

The Triathlon condylar-stabilizing (CS) lipped insert is designed to provide anteroposterior (AP) stability of the posterior-stabilized (PS) insert, without a post. The purpose of this study was to compare the AP stability of the knee in patients with Triathlon CS and PS total knee arthroplasty (TKA) with midterm follow-up. Thirty-one patients received a Triathlon PS TKA in one knee and a Triathlon CS TKA in the contralateral knee, and 28 patients were followed up with a minimum duration of 5years. Although there was no difference in functional outcomes, the posterior displacement was significantly greater in the CS TKA group than in the PS TKA group (P<0.001). The Triathlon CS lipped insert could not restore posterior stability with PCL sacrifice.

The impact of AI-enabled CRM systems on organizational competitive advantage: A mixed-method approach using BERTopic and PLS-SEM.

The recent advances in machine learning and deep learning algorithms, along with the advent of generative AI, have led AI to become the "new normal" in organizations. This trend has extended to CRM, resulting in the development of AI-enabled CRM systems, or AI-CRM. Despite the growing adoption of AI as part of competitive strategies, many firms report minimal or no positive effect of AI on performance. This study addresses the research questions: "What are the critical features of AI-CRM systems?" and "How do these features impact organizational competitive advantage?" To explore this, we aim to identify key characteristics of AI-CRM and assess their impact on organizational performance. In Study 1, we utilize BERTopic topic modeling to extract critical features of AI-CRM from user reviews. Study 2 employs PLS-SEM to examine how these features influence organizational competitive advantage. Study 1 reveals four main characteristics of AI-CRM (general, marketing, sales, and service/support), each comprising distinct features. Study 2 shows that these characteristics differentially impact CRM capability, significantly affecting performance and competitive advantage. The findings offer valuable insights for both theory and practice regarding the effective use of AI in organizations.