The integration of the da Vinci single-port (SP) platform into head and neck practice represents a major transition from conventional multi-port robotic systems, yet real-world data on early institutional adoption remain limited. This study evaluated the clinical integration of the SP platform during an early implementation period, with particular focus on case accrual, diversification of surgical access routes, surgeon-specific adoption patterns, and temporal evolution of case selection. This retrospective observational study included consecutive robotic head and neck procedures performed with the da Vinci SP system at a single institution during a 9-month transition period prior to the installation of a second SP system. Clinical, operative, and perioperative variables were extracted from an amended institutional dataset and operative records. Cases were analyzed overall, compared between the 2 primary surgeons, and chronologically stratified into Early and Later phases. A total of 64 cases were performed, including 34 malignant (53.1%) and 30 benign (46.9%) lesions. Case accrual increased steadily throughout the study period. Transoral surgery was the most common access route (42/64, 65.6%), followed by transoral plus transcervical (12/64, 18.8%), transcervical alone (5/64, 7.8%), and retroauricular access (5/64, 7.8%). Surgeon 1 performed 51 cases and treated an older population with significantly higher rates of tobacco, alcohol, and betel quid exposure, more malignant disease, and broader anatomic distribution. Surgeon 2 performed 13 cases, all through a transoral approach, predominantly for benign lesions. A chronological comparison between the Early and Later phases showed stable surgeon distribution, pathology patterns, and approach patterns, but oral cavity cases and reconstructive procedures became more prominent in the Later phase. Cumulative accrual curves for benign and malignant disease progressed in parallel, suggesting that SP adoption expanded across both oncologic and benign indications rather than being confined to a single clinical niche. Early institutional integration of the da Vinci SP platform was associated with steady case accrual, expansion of operative access pathways, and broad adoption across malignant and benign head and neck indications. These findings provide real-world evidence that transition from multi-port to single-port robotic surgery can be achieved successfully within a high-volume head and neck program.
Pipkin type III femoral head fracture-dislocation in a gravid patient is an exceptionally rare clinical entity. We report the case of a woman in her early 40s who presented at 36 weeks of gestation following a high-energy motor vehicle collision. Clinical examination and imaging confirmed a left posterior hip dislocation; computed tomography revealed a severely comminuted Pipkin type III fracture that precluded open reduction and internal fixation. A multidisciplinary team formulated a staged single-anaesthetic operative strategy; emergency caesarean section was performed immediately before cementless total hip arthroplasty (THA) within the same anaesthetic episode. A live male neonate was delivered (Apgar scores 3, 6, and 7 at one, five, and 10 minutes). Intraoperatively, the dislocated femoral head was confirmed in direct apposition with the sciatic nerve. THA was completed successfully via a posterolateral approach. Total estimated blood loss was 1,900 mL, requiring transfusion of six units of packed red blood cells. The patient achieved full weight-bearing on postoperative day three and was discharged neurologically intact after eight days. At the three-month follow-up, the Merle d'Aubigné score was 17/18. This case, supported by a focused literature review, demonstrates that a staged same-anaesthetic strategy can achieve favourable maternal and neonatal outcomes in this rare, high-stakes clinical scenario and provides a practical decision-making framework for multidisciplinary teams.
Head and neck cancer (HNC) patients are advised to undergo dental extraction of teeth with poor prognosis prior to radiotherapy (RT) initiation to prevent osteoradionecrosis (ORN). However, insufficient healing time may result in persistent extraction wounds during RT, which constitute a potential risk factor for ORN, whereas excessive delay in RT initiation may compromise cancer control. To identify an optimal healing period between pre-RT dental extraction and RT initiation to minimize ORN risk in HNC patients. This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) framework, with a pre-specified PROSPERO registration (ID: CRD42024586754). The Newcastle-Ottawa Scale was employed to assess the quality of included studies. Patients were stratified into ≤ 7 days versus > 7 days and ≤ 14 days versus > 14 days groups based on the interval between dental extraction and RT initiation. Subgroup analyses were performed by geographic population. Eight retrospective cohort studies involving 47,527 HNC patients and 2863 ORN cases were included. No significant association was observed between the timing of pre-RT dental extraction and ORN risk in the overall population (OR = 0.99, 95%CI: 0.67-1.47), with significant heterogeneity (I² = 92%, τ² = 0.2079, p < 0.01). In Western populations, patients initiating RT within < 7 days or < 14 days after dental extraction demonstrated significantly elevated ORN risk (OR = 3.07, 95%CI: 1.52-6.21 and OR = 2.01, 95%CI:1.10-3.68, respectively). An insufficient healing interval between dental extraction and RT initiation may significantly increase ORN risk, particularly in specific population subgroups.
Large language models (LLM) are being rapidly integrated into healthcare, particularly to streamline time- and labor-intensive administrative processes. However, the potential for artificial intelligence (AI) systems to demonstrate bias when employed for insurance authorization remains poorly understood. As insurers increasingly adopt AI to make coverage decisions, this study examined bias in LLM-driven prior authorization in otolaryngology, using oral cavity squamous cell carcinoma (SCC) as a case study. Using OpenAI's generative transformer GPT-4o, this study assessed for LLM bias when simulating insurance coverage decisions for head and neck cancer reconstruction. A standardized clinical scenario was constructed involving patients with T2N2 oral cavity SCC, all requiring surgical resection and reconstruction. The LLM was prompted to choose between a radial forearm free flap (RFFF) and split-thickness skin graft (STSG) for reconstruction, across 19,900 simulations. Patient profiles were systematically varied by age, sex, race/ethnicity, zip code-based income level, socioeconomic status (SES), and substance use history. The LLM output showed significant disparities in approval decisions. RFFF was more frequently approved for younger, Asian, or white patients from high-income zip codes or high SES backgrounds (p < 0.0001). Older, Black, and Hispanic patients, and those from lower-income areas or with substance use histories, were less likely to receive RFFF authorization (p < 0.0001). On sensitivity analysis, inclusion of tumor-specific information markedly skewed recommendations towards RFFF across sociodemographic backgrounds. In this experimental study, the LLM's outputs exhibited significant disparities for oral cavity cancer reconstruction based on patient demographic variables in the setting of limited clinical information. Inputs to LLMs for clinical decision-making should include pertinent and detailed information to reduce the risk of bias. As insurers increasingly integrate AI for prior authorization, recognition of its biases, rigorous safeguards, and increased regulatory governance are needed to promote equitable health care.
Boron neutron capture therapy (BNCT) is an emerging binary-targeted radiotherapeutic modality with promising potential for treating recurrent or refractory head and neck squamous cell carcinoma. We comprehensively evaluated the safety, efficacy, pharmacokinetics, and mechanisms of action of a novel 10B-boronophenylalanine (10B-BPA) combined with a radio-frequency quadrupole (RFQ) accelerator-based neutron source using systematic preclinical experiments. This systematic preclinical study began by evaluating the drug's in vivo pharmacokinetics, tumor accumulation specificity, maximum tolerated dose, and systemic toxicity to verify its safety profile. Subsequently, its antitumor efficacy was assessed through dose-dependent experiments, and the cellular and molecular mechanisms of BNCT treatment were investigated. The novel 10B-BPA exhibited rapid and highly specific tumor accumulation, achieving a stable tumor-to-blood ratio of approximately 3.5. The treatment resulted in dose-dependent tumor regression without inducing systemic toxicity, with a maximum tolerated dose of more than 1000 mg/kg. Mechanistic investigations revealed that BNCT triggered a hypoxic stress response, leading to a substantial accumulation of reactive oxygen species and induced DNA double-strand breaks. This metabolic crisis subsequently activated the hypoxia-inducible factor-1 alpha and nuclear factor kappa-B signaling axes during apoptosis. The novel 10B-BPA/RFQ accelerator-based neutron source BNCT system demonstrates favorable safety, potent antitumor activity, and multi-target molecular regulatory mechanisms. These findings provide a solid foundation for its clinical translation.
Introduction Intracerebral hemorrhage (ICH) is frequently associated with impaired consciousness due to disruption of cortical, subcortical, and brainstem arousal networks. Reduced consciousness limits participation in rehabilitation and highlights the need for safe early interventions to facilitate responsiveness. Conventional multisensory stimulation provides visual, auditory, tactile, and olfactory input to support arousal. Graded vestibular stimulation may offer additional benefit through head movements, positional changes, and visual-vestibular activities; however, its role in patients with ICH remains insufficiently explored. This study aimed to evaluate the effectiveness of adding graded vestibular stimulation exercises to conventional multisensory stimulation for improving the level of consciousness (LOC) in patients with ICH. Methods This randomized controlled parallel-group trial was conducted in the neuro-ICU of Krishna Vishwa Vidyapeeth (Deemed to be University), Karad. Thirty-six patients with ICH were randomly allocated to an experimental group or a control group (n = 18 each). Both groups received conventional multisensory stimulation. The experimental group additionally received a graded vestibular stimulation exercise protocol, modified according to the patient's LOC, including head and head-trunk movements, head-end inclination and declination positioning, rocking-based vestibular stimulation, wheelchair mobilization, gaze stabilization, eye movement exercises, and optokinetic visual stimulation. Interventions were administered once daily for 14 consecutive days; total treatment exposure was greater in the experimental group because vestibular exercises were provided as an add-on intervention. LOC was assessed by a blinded assessor using the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) score at baseline (Day 1), Day 7, and Day 14. Statistical significance was set at p < 0.05. Results Both groups demonstrated significant improvement in level-of-consciousness scores from baseline to Day 14 (p < 0.001). Baseline GCS and FOUR scores did not differ significantly between groups. On Day 7, the experimental group demonstrated significantly higher GCS scores than the control group (9.2 ± 1.3 vs. 8.1 ± 1.2; p = 0.018) and significantly higher FOUR scores (11.0 ± 1.6 vs. 9.6 ± 1.5; p = 0.013). On Day 14, GCS scores remained significantly higher in the experimental group (11.3 ± 1.4 vs. 10.1 ± 1.3; p = 0.010), as did FOUR scores (13.4 ± 1.7 vs. 11.8 ± 1.6; p = 0.005). From Day 1 to Day 14, mean GCS and FOUR scores increased by 4.5 and 5.2 points, respectively, in the experimental group, compared with 3.4 and 3.7 points in the control group. Conclusions The addition of graded vestibular stimulation exercises to conventional multisensory stimulation was associated with significantly higher GCS and FOUR scores at Day 7 and Day 14 than conventional multisensory stimulation alone in patients with ICH. As total treatment exposure was greater in the experimental group, the findings reflect the effect of the add-on intervention rather than the isolated effect of vestibular stimulation alone.
Accurate dose estimation following radiation accidents remains challenging, particularly when personal dosimeter data are unavailable. This study presents a practical post-accident dose reconstruction approach based on minute-rate thermoluminescent dosimeter (TLD) measurements combined with exposure scenario reconstruction, demonstrated through a wavelength-dispersive X-ray fluorescence (WD‒XRF) spectrometer accident. The exposure scenario was reconstructed by placing LiF(Mg,Cu,P) TLDs at seven representative positions corresponding to head and hand locations, with the spectrometer operated under the recorded technical parameters (40 kV, 7 mA). Minute personal dose equivalent rates, H p'(10), were measured and combined with reconstructed retention times to calculate cumulative doses, from which skin absorbed doses were derived. The measured dose rates ranged from 0.13 to 358.38 mSv/min for the head and from 0.07 to 620.24 mSv/min for the hands. The resulting cumulative skin absorbed doses were 7.58 Gy for the head and 12.52 Gy for the hands, consistent with reported dose ranges associated with localized radiation injury. This approach provides a feasible supplementary strategy for retrospective dose reconstruction under emergency or resource-limited conditions when conventional dosimetric information is unavailable.
The aim was to examine how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) differentially affect in-class attention among fifth-grade students, with the goal of informing evidence-based physical education curriculum design. Seventy-two children aged 10-11 years were randomly assigned to three groups: HIIT, MICT, and a control group (n = 24 each). The HIIT group completed a 6-week intervention with three 24-minute sessions per week (≥85% maximum heart rate (HRmax)), while the MICT group performed continuous running at 60-69% HRmax at the same frequency. The control group maintained regular school activities. Exercise intensity was monitored using Polar heart rate sensors. Attention was assessed pre- and post-intervention via an intelligent video-based system analyzing four sub-indicators: head posture, gaze direction, eye openness, and facial detection, along with an overall attention score. Data were analyzed using repeated-measures analysis of variance (ANOVA). Both HIIT and MICT significantly improved the overall attention score (P < 0.01). The HIIT group increased from 0.39 ± 0.08 to 0.70 ± 0.14 (a 79.5% improvement), while the MICT group rose from 0.38 ± 0.10 to 0.67 ± 0.12 (a 76.3% improvement). The HIIT group demonstrated a significantly greater improvement than the MICT group (P < 0.01). The control group showed minor gains (31.0%; P < 0.05). Sub-indicator analysis revealed that HIIT significantly enhanced head posture and gaze direction (P < 0.01), while MICT primarily improved facial detection (P < 0.01). Both high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) demonstrated positive effects on the enhancement of children's overall in-class attention. Notably, HIIT demonstrated superior overall effects and produced significantly greater improvements across multiple attention sub-dimensions compared with MICT. These findings provide empirical support for the incorporation of HIIT into school-based physical education curricula as an effective strategy for enhancing students' cognitive performance.
Schizophrenia remains a highly disabling neuropsychiatric disorder, particularly due to the paucity of effective therapeutic interventions for negative symptoms and cognitive deficits. For more than seven decades, antipsychotic drug development has been overwhelmingly centered on dopamine D2 receptor antagonism. A paradigm shift occurred in 2024 with the FDA approval of KarXT, a first-in-class muscarinic acetylcholine receptor agonist selectively targeting M1 and M4 subtypes, marking the first non-D2 receptor-based antipsychotic approved in over 70 years. This review provides a systematic evaluation of emerging non-D2 receptor-based therapeutic strategies for schizophrenia, with particular emphasis on the muscarinic cholinergic pathway (exemplified by KarXT) and the glutamatergic pathway (represented by GlyT1 inhibitors). Phase III clinical trial data demonstrate that KarXT significantly improves both positive and negative symptom domains, exhibits favorable metabolic safety relative to conventional antipsychotics, and shows no evidence of clinically meaningful weight gain or glucose dysregulation. Preliminary evidence from exploratory subgroup analyses suggests potential cognitive benefits in patients with baseline cognitive impairment, but these findings require prospective validation. Long-term safety data remain limited. In contrast, clinical trial outcomes for glutamatergic agents, including GlyT1 inhibitors, have been heterogeneous and inconsistent, leaving the therapeutic viability of this pathway uncertain. Collectively, muscarinic agonism constitutes the first clinically validated non-D2 receptor-based mechanism in schizophrenia treatment. Advancing precision psychiatry will require rigorous head-to-head comparative trials and biomarker-informed patient stratification to extend therapeutic benefits beyond psychosis control to functional and cognitive recovery.
Herpes simplex virus type 1 encephalitis is a neurologic emergency that can present with focal language deficits before the diagnosis becomes clinically apparent. We present an 82-year-old man with diabetes mellitus, hypertension, and hyperlipidemia who developed acute confusion and expressive aphasia after an emergency department visit the previous day for fever, chills, fatigue, sore throat, dizziness, and abdominal discomfort. On arrival for the aphasia presentation, the temperature was 100.3°F, and there were no motor or sensory deficits. Computed tomography of the head, computed tomography angiography of the head and neck, and computed tomography perfusion showed no hemorrhage, large vessel occlusion, or perfusion abnormality. Magnetic resonance imaging of the brain on day 2 showed a focal left temporal lobe abnormality with fluid-attenuated inversion recovery and gradient recalled echo signal change and slight restricted diffusion, without abnormal enhancement. Empiric intravenous acyclovir and broad-spectrum antibiotics were started after magnetic resonance imaging raised concern for encephalitis. Cerebrospinal fluid showed white blood cells 159 cells/µL, 100% lymphocytes, protein 218 mg/dL, glucose 63 mg/dL, and herpes simplex virus type 1 polymerase chain reaction positivity. Electroencephalogram showed diffuse slowing with independent bitemporal sharp waves, at times periodic, without electrographic seizures. His course was complicated by hypotonic hyponatremia, concerning for syndrome of inappropriate antidiuretic hormone secretion, although urine osmolality and urine sodium did not result. Herpes simplex virus type 1 encephalitis should be considered early in older adults with acute aphasia, confusion, recent febrile symptoms, negative vascular imaging, and temporal lobe magnetic resonance imaging abnormalities.
Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is frequently diagnosed at an advanced stage and remains associated with poor survival outcomes. Durable responses to systemic therapy in metastatic disease are uncommon. We report a case of metastatic PDAC with prolonged survival and sustained response following first-line treatment with NALIRIFOX. This report describes a patient with metastatic PDAC who achieved prolonged disease control and sustained response following first-line treatment with NALIRIFOX. Case Presentation: A 64-year-old woman presented with abdominal pain, early satiety, weight loss, and markedly elevated CA 19-9 levels. Imaging demonstrated a pancreatic head mass with multiple hepatic metastases, and biopsy confirmed metastatic poorly differentiated PDAC. The patient initiated first-line therapy with NALIRIFOX as part of the NAPOLI-3 protocol and completed 20 cycles over approximately 25 months. Following an early treatment delay secondary to grade 2 neutropenia, she achieved substantial biochemical and radiographic improvement. After eight cycles, imaging demonstrated marked radiographic response with disappearance of the pancreatic lesion and marked regression of hepatic metastases. Disease stability was maintained for more than two years before progression was identified in a dominant hepatic lesion after cycle 20. Conclusion: This case highlights the potential for prolonged disease control and extended survival with NALIRIFOX in metastatic PDAC, emphasizing the meaningful clinical benefit that may be achieved in selected patients despite historically poor outcomes.
To determine the most common body regions, diagnoses, and mechanisms of injury among pediatric dance-related injuries in the United States. A descriptive epidemiologic analysis of the National Electronic Injury Surveillance System from January 1, 2019 to December 31, 2023 identified emergency department presentations for primary dance-associated injuries using the recreational activity code 3728. Data on demographics, body region, diagnosis, and mechanism of injury were collected. Patients were stratified by sex (male vs female) and age (children (3-9) vs adolescents (10-17)). Descriptive statistics and chi-square tests were used, with significance set a P < .05. A total of 3600 (National Estimate = 93,062) cases were analyzed. The most commonly injured regions were knees (20.8%) and ankles (15.8%). The most common diagnoses were sprains/strains (31.4%) and fractures (12.3%). Common mechanisms included impacts with the floor (37.0%) and ankle rolling (13.5%). Compared with adolescent dancers, children sustained knee (26.2% vs 5.5%, P < .001) and ankle (17.5% vs 10.4%, P < .001) injuries, experience sprains/strains (35.5% vs 18.3%, P < .001), and were injured due to ankle rolling (14.4% vs 8.1%, P < .001) and noncontact movements (11.8% vs 2.3%, P < .001). Adolescent dancers more often sustained fractures (14.4% vs 11.3%, P = .010). Females were more likely to sustain knee (21.8% vs 15.3%, P < .001) and ankle (16.6% vs 11.7%, P = .012) injuries and experience sprains/strains (33.1% vs 22.2%, P < .001), whereas males frequently sustained head injuries (23.7% vs 11.5%, P < .001) and fractures (15.7% vs 11.7%, P = .019). Knees and ankles were the most commonly injured body regions, with sprains/strains and fractures representing the most frequent diagnoses. The most common mechanisms of injury included impact with the floor, ankle rolling, and noncontact movements. Females and younger children were significantly more likely to sustain knee and ankle injuries and experience sprains/strains, whereas males and adolescents more often sustained fractures. Level IV, retrospective epidemiological study.
Cutaneous metastasis of papillary thyroid carcinoma is rare, which may present as slowly growing nodules, erythematous papules, or ulcerative nodules. The pathophysiological mechanisms of skin metastasis in thyroid cancer remain unclear. Skin metastasis of thyroid papillary carcinoma represents a poor prognostic factor in previous studies, and whether there exist relative genes still needs to be further investigated. Eight years after a radical surgery for left-sided thyroid cancer, a 29-year-old female presented to our dermatology department after discovering a patch of hyperpigmentation on the right side of her neck for 2 years. The dermatologist performed a biopsy of the neck skin mass under local anesthesia, and the gross specimen consisted of a piece of skin tissue measuring 0.4 cm × 0.3 cm × 0.3 cm, with a gray-black area of 0.4 cm on the surface. Microscopic examination, along with the clinical history, suggested metastasis of papillary thyroid carcinoma. Further immunohistochemical analysis showed results consistent with metastasis of papillary thyroid carcinoma, with tumor cells expressing TTF-1 (positive), TG (-), Ki67 (-), PAX-8 (+), GCDFP (-), ER (-), PR (20%), and GATA-3 (-). Skin metastases account for a relatively small proportion of metastatic thyroid cancer and can be easily misdiagnosed. Patients with skin lesions, especially in the head and neck area, that appear during the follow-up of thyroid cancer should be carefully selected and diagnosed.
There is growing concern over potential neurological impairment associated with accumulation of repetitive head acceleration events (HAE) in sport, particularly during periods of neurological vulnerability, including youth. Despite the high volume of HAEs sustained during downhill mountain biking, it is currently unknown downhill mountain biking is associated with neural function in youth. Thus, the purpose of this study was to investigate the association between exposure to downhill mountain bike racing and sensory, attentional, and cognitive processing in youth using N100, P300 and N400 Event related Potentials (ERPs). Fifteen participants (6 female, 9 male; ages 15-24 years) contributed 38 ERP observations at baseline timepoints and following up to 5 days of elite downhill mountain bike competition. Conditional linear regression models demonstrated that the average marginal difference in N400 amplitude in measures taken post-mountain bike exposure was 1.26 μV (95% CI: -2.16, -0.36; p = 0.006) less than before riding. N400 latency, P300 amplitude and latency, and N100 amplitude and latency were unchanged from baseline by days (range: 1-4) of mountain biking (all p > 0.26). In agreement with studies in hockey and football, our results showed that participation in downhill mountain biking is associated with acute cognitive neural processing impairments. The contribution of exercise, focus and HAEs to these impairments is unclear. This study expands the growing evidence of neural processing impairments occurring acutely following sport participation to the understudied sport of downhill mountain biking.
Objectives: Nasopharyngeal carcinoma (NPC) is an aggressive head and neck malignancy in which post-treatment recurrence and distant metastasis remain major contributors to poor clinical outcomes. Although microRNAs are important post-transcriptional regulators of tumor progression, the role of miR-320d in NPC remains incompletely understood. This study evaluated the biological role of miR-320d and explored whether it is involved in regulating neutrophil extracellular trap (NET) formation through the nuclear factor kappa-B (NF-κB)/interleukin-8 (IL-8) signaling axis. Methods: miR-320d was overexpressed in NPC cell lines S18 and 5-8F, and cell viability, migration, and invasion were evaluated. Integrated transcriptomic and proteomic analyses were performed to identify miR-320d-regulated genes, proteins, and pathways. Western blotting, immunohistochemistry, and immunofluorescence analyses were used to validate NET-associated proteins, including glycoprotein Ib platelet subunit alpha (GP1BA), histone deacetylase 10 (HDAC10), and fibrinogen gamma chain (FGG), as well as the expression of NET formation markers, including peptidyl arginine deiminase 4 (PADI4), myeloperoxidase (MPO), and neutrophil elastase (NE); and key components of the NF-κB/IL-8 axis. Results: miR-320d overexpression significantly inhibited the viability, migration, and invasion of both S18 and 5-8F cells. Multi-omics analyses indicated that miR-320d-regulated molecules were mainly enriched in NET-related pathways. Consistently, miR-320d reduced the expression of GP1BA, HDAC10, FGG, PADI4, MPO, and NE. Mechanistically, miR-320d suppressed NF-κB signaling, as shown by decreased phosphorylated NF-κB (p-NF-κB) and total NF-κB levels, and reduced IL-8 secretion in NPC cells. Conclusion: miR-320d may suppress NPC progression, at least in part, by attenuating NF-κB/IL-8-associated NET formation. These findings suggest that the miR-320d/NF-κB/IL-8/NET regulatory axis may participate in NPC progression and may warrant further translational investigation.
This study aims to summarize and appraise the credibility of existing epidemiological evidence on the association between periodontal diseases (PDs) and the risk of site-specific cancers. PubMed, Embase, and Cochrane Library were searched from inception to June 2026. Meta-analyses of observational studies investigating PDs and cancer risk were included. Each association was classified into five levels according to a predefined criterion, which included statistical significance, heterogeneity, sample size, and bias assessment. AMSTAR 2 was used to evaluate the quality of studies. Corrected covered area and the author's own meta-analysis were performed to ensure a rigorous methodology. In total, 66 associations from 38 meta-analyses investigating 14 cancer types were appraised, including head and neck cancer (HNC), oral, lung, breast, esophageal, gastric, pancreatic, liver, colorectal, bladder, kidney, prostate, melanoma, and hematopoietic and lymphatic cancers. Among 23 main associations, highly suggestive evidence was identified in associations between PDs (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.85-3.17) in HNC, and PDs in oral cancer (OR, 2.94; 95% CI, 2.13-4.07). Another seven associations were recommended as suggestive evidence (class III). Fourteen associations were classified as weak (class IV) or showing no significant evidence (class V). Associations between PDs and site-specific cancers demonstrated varying levels of evidence. This analysis highlighted strong correlations in HNC and oral cancer, while failing to show credible evidence for the remaining 12 cancers. Overall, our study yielded novel insights into oral health interventions, calling for the incorporation of periodontal health into public health policy. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024585375, identifier CRD42024585375.
Oculomotor function is a sensitive marker of neurological impairment, and smooth pursuit deficits have been reported across multiple neurological disorders. However, the oculomotor deficits following traumatic brain injury (TBI) remain incompletely characterized, particularly in relation to current functional status during rehabilitation. In this study, we employed a bedside, head-free eye-tracking paradigm based on short, repeated linear tracking segments, to assess oculomotor dysfunction in 30 TBI patients undergoing inpatient rehabilitation and 30 age-matched controls. This design enabled the extraction of multiple complementary oculomotor indices, including saccadic pursuit (catch-up saccade contribution), tracking deviation under occlusion, initial tracking speed, initial catch-up saccade latency, pupil response, and vergence instability. TBI patients exhibited widespread deficits across these indices compared with controls (AUC = 0.71-0.84). These measures also correlated significantly with functional status as indexed by the Functional Independence Measure (R = 0.39-0.77, p < 0.001) but, importantly, showed no association with initial injury severity as indexed by the Glasgow Coma Scale. These findings indicate that TBI disrupts multiple components of the oculomotor system, extending beyond basic pursuit gain to predictive tracking, pupil-linked arousal, and binocular coordination. The dissociation between functional status and initial acute injury severity highlights the sensitivity of oculomotor measures to current brain function during rehabilitation. Together, these results support the use of brief, clinic-friendly eye-tracking assessments as a quantitative approach for evaluating current functional status in TBI, with potential future applications for longitudinal monitoring pending further validation.
To evaluate the clinical and radiologic outcomes at a 2-year follow-up of arthroscopic rotator cuff repair (RCR) augmented with superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) in patients with reparable posterosuperior rotator cuff tears. This retrospective, multicenter study included patients who underwent arthroscopic RCR with LHBT-based SCR at 2 institutions: Center A (October 2020 to March 2023) and Center B (June 2022 to July 2024), with a follow-up of 2 years. Indications included reparable supraspinatus and/or infraspinatus tears with Patte stage 2-3 retraction and Goutallier grade 3-4 fatty infiltration. Patients underwent RCR with either in situ LHBT fixation (Center A) or rerouted LHBT fixation to the center of the greater tuberosity (Center B). Exclusion criteria included prior shoulder surgery, infection, irreparable subscapularis tear, or loss to follow-up. Clinical outcomes were assessed using the visual analog scale, American Shoulder and Elbow Surgeons score, and range of motion. Radiologic evaluation included acromiohumeral distance, Hamada grade, and repair integrity via ultrasound or magnetic resonance imaging. After excluding 10 patients, 58 were included (N = 26, Center A; N = 32, Center B), and their 2-year clinical outcomes were compared. Visual analog scale improved from 5.9 ± 1.5 to 2.1 ± 1.3, and American Shoulder and Elbow Surgeons score from 41.2 ± 10.0 to 73.6 ± 12.7 (P < .001). Minimal clinically important difference was achieved in 96.5% (visual analog scale) and 94.8% (American Shoulder and Elbow Surgeons). Range of motion improved significantly in forward elevation, abduction, and external rotation. Acromiohumeral distance (increased from 8.1 to 9.0 mm [P < .001]) with no progression in Hamada grade. Both centers showed comparable improvements with no significant differences in outcomes between techniques. Arthroscopic RCR augmented with SCR using the LHBT resulted in significant improvements in pain, function, and range of motion at the 2-year follow-up in patients with reparable rotator cuff tears. Both in situ and rerouted LHBT-based SCR techniques produced comparable clinical and structural outcomes, with no significant differences observed between the 2 methods, with the potential for type II error due to low power. Level III, retrospective comparative case series.
Chronic rhinosinusitis (CRS) exhibits temporal and geographic diversity in pathological endotypes with progressive eosinophilic infiltration, while the underlying causes remain unclear. Current pathological endotypes determination relies on mean cell count per high-power field, requiring accuracy optimization. In this retrospective study, 970 CRS patients in Guangzhou from 2000 to 2018 undergoing endoscopic sinus surgery were divided into five biennial cohorts. Demographic, clinical, and pathological data were analyzed to compare subgroup differences and assess correlations between pathological features and urbanization indicators, including land use, socioeconomic status, and motor vehicle ownership. Pathological outcomes were assessed via artificial intelligence‑based whole-slide imaging. Allergic comorbidity of CRS patients increased from 5.38% to 15.36% (p < 0.05). Pathological eosinophil density surged from 7.58 to 265.98 counts/mm², with eosinophilic CRS prevalence rising from 10.75% to 40.85%. Urbanization indicators were strongly associated with overall inflammation and eosinophilia, underscoring urbanization's role in CRS inflammatory progression. Motor vehicle ownership (R² = 0.91, p < 0.01) and population density (R² = 0.90, p < 0.01) ranked as the top two correlates of eosinophil density. Furthermore, population density (R² = 0.94, p < 0.01) and per capita gross regional product (R² = 0.92, p < 0.01) ranked as the top two correlates of total inflammation cell density. Among CRS patients in Guangzhou, pathological overall inflammation and eosinophilic infiltration progressively increased, while the proportion of lymphocytes declined. Additionally, urbanization indicators, notably population density, were strongly associated with shifts in the inflammatory profile and the rising prevalence of allergic comorbidities.