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The pseudocapsule (PC) status of clear cell renal cell carcinoma (ccRCC) is closely associated with tumor aggressiveness and surgical strategy, yet accurate preoperative non-invasive assessment remains challenging. This study aimed to develop and internally validate a contrast-enhanced ultrasound (CEUS)-based prediction model for assessing PC status in patients with ccRCC. This retrospective study enrolled 254 patients with pathologically confirmed ccRCC who underwent surgery at Shanghai General Hospital, between August 2021 and December 2024. All patients received preoperative conventional ultrasound and CEUS examinations. Independent risk factors for PC absence or penetration were identified using multivariable binary logistic regression analysis. These factors were then incorporated into a nomogram to construct a predictive model. The model's discriminatory performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Internal validation was performed using bootstrap resampling to generate calibration curves and evaluate goodness-of-fit via the Hosmer-Lemeshow test. Finally, the clinical utility of the nomogram was determined using decision curve analysis (DCA). Three CEUS features-incomplete PC sign, peak hypoenhancement, and rapid washout pattern-were independent predictors in the final model. The nomogram showed acceptable discrimination [training AUC: 0.779, 95% confidence interval (CI): 0.692-0.867; validation AUC: 0.749, 95% CI: 0.600-0.898] and calibration (Hosmer-Lemeshow P>0.05). DCA supported its potential clinical utility. In conclusion, a CEUS-based nomogram was developed and internally validated to preoperatively predict PC status in ccRCC. This practical, non-invasive tool can guide and optimize surgical planning.
Revision meniscal repair may yield better postoperative outcomes than meniscectomy. Few studies concerning the postoperative results of revision meniscal repair are available. To evaluate the clinical outcomes following revision meniscal repair for meniscal retears after isolated meniscal repair. Case series; Level of evidence, 4. The cases of 11 knees with ≥1 year of postoperative follow-up were retrospectively analyzed after they had undergone revision as a result of retear at the initial suture site between 2018 and 2024. We compared the patients' presurgical and final follow-up values on the Tegner sports activity score (Tegner score), Lysholm score, and International Knee Documentation Committee (IKDC) Subjective Knee Form by Wilcoxon signed-rank test. At 1 year postoperatively, the revision site was structurally evaluated by magnetic resonance imaging (MRI). To account for multiple comparisons across outcome measures, a Bonferroni correction was applied, with statistical significance set at a P value of < .02. Of the 11 knees, 7 were male and 4 were female (median age at revision: 23 years; IQR, 17-32 years). The median Lysholm and IKDC scores both improved significantly from 57.0 (IQR, 40.0-81.0) and 50.8 (IQR, 37.9-72.4) before revision surgery to 91.0 (IQR, 90.0-100.0) and 88.5 (74.7-94.3) at the final follow-up (P = .002, r = 0.89; P = .002, r = 0.89), respectively. Postoperative MRI findings revealed low-signal intensity changes at the revision site in 8 of 11 patients, whereas 3 patients demonstrated persistent high-signal intensity. Our study showed that revision meniscal repair may improve short-term clinical results in carefully selected patients with retears. Further research is required to define optimal indications and techniques.
Lamb survivability is a primary determinant of profitability in sheep production. Most published heritability estimates for this complex trait are low (< 0.05). A comprehensive analysis of lamb survivability using five random effects models of increasing complexity and three fixed effects models for combined ("Combined") and separate birth types ("Multivariate") for Polypay, Rambouillet, Targhee, and Suffolk U.S. sheep breeds was performed along with birth weight in a linear-threshold model. Records from 1980 to 2024 from the U.S. Sheep Experiment Station were used and included 22,284 Polypay, 25,085 Rambouillet, 20,004 Targhee, and 3,965 Suffolk lamb survivability observations. For the final models for all breeds, direct heritability for each birth type was higher than when birth types were combined and analyzed as a single trait. The final model for Suffolk did not include maternal permanent environment. Heritability estimates for the Combined data set were low for direct (0.011 for Polypay to 0.152 for Suffolk) and maternal components (0.038 for Polypay to 0.102 for Suffolk). For the Multivariate data sets, each birth type had a higher direct heritability estimate than the Combined data set, with twins being generally lower within breed (0.056 for Rambouillet to 0.158 for Suffolk) compared to singles (0.111 for Targhee to 0.311 for Suffolk) and triplets (0.183 for Rambouillet to 0.199 for Polypay). Estimated breeding values (EBV) were computed for all pedigree animals and converted to the 80% probability scale and genetic trends were derived. There were sires that had above average EBV for both direct and maternal lamb survivability, suggesting genetic progress can be made for both components of the trait. Evaluating single, twin, and triplet lamb survivability as separate traits is warranted because the direct and maternal influences differ by birth type and heritability estimates were substantially increased over considering all birth types in a single trait. Lamb survivability is of economic importance to sheep producers due to its role in reproductive efficiency. A comprehensive threshold model analysis was undertaken to determine the most appropriate lamb survivability model for each of four sheep breeds at the U.S. Sheep Experiment Station. The breeds included the Polypay, Rambouillet, Targhee, and Suffolk and included records from 1980 to 2024. In addition to determining the most appropriate model for each breed, analyses included a combined data set and a multivariate data set separated by birth type. In agreement with literature estimates, both the direct and maternal components of lamb survivability were low to moderate. Because the direct and maternal influences differed by birth type, and the heritability estimates were higher than with the combined data set, analyzing lamb survivability as separate traits by birth type is warranted. There were sires that had above average estimated breeding values for both direct and maternal lamb survivability, suggesting genetic progress can be made for both components of the trait.
Strategies for improving suboptimal diet quality are needed and may be informed by investigating associations between determinants of food choice and diet quality. This study aims to assess associations between determinants of food choice and diet quality assessed by Healthy Eating Index-2020 (HEI-2020) in a nationally representative sample of United States adults. This cross-sectional analysis included adult participants in the NHANES 2017-March 2020. Determinants of food choice were identified using a previously proposed conceptual framework and included modifiable (i.e., use of nutrition labels, consumption of food away from home, familiarity with MyPlate, perceived diet quality, typical work schedule, number of hours worked per week) and nonmodifiable (i.e., age, sex, race, BMI, education, relationship status) determinants. Survey-weighted univariate and multivariate hierarchical regression was used to assess the relationship between food choice determinants and the HEI-2020 score. Significant variables from the final model were used to predict adequacy and moderation component subscores of the HEI-2020. In the final model, modifiable determinants of diet quality associated with the HEI-2020 score included use of nutrition labels, frequency of food away from home, and perceived diet quality (R 2 adj = 0.23, P < 0.001). Those reporting rarely or never using nutrition labels had a 6.73-point lower HEI-2020 score than those reporting using them always or most of the time (P < 0.001). Those consuming ≥5 meals away from home in the past week had a 4.78-point lower HEI-2020 score than those consuming 0 meals away from home per week (P = 0.004). Those reporting fair or poor perceived diet quality had a 5.15-point lower HEI-2020 score relative to those with excellent or very good perceived diet quality (P < 0.001). Determinants accounted for a higher proportion of variance in the adequacy score (R 2 adj = 0.26, P < 0.001) than the moderation score (R 2 adj = 0.09, P < 0.001). These findings suggest that interventions seeking to meaningfully improve diet quality may benefit from simultaneously targeting multiple determinants of food choice.
In Germany, 80-90% of people require palliative care in the final stages of life. Inpatient care facilities are increasingly becoming the final place of residence for many people, and therefore also often their place of death. Inadequate identification of palliative care needs can result in substandard palliative care in nursing homes, where residents are often admitted to the hospital towards the end of their lives. This study investigated whether a special palliative care qualifications for nursing staff could improve the care for residents in inpatient care facilities. A cluster-randomised intervention study was conducted. Nursing staff from the participating care facilities in the intervention group took part in the 40-hour 'Palliative Care - Multiprofessional' basic qualification course. The outcomes were the use of specialised outpatient palliative care, and the documentation of palliative-relevant symptoms and measures for residents in the three months prior to their death. Data from the patient records were assessed and statistically analysed. During the observation period, 119 residents deceased in the 10 participating nursing homes (5 of which were in the intervention group), of whom 42 were in the intervention group and 77 were in the control group. Specialised outpatient palliative care was documented for 19.0% of residents in the intervention group and 9.1% of residents in the control group. Pain was documented in 57.1% of residents in the intervention group versus 49.4% in the control group. This palliative symptom was documented 225 times in total. An appropriate subsequent measure was documented in 150 cases (73.6% in the intervention group versus 61.9% in the control group). Logistic multilevel analysis showed that residents in the intervention group were more likely to receive a measure for a documented pain event (OR 1.804). The results show that having a qualification in palliative care leads to palliative symptoms being identified more accurately and appropriate measures being implemented more effectively. Using data from real healthcare settings is challenging because there are no overall standards. Nevertheless, the results reflect real healthcare practice. Advanced training in palliative care helps improves the care provided to palliative residents in nursing homes. Trained staff can help to identify the need for care more accurately and ensure that appropriate palliative care is provided. German Clinical Trials Register, DRKS00020749 (https://drks.de/search/en/trial/DRKS00020749/entails), 7 May 2020.
Facioscapulohumeral Muscular Dystrophy (FSHD) is among the most common hereditary muscular dystrophies, often affecting periscapular muscles and causing scapular winging, which severely impairs activities of daily living. Scapulothoracic arthrodesis (STA) aims to stabilize the scapula, improving upper extremity range of motion. Despite its long-standing use, the ideal scapular fixation position remains undetermined, and level-specific fusion outcomes have not been evaluated. This retrospective cohort study evaluates fusion rates based on early and late computed tomography (CT) images, introduces a novel fusion grading system, and quantifies three-dimensional fixation positions in bilateral STA cases. We hypothesized that STA would achieve a high rate of solid fusion detectable on CT within 12 months. Furthermore, we expected that bilateral procedures would yield symmetric scapular orientation within individual patients, and that the proposed fusion grading system would demonstrate substantial inter-observer reliability. CT imaging of 36 patients (56 shoulders) was reviewed using 3D Slicer software. A novel five-point Qualitative Fusion Score (QFS) was developed, categorizing fusion at each rib level as: A (clear union), B (probable union), C (probable non-union), D (clear non-union), and F (scapula fracture). For bilateral STA cases (14 patients, 28 shoulders), scapular positions were assessed three-dimensionally using anatomical landmarks: glenoid center, scapular spine midpoint, and inferior angle. Angles between the scapular plane and coronal, sagittal, and transverse planes were analyzed using paired samples t-tests. Subgroup analysis compared early (3-6 months) and late (≥12 months) CT fusion scores in 17 shoulders. Overall fusion success (Grade A + B) was achieved in 82.3% of sites at final follow-up (mean 38.4 months), with significant variation by rib level. Grade A (solid union) rates ranged from 37.78% (7th rib) to 58.82% (2nd rib). The 7th rib demonstrated the poorest outcomes with the highest rates of definite non-union (13.33%) and fracture (8.89%), while most fractures occurred exclusively at this level. The prevalence of cable fixation varied between 78.43 and 100% across fixation levels, with high-strength polyethylene tape sutures utilized selectively in 0 to 21.57%. In bilateral cases, scapular positioning showed excellent symmetry with no significant differences in angles relative to coronal (p = 0.271), sagittal (p = 0.297), or transverse planes (p = 0.053), and mean vertical position difference of 12.15 mm. Early CT evaluation demonstrated strong predictive value: all Grade B sites progressed to Grade A (100%), while only 35% of Grade C sites showed improvement. The QFS showed significant improvement from early to late imaging (20.8 ± 3.3 vs 24.8 ± 4.6, p < 0.001) with moderate-to-good inter-observer reliability (ICC = 0.725). STA achieved high overall fusion success with significant level-specific variation, demonstrating superior outcomes at upper rib levels and increased complications at the 7th rib level. Bilateral procedures yielded highly symmetric scapular positioning. Early CT evaluation at 3 months effectively predicts final fusion outcomes, particularly identifying patients at risk for poor healing. The novel QFS provides a standardized assessment tool for postoperative monitoring and clinical decision-making. III; Retrospective Cohort Study.
To compare clinical characteristics and visual outcomes according to recurrence timing in eyes with myopic choroidal neovascularization (CNV) following anti-vascular endothelial growth factor (anti-VEGF) therapy. This retrospective cohort study included eyes with treatment-naïve myopic CNV that achieved complete resolution after initial anti-VEGF therapy. To specifically evaluate the impact of recurrence timing, analyses were restricted to eyes that developed recurrence, which were categorized as early (< 12 months) or late (≥ 12 months). Baseline characteristics, multimodal imaging features, treatment profiles, and recurrence-specific parameters were compared. Longitudinal changes in best-corrected visual acuity (BCVA) were analyzed using linear mixed-effects models, and factors associated with the final BCVA were evaluated using multivariable linear regression. Of the 79 eyes, 32 (40.5%) experienced recurrence during the mean follow-up of 36.9 ± 23.7 months (early: 15 eyes; late: 17 eyes). The early recurrence group exhibited a significantly longer axial length (p = 0.019); other baseline features and treatment profiles were similar between groups. At recurrence, subretinal hyperreflective material height was significantly greater in the late recurrence group (p = 0.041). Both groups showed visual improvement after initial treatment, without a significant difference in BCVA at any predefined time point. Baseline BCVA was the only independent predictor for final BCVA (β = 0.46, p = 0.039); no significant association between recurrence timing and visual outcomes was detected. Visual outcomes were comparable between early and late recurrences of myopic CNV. Baseline BCVA was the strongest factor associated with long-term visual outcome, whereas no association between recurrence timing and visual outcomes was detected in this cohort.
Atrial fibrillation detected after stroke (AFDAS) is clinically important, but AFDAS-specific risk tools for patients without known atrial fibrillation (AF) remain limited. We developed and temporally validated the Prediction of AF in Ischemic Stroke (PAFIS) score. We retrospectively analyzed ischemic-stroke patients from the National Taiwan University Hospital Integrative Medical Data Center. The development cohort included patients hospitalized in 2010-2020 (n = 3406), and the temporal validation cohort included those hospitalized in 2021-2023 (n = 1366). Known AF (KAF) was defined as AF documented before stroke or within 14 days after stroke; AFDAS was defined as newly documented AF beyond 14 days among patients without KAF. Multivariable logistic regression restricted to KAF-free patients was used for score derivation. Discrimination, calibration, and time-to-AFDAS risk stratification were assessed. Among KAF-free patients, AFDAS was detected during routine clinical follow-up in 176 of 2175 (8.1%) in the development cohort and 148 of 1366 (10.8%) in the validation cohort. The final PAFIS score included age ≥ 75 years, female sex, valvular heart disease, left atrial diameter ≥ 40 mm, and tricuspid regurgitation peak gradient ≥30 mmHg. AUCs were 0.72 (95% CI, 0.68-0.76) in development and 0.65 (95% CI, 0.60-0.70) in validation. PAFIS outperformed CHA₂DS₂-VASc, HAVOC, and AF-ESUS, but not Brown ESUS-AF. Observed AFDAS detection rates increased across risk groups in both cohorts. PAFIS provides a simple AFDAS-specific tool for selective post-stroke rhythm monitoring. Because AF ascertainment was based on routine clinical care without standardized prolonged monitoring, PAFIS predicts AF detection under routine practice rather than true AFDAS incidence. Prospective multicenter validation with standardized monitoring is warranted.
Biopsy-confirmed International Society of Urological Pathology (ISUP) Grade Group 1 prostate cancer (PCa) is often considered suitable for active surveillance (AS). However, postoperative Gleason score upgrading (GSU) remains a major source of uncertainty in selected patients who proceed to radical prostatectomy (RP). This study aimed to develop and internally validate a multivariable model for predicting postoperative GSU in men with biopsy-confirmed Gleason score 3+3=6 disease who underwent RP. We retrospectively reviewed patients who underwent transperineal prostate biopsy followed by RP at Northern Jiangsu People's Hospital Affiliated to Yangzhou University between October 2022 and May 2025. Patients with biopsy Gleason score 3+3=6 and no preoperative evidence of metastasis were included; patients with prior androgen-deprivation therapy or chemotherapy, incomplete key data, coexisting malignancy, or active inflammatory/infectious disease were excluded. Candidate predictors included demographic, laboratory, imaging, pathological, and clinical variables. The reference standard for GSU was final RP pathology, with GSU defined as ISUP Grade Group 2 or higher. Patients were randomly divided into training and validation cohorts at a 7:3 ratio. Variables associated with GSU in preliminary analysis and considered clinically plausible were entered into least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression for effect estimation and nomogram construction. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, the Hosmer-Lemeshow test, decision curve analysis (DCA), threshold-based classification metrics, and bootstrap internal validation. Among 312 patients, 143 (45.9%) had postoperative GSU. The median age was 72 years, and the median prostate-specific antigen (PSA) level was 9.00 ng/mL. In multivariable analysis, age [odds ratio (OR) =1.06, 95% confidence interval (CI): 1.02-1.11], percentage of positive biopsy cores (OR =1.05, 95% CI: 1.03-1.08), and Prostate Imaging Reporting and Data System (PI-RADS) score ≥4 (OR =2.26, 95% CI: 1.22-4.21) were independently associated with GSU. The nomogram showed AUCs of 0.78 (95% CI: 0.72-0.84) in the training cohort and 0.73 (95% CI: 0.63-0.83) in the validation cohort. At the Youden-index cutoff, sensitivity/specificity were 0.87/0.53 in the training cohort and 0.90/0.40 in the validation cohort, with acceptable calibration and net clinical benefit across clinically relevant threshold ranges. This internally validated model provides a quantitative adjunct for estimating the probability of postoperative GSU in biopsy ISUP Grade Group 1 patients undergoing RP. Because the cohort was derived from a single center and lacked external validation, the model should be interpreted as exploratory and requires prospective multicenter validation before routine clinical use.
Candida auris is an emerging multidrug resistant fungal pathogen associated with high mortality rates, rapid global dissemination and resistance to conventional antifungal therapies. It's remarkable ability to evade host immune responses and persist in health care setting demands the development of effective immunotherapeutic strategies. In this study, a reverse vaccinology and immunoinformatics based approach was employed to design a novel chimeric multi-epitope vaccine targeting surface expose N-terminal domain of the agglutinin like protein involved in host pathogen interactions. High affinity B-cell and T-cell (MHC class I and II) epitopes were identified and screened based on antigenicity, allergenicity, toxicity and population coverage. Selected epitopes were assembled using optimized linkers (EAAAK, AAY and GPGPG) along with an adjuvant to enhance immunogenicity and structural stability. Physicochemical characterization, structural validation, molecular docking with human Toll-like receptor 4 (TLR4), Normal Mode Analysis (NMA), immune simulation, codon optimization and in silico cloning into the pET28a+ vector were performed to evaluate the vaccine construct. The selected epitopes demonstrated a global population coverage of 97.31%. the final vaccine construct was predicted to highly antigenic, non-allergenic, structurally stable and soluble. Molecular docking analysis revealed strong and stable interactions between the vaccine construct and human TLR4, with a binding energy of - 906.1 kcal/mol. Normal Mode Analysis further supported the structural stability of the vaccine receptor complex. Immune simulations predicted robust primary and secondary responses characterized by elevated IgG and IgM antibodies along with a Th1-skewed cytokine profile dominated by IFN-γ and IL-2 expression. Codon optimization and in-silico cloning indicated favorable translational efficiency in the pET28a+ expression system. The designed chimeric multi epitope vaccine demonstrated promising immunogenic, structural and receptor binding properties against Candida auris. These findings suggest that the proposed vaccine construct may serve as a potential candidate for further experimental validation and future development of effective immunotherapeutic interventions against multidrug- resistant fungal infections.
Accurate prediction of breast cancer recurrence remains difficult because prognosis varies significantly across molecular subtypes. This underscores the need for scalable, affordable, and interpretable prognostic tools. We developed machine learning models integrating hematological indices with clinicopathologic data to predict 2- and 10-year recurrence or all-case death. We retrospectively analyzed 4277 women with primary breast cancer (2008-2022). The cohort included hormone receptor-positive (HR + ), HER2-positive, and triple-negative (TNBC) subtypes. We trained multiple classifiers and integrated them into a stacked ensemble using logistic regression as the final learner. Class imbalance was addressed with SMOTE applied to training sets. The ensemble achieved strong discrimination: general cohort AUC 0.859 (2-year) and 0.811 (10-year), with specificity 84-82% and sensitivity 68-61%. Subtype-specific performance remained robust across time horizons: HR + AUC 0.862/0.804, HER2 + AUC 0.877/0.831, and TNBC AUC 0.826/0.826 (2-year/10-year respectively). SHAP analysis identified advanced tumor stage, elevated inflammatory ratios (NLR, PLR, MLR), elevated red cell distribution width, and age as key adverse predictors with stronger effects on early recurrence. This interpretable tool uses routine blood tests and clinico-pathological data at diagnosis. It flaggs high-risk patients for intensified therapy, useful where genomic testing is unavailable.
Achilles tendon rupture is a rare but potentially career-altering injury in elite basketball athletes. Contemporary data specific to National Basketball Association (NBA) players are limited, particularly regarding return-to-play (RTP) timing, functional outcomes, and long-term incidence trends in the modern high-pace era. To evaluate RTP rates, time to return, postinjury performance changes, and temporal patterns of Achilles tendon rupture in NBA players over a 25-year period. Descriptive epidemiology study. NBA players with a confirmed Achilles tendon rupture between the 2000-2001 and 2024-2025 seasons were identified through multisource verification, including team announcements, league injury reports, Basketball Reference records, NBA.com injury logs, and contemporaneous reporting from major sports media outlets. RTP was defined as participation in at least one official NBA regular season or postseason game after the index rupture. Season-level performance metrics were extracted for the final full preinjury season and the first full postreturn season. Paired pre- versus postinjury comparisons were performed, effect sizes were calculated using Cohen d, and selected metrics were normalized per 48 minutes to account for changes in playing time. The annual rupture incidence was evaluated in relation to league-wide pace using Pearson correlation. A total of 22 NBA players sustained a confirmed Achilles rupture. Among athletes with adequate follow-up (n = 15), 13 players (86.7%) returned to NBA competition. The mean time to RTP was 10.8 ± 4.3 months. Significant declines were observed in minutes per game (-7.6 minutes; P < .001), points per game (-5.4; P < .001), effective field goal percentage (-0.055; P = .005), rebounds (-1.3; P = .008), assists (-1.0; P = .002), defensive rebounds (-1.01; P = .014), steals (-0.28; P = .001), and blocks (-0.19; P = .026). When normalized per 48 minutes, scoring production still decreased significantly (-3.36 points; P = .004), while defensive metrics were preserved. Games started decreased substantially (-44 percentage points; P = .003). Annual rupture incidence remained low overall, with a notable spike in the 2024-2025 season, but no significant correlation with league pace was observed. This study showed that most NBA players with adequate follow-up returned to professional play after Achilles tendon rupture, typically within approximately 11 months. However, reductions in playing time, scoring output, offensive efficiency, and starting role prevalence were common after return. Per-48-minute analyses suggested that scoring decline persisted even after accounting for reduced playing time, whereas several defensive and rebounding metrics were relatively preserved. Annual rupture incidence remained low overall, although a notable cluster was observed during the 2024-2025 season. These data may be helpful for counseling players regarding performance expectations and decision-making after Achilles tendon rupture in elite basketball players.
A plausible association between adolescent idiopathic scoliosis (AIS) and eating disorders (EDs) is suggested by the current research, although this potential relationship is poorly defined. This systematic review seeks to better understand the association between AIS and EDs. Medline, Embase, and Web of Science were searched for articles that assessed the combination of AIS and EDs. Twelve articles were included in the final review. Six of the twelve studies were assessed as having serious risk of bias, and one was assessed to have moderate risk of bias. Three plausible associations are suggested from studies in this review: (1) individuals with AIS tend to have lower BMIs, (2) there is little evidence to suggest that individuals with AIS exhibit increased ED psychopathology, and (3) limited studies using sample cohorts of individuals diagnosed with EDs suggest an increased likelihood of also being diagnosed with AIS. Additional longitudinal research in the ED population is needed to better understand the association between EDs and AIS and whether EDs confer increased risk to develop AIS.
Bony Bankart lesions (anteroinferior glenoid avulsion fractures) often occur after anterior shoulder dislocations, with an incidence up to 33% in first-time dislocaters. Detachment of the labrum and underlying glenoid bone piece can lead to recurrent instability, especially with increasing glenoid bone loss. Treatment is generally arthroscopic bony Bankart repair in acute injuries with viable bone fragments and minimal glenoid bone loss (<13.5%). However, there is no gold standard for arthroscopic fixation. Given the acuity of the lesion with a sizeable bony Bankart fracture, a reducible fragment, and the patient's high activity level, arthroscopic reduction and fixation were indicated. A high posterolateral viewing portal was created, with the remainder of the portals created under direct visualization. The fracture hematoma was debrided with a shaver. The anterior glenoid fracture was identified with the labrum still attached, and a radial tear of the superior labrum was noted. A combination of instruments was used to release and mobilize the fracture fragment. Two traction stitches were placed into the superior and inferior ends of the fragment to control it during reduction. A hooked guide was used to reduce the fracture back to its origin. A cannulated drill was used to drill through the posterior glenoid through the fracture fragment. The suture and the button were passed anterior to posterior to secure the fragment, tensioned to 100 N, and the fragment was stable in an anatomic position. A luggage tag suture was placed into the capsular-labral complex at the superior aspect of the bony Bankart lesion, and this was impacted just superior to the end of the fracture fragment to secure the labrum back in place. The patient was immobilized in a sling for weeks 0 to 4, progressed in range of motion from weeks 5 to 12, and began strengthening at 12 weeks. At the final follow-up, the patient was back to his usual activities without complaints of pain or apprehension. Arthroscopic reduction and suspensory button fixation of bony Bankart lesions is a viable option for reducing and fixing these injuries to prevent future development of recurrent instability. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
The increasing number of employed mothers in the workforce is an inevitable trend in China. Employed mothers may stop breastfeeding due to work-related stressors. However, many mothers overcome these challenges and continue breastfeeding after returning to work. This study aimed to develop and validate a tool to understand employed mothers' experiences with continuing breastfeeding after returning to work, based on Kumpfer's Resilience Framework, in China. The study comprised three phases. Phase 1 involved item pool generation through a literature review, focus groups, and a Delphi survey, followed by pre-testing with 15 mothers to finalize the breastfeeding resilience scale (BRS) trial version. In Phase 2, the trial BRS was administered in a cross-sectional survey of employed mothers from 18 provincial-level regions of China who were recruited using purposive sampling, and valid responses from 172 participants were included in item analysis and exploratory factor analysis (EFA) to develop the provisional BRS. In Phase 3, the provisional BRS and the Connor-Davidson Resilience Scale (CD-RISC) were administered in a cross-sectional survey of employed mothers from 23 provincial-level regions of China who had returned to work, using purposive sampling. Valid responses from 200 participants were included to evaluate reliability and validity and develop the formal BRS. Reliability was examined using internal consistency and split-half coefficients. Validity was assessed through content, construct, convergent, discriminant, and criterion-related validity analyses. The formal BRS contains 24 items across five dimensions. Cronbach's α was 0.897 (95% CI: 0.875-0.916) for the overall scale, and Cronbach's α coefficients for the five dimensions ranged from 0.750 (95% CI: 0.683-0.805) to 0.875 (95% CI: 0.847-0.900). Split-half reliability was 0.787. EFA yielded five factors explaining 63.139% of the variance, with all item loadings exceeding 0.50. Confirmatory factor analysis (CFA) showed that most fit indices met the recommended criteria, with χ²/df = 1.654, RMSEA = 0.057, CFI = 0.923, IFI = 0.924, TLI = 0.912, although GFI = 0.860 and NFI = 0.828 were below the 0.90 cutoff. Average variance extracted (AVE) values ranged from 0.441 to 0.570, with the social dimension having an AVE of 0.441, and composite reliability (CR) values ranged from 0.755 to 0.876. Correlation coefficients among the dimensions were below 0.50, and the square roots of the AVE values for each dimension ranged from 0.663 to 0.755. Correlations between BRS dimensions and the total score on the CD-RISC criterion scale ranged from 0.410 to 0.629, all statistically significant. This study developed and validated a Breastfeeding Resilience Scale for employed mothers after returning to work. It may provide healthcare workers engaged in breastfeeding promotion with an assessment tool to identify employed mothers' intrinsic motivation and psychological resilience throughout their breastfeeding journey. Not applicable.
Biliary stent fragments are sometimes advanced into the bowel during percutaneous procedures with the expectation of spontaneous passage. We present a 67-year-old woman who underwent open left hepatectomy with en bloc resection of the common hepatic duct, Roux-en-Y hepaticojejunostomy, and cholecystectomy for hilar cholangiocarcinoma, and was subsequently found to have a retained fractured plastic biliary stent fragment within the intrahepatic bile ducts. During percutaneous transhepatic cholangiography (PTC), the fragment was captured with a snare and advanced into the small bowel, with the final cholangiogram confirming the fragment within the bowel. Surveillance imaging, however, demonstrated the fragment back within the intrahepatic bile ducts. It was definitively removed at a second PTC, after which an internal-external biliary drain was placed. The patient recovered well; the drain was later capped and removed at the bedside, and she remained asymptomatic with normal white-cell counts on follow-up. This case demonstrates that, in patients with hepaticojejunostomy, advancement of a stent fragment into the bowel may not be definitive, and that confirmatory imaging and consideration of complete retrieval are warranted.
Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates and heterogeneous progression risk, making accurate diagnosis, risk stratification, and personalized management challenging. Conventional clinical scoring systems provide general guidance but often fail to fully capture tumor complexity and interpatient variability. This review summarizes current applications of artificial intelligence (AI) in NMIBC, focusing on diagnosis, prognostic, and clinical decision-making. A comprehensive literature search was conducted in PubMed, Google Scholar, Embase and Scopus. Keywords related to AI and NMIBC including machine learning, deep learning, imaging, cystoscopy, radiomics, and computational pathology were used. Studies were independently screened, followed by full-text assessment for eligibility. A total of 35 English-language studies, published between January 2019 and March 2026, were included in the final qualitative synthesis. AI applications in NMIBC span cystoscopy, imaging, histopathology, and prognostic modeling, demonstrating high diagnostic and predictive performance. In cystoscopy, deep learning models achieve sensitivities ranging from 88% to 97% and specificities from 92% to 99%, with area under the curves (AUCs) up to 0.98-0.99. Real-time segmentation reports Dice coefficients between 74% and 93%, with processing times approximately 6-7 ms per image. In imaging, AI-based radiomics and deep learning applied to magnetic resonance imaging (MRI) and computed tomography (CT) provide AUCs ranging from 0.82 to 0.99, often outperforming conventional models. Multiparametric MRI achieves AUCs of 0.88-0.91 for recurrence prediction, while CT-based models reach up to 0.997 for differentiating NMIBC from muscle-invasive disease. Prognostic models using machine learning, including random survival forests and neural networks, demonstrate improved discrimination compared to traditional scores, with concordance indices up to 0.79-0.88, enabling more granular risk stratification. In histopathology, AI-driven analysis of whole-slide images achieves accuracies of 74-90% for recurrence prediction and AUCs up to 0.86, while identifying patients at significantly higher risk of progression or treatment failure. AI enhances NMIBC management by enabling more precise, reproducible, and individualized diagnosis and risk assessment. The integration of multimodal data may improve clinical decision-making and support personalized treatment strategies, although further validation and standardization are required before widespread clinical implementation.
Researchers and funders increasingly see potential for integrating human-centered design (HCD) and implementation science (IS) approaches to enhance the design and uptake of health interventions and implementation strategies. These approaches offer complementary strengths. HCD prioritizes developing compelling, intuitive, and adoptable innovations grounded in user and contextual needs; IS focuses on ensuring evidence-based practices reach and work for their intended populations. Integrating HCD and IS creates challenges that existing IS proposal writing guidelines do not address. HCD's inherent uncertainty-since final designs are developed through iteration rather than pre-determined-can unsettle researchers and funders accustomed to more defined endpoints. Variation in how HCD is understood adds further difficulty when collaborating across disciplines or communicating with funders. There are currently no published recommendations to help researchers design strong studies integrating HCD and IS and communicate them effectively to funders. We present tips to support both rigorous study design and effective proposal writing that integrate HCD and IS. This draws from our experiences leading, supporting, and reviewing both funded and unfunded projects. Our considerations are informed primarily by experiences with teams in the United States in the mental health and behavioral health domains; however, we have found our findings also apply to projects globally and in other health sectors. Our intent is that this guide will advance good research that leverages both approaches and is viable for funding. We also hope that the tips will support funders in developing solicitations and evaluating proposals. There is untapped potential for innovative health research integrating HCD and IS, but realizing it requires both rigorous study design and an ability to attract funding. We offer practice guidance to help researchers and funders develop quality projects and proposals, and we encourage others to build on these recommendations.