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Bone is a common site for metastasis from various malignancies and is considered a poor prognostic indicator for both life expectancy and quality of life. Skeletal metastases lead to severe pain and pathological fractures, significantly impairing patients' daily functioning and well-being. Effective management of impending and pathological fractures is crucial in improving these patients' quality of life. To evaluate the quality of life in patients with metastatic bone disease who underwent surgical treatment for impending and pathological fractures of the lower limb at a tertiary care hospital. This retrospective observational study included patients who underwent surgical intervention for impending and pathological fractures of the lower limb due to metastatic bone disease. Functional outcomes were assessed using the Hindi-translated Indian version of the Toronto Extremity Salvage Score (TESS) for the lower limb. A total of 22 patients were included, with a mean age of 50&#xa0;years (SD 17.9). The average TESS score for all patients was 48.8 (SD 20.02). The mean follow-up period was 15&#xa0;months (range 3-56&#xa0;months). A statistically significant difference in TESS scores was observed when age was considered as a variable (p&#x2009;<&#x2009;0.05), indicating an age-related impact on functional outcomes. Prophylactic and therapeutic fixation of metastatic fractures significantly improves the quality of life in patients with metastatic bone disease. The use of the Indian version of the TESS questionnaire provided valuable insights into functional outcomes and quality of life in the Indian population.

Glioma patients risk incurring motor deficits, which are detrimental to quality of life and survival. The brain's varying ability to tolerate neurological stress and preserve function-conceptualized as the neuronal reserve capacity-can be profiled using navigated transcranial magnetic stimulation (nTMS). We seek to characterize this capacity by distinguishing features associated with motor stability from those that signal impending impairment. Identifying determinants of motor status can guide patient counselling, refine surgical planning, and optimize neurological outcomes. We analyzed data of 194 patients suspected of glioma who underwent preoperative nTMS motor mapping between 2015 and 2022. Logistic regression analyses were performed to evaluate associations between perioperative motor status and patient, tumor, and neurophysiological variables. Multivariable regression showed reduced resting motor threshold ratios (odds ratio [OR] = 0.066; 95% CI, 0.005-0.950; P = .046) and elevated recruitment curve slope ratios (OR = 1.311; 95% CI, 1.029-1.670; P = .028) to be associated with baseline-adjusted motor deficit, alongside shorter tumor-to-tract distance (OR = 0.888; 95% CI, 0.824-0.958, P = .002) and recurrent tumor status (OR = 2.724; 95% CI, 1.192-6.211; P = .017). Female sex was protective (OR = 0.265; 95% CI, 0.089-0.785; P = .017). In univariable analyses, elevated cortical silent period ratios correlated with poorer baseline status (OR = 3.895; 95% CI, 1.306-11.081, P = .014), while motor-impaired patients had a smaller motor volume in the lesioned hemisphere (r = 0.391; P = .022). Hyperexcitability and inadequate neuronal recruitment in tumor-affected hemispheres indicate an unstable compensatory capacity and warn of impending motor impairment, with shorter tumor-to-tract distance also increasing risk. Excessive GABAergic inhibition reflects neuronal reserve exhaustion, whereas shrunken motor volume may indicate failure to initiate compensatory remodeling. More robust reserve is seen in primary tumor presentations and female sex. Integrating nTMS findings with tumor characteristics and patient history ensures a tailored approach aimed at optimizing neurological outcomes.

Complex systems involving multiple oscillatory components are known to exhibit emergent collective spatiotemporal patterns. The turbulent annular combustor is a prime example where the interaction between the acoustic field and the heat release rate fluctuations from multiple flames gives rise to rich spatiotemporal collective behavior. The collective dynamical behavior leads to high-amplitude, self-sustained oscillations in the acoustic field, which are detrimental to the system. In this study, we investigate the transition among various collective dynamical states, including the splay state, the two-cluster state, the in-phase state, the amplitude-modulated two-cluster state, and the quasiperiodic weak chimera, in the acoustic field of a turbulent annular combustor as the control parameter is varied. We also observe the signatures of the impending dynamical state before the transition. We introduce a network-based characterization method to characterize these dynamical states. We construct a functional network among the acoustic pressure fluctuations recorded around the annulus of the annular combustor. We show that each dynamical state has a unique network topology. Further, we demonstrate that the network-based measure can detect the impending transition between states in the annular combustor. This can potentially enable the timely implementation of control actions to prevent such transitions to the collective states.

The United States surgical workforce faces an impending crisis, with projections of a shortage of 10,000-19,900 surgeons by 2036 and no meaningful expansion of general surgery residency positions. In this fixed-capacity system, retention is synonymous with workforce production. Yet, attrition disproportionately affects trainees from underrepresented backgrounds, resulting in preventable losses of talent and leadership potential. This manuscript expands upon the 2025 Academic Surgical Congress Presidential Address, using the framework of "Hidden Figures" to explore how systemic invisibility, lack of sponsorship, and absence of allyship undermine resident persistence and career advancement. Through personal narrative and professional reflection, Dr Callisia Clarke illustrates how microinvestments, intentional leadership development, and caritas-driven allyship can reverse attrition trends and strengthen the academic surgical pipeline. Throughout this commentary, brief italicized passages reflect personal narrative from her Presidential Address, followed by analytic reflections that situate these experiences within broader structural and workforce challenges in academic surgery. True workforce sustainability calls for a change from symbolic diversity to measurable retention, promotion, and belonging.

Nearly 30% of emerging infectious disease events worldwide are transmitted by arthropod vectors, and this proportion continues to rise. Rapid and accurate detection is critical for directing vector control interventions, thereby reducing the likelihood of widespread transmission. Surveillance of infected mosquitoes can provide an early warning of impending human infection; however, conventional virus testing relies on processing large pools of mosquitoes and requires labor-intensive pre-processing. During rapidly developing epidemic or panzootic events, these delays may limit the effectiveness of public health responses. Mosquito excreta has recently emerged as a promising alternative substrate for pathogen detection. Sugar-fed mosquitoes regularly excrete gut contents, offering a rich source of nucleic acids. In this study, we developed and applied custom superhydrophobic excreta-collection funnels that efficiently aggregate excreta produced by field-collected Culex mosquitoes into attached microcentrifuge tubes. Shotgun metagenomic sequencing of this material revealed a diverse RNA virome, including both globally distributed viruses and those reported here for the first time from the Americas. Beyond virus detection, additional analyses enabled confirmation of host mosquito species and identification of trypanosomatid parasites, demonstrating the broader utility of mosquito excreta for integrated surveillance. We anticipate that methods and devices of this type will become valuable components of vector surveillance programs, particularly in remote or resource-limited settings where repeated collections are challenging. Overall, our findings highlight the potential of excreta-based monitoring to improve early detection of emerging or unknown pathogens of One Health importance, refine our understanding of mosquito virome biogeography, and facilitate the discovery of previously undescribed viruses.IMPORTANCEMany infectious diseases that affect people and animals are spread by mosquitoes and other biting insects, and the number of these outbreaks is increasing. Detecting pathogens in mosquito populations early can provide a critical warning before human cases begin, allowing health officials to act quickly. However, traditional surveillance requires collecting and processing large numbers of mosquitoes, which can be slow and labor-intensive during fast-moving outbreaks. Here we demonstrate a simpler approach: testing mosquito waste. When mosquitoes feed on sugar, they excrete material that contains genetic traces of viruses and other organisms. Using specially designed collection devices and modern genetic sequencing, we show that mosquito excreta can reveal a wide range of viruses and parasites while also identifying the mosquito species present. This method could make disease surveillance faster and more practical in remote or resource-limited settings, improving our ability to detect emerging pathogens that threaten human, animal, and environmental health.

A 90-year-old woman underwent aortouni-iliac endovascular aortic repair and simultaneous embolization of the left common iliac artery using a vascular plug for an impending rupture of an abdominal aortic aneurysm. The aortic aneurysm diameter gradually increased after the procedure, and an endoleak through the vascular plug in the left common iliac artery was observed by contrast-enhanced computed tomography. Using a highly penetrating microsystem to penetrate the mesh of the vascular plug, metallic coils were placed inside and around the vascular plug. Using a triple coaxial system, the proximal portion of the left common iliac artery and the endoleak cavity of the aneurysm were embolized with 20% n-butyl-2-cyanoacrylate&#x2012;Lipiodol mixture via collateral arteries. The endoleak disappeared after transcatheter embolization. To our knowledge, this is the first reported case in which transcatheter embolization with metallic coils using a highly penetrating microsystem was performed to treat an endoleak through a vascular plug following endovascular aortic repair with an aortouni-iliac device and simultaneous embolization of the contralateral common iliac artery.

Myasthenia gravis (MG) is a heterogeneous autoimmune disorder of the neuromuscular junction. Diagnosis and management remain challenging in real-world settings, particularly in public health systems. Data from resource-constrained countries are limited. This study aimed to characterize the epidemiological, clinical, and therapeutic profile of MG patients followed in a Brazilian public tertiary center, emphasizing diagnostic delay and treatment outcomes. We conducted a retrospective single-center cohort study of 150 adult MG patients evaluated from 2024 to 2025. Clinical, immunological, therapeutic, and diagnostic-journey data were extracted from institutional electronic and paper medical records, and structured patient questionnaires, when available. Patients were classified as drug-responsive, corticosteroid-dependent, or drug-refractory using predefined operational criteria informed by international consensus guidance. Between-group comparisons used parametric or nonparametric tests, and categorical variables were analyzed with chi-square, Fisher's exact, or Monte Carlo permutation chi-square tests, as appropriate. The cohort had female predominance (65.3%), with a median age at onset 35.5 years (IQR 25-48). Among those tested, most were AChR antibody-positive (67.6%) and presented generalized MG (93.3%). Median diagnostic delay was 11 months, and 47.3% had delays &#x2265;1 year. Refractory MG occurred in 14% and corticosteroid dependence in 10.6%. Documented myasthenic crisis and impending crisis occurred in 25.2% (35/139) and 27.3% (38/139), respectively; documented myasthenic crisis was more frequent in refractory than in drug-responsive patients (45.0% vs 21.0%). Treatment-related adverse events were documented in 47.5% (67/141); among affected patients, the most common were hyperglycemia (37.3%), osteoporosis/osteopenia (17.9%), and weight gain (16.4%). MG patients followed at this Brazilian public tertiary center showed clinical profiles broadly comparable to those reported in international cohorts, but diagnostic delays were frequent. The frequencies of refractory disease and corticosteroid dependence highlight the need for earlier recognition, specialized management, optimized steroid-sparing strategies, and improved access to comprehensive MG care.

The resuscitative thoracotomy (RT) is a time-sensitive procedure performed on trauma patients with impending fatality, particularly those with penetrating thoracic injuries. We present a case of a male in his twenties with pulseless electrical activity following a gunshot wound (GSW) to the right chest. This patient experienced rapid haemodynamic deterioration in concurrence with signs of cardiac tamponade, leading to the performance of a clamshell thoracotomy, followed by a pericardiotomy, and subsequent myocardial repair. Direct haemorrhage control, cardiac massage and rapid transfusion achieved return of spontaneous circulation (ROSC) in the emergency department (ED). The patient survived neurologically intact after definitive surgical repair. This case underscores RT's life-saving potential when executed promptly for penetrating trauma with pericardial tamponade or haemorrhage. While mortality remains high, survival hinges on immediate intervention, surgical expertise and coordinated resuscitation. When indicated, this aggressive procedure remains the only chance for survival in otherwise fatal injuries.

Head and neck squamous cell carcinoma (HNSCC) predominantly spreads locoregionally, while distant metastases are uncommon and typically involve the lungs, liver, or axial skeleton; femoral metastasis is exceptionally rare. This study reports a case of femoral shaft metastasis arising from tongue squamous cell carcinoma and presents a systematic review of the existing literature to characterise clinical features, management, and outcomes. A systematic search of PubMed, Scopus, ScienceDirect, the British Medical Journal, and Google Scholar was conducted in accordance with PRISMA guidelines, identifying English-language case reports describing histologically confirmed HNSCC with femoral metastasis. Five published cases were identified and, together with the present case, six cases were analysed. The mean age at diagnosis was 57 years, with a male predominance (66.7%). The tongue was the most common primary tumour site (66.7%), and smoking was the most frequently reported risk factor. Time to femoral metastasis ranged from six months to 19 years, with most cases demonstrating early recurrence and advanced disease with nodal involvement or additional distant metastases. Management following femoral involvement was predominantly palliative and included radiotherapy, chemoradiotherapy, and orthopaedic stabilisation for impending or pathological fracture. Overall prognosis was poor, reflecting aggressive tumour biology and limited treatment options once distant skeletal disease is established. Femoral metastasis from HNSCC represents an advanced and uncommon disease manifestation, and early recognition is essential to facilitate timely palliative intervention, prevent skeletal complications, and optimise quality of life. Further multicentre studies and pooled analyses are required to better define risk factors, metastatic pathways, and optimal management strategies.

Comprehensive orthodontic treatment can provide excellent long-term oral health outcomes for adolescent patients with compromised first permanent molars. Eliminating impending restorative requirements, resolving the malocclusion, and improving the likelihood of future third molar eruption are all potential advantages of this treatment approach.

Intracardiac extension of hepatocellular carcinoma (HCC) via the inferior vena cava (IVC) is uncommon and may result in fatal cardiac complications. We report a case of urgent cardiac surgery performed to prevent imminent cardiac deterioration and facilitate subsequent multidisciplinary treatment. A 64-year-old man with a history of right hepatectomy for stage III HCC and radiofrequency ablation for recurrent disease was admitted following a traffic accident. Echocardiography revealed a 4.6&#x2009;&#xd7;&#x2009;3.6 cm right atrial mass continuous with the IVC. Although the patient had no overt cardiac symptoms, frequent episodes of non-sustained ventricular tachycardia and bilateral lower extremity oedema raised concern regarding impending cardiac complications. Urgent tumour resection was performed under moderate hypothermic circulatory arrest (lowest rectal temperature, 32&#x2009;&#xb0;C). Following cardiac and orthopaedic surgery, the patient underwent transcatheter arterial chemoembolization and systemic therapy with durvalumab plus tremelimumab. At a 1-year follow-up, no intracardiac recurrence was observed, pulmonary metastatic lesions had regressed, and the patient remained clinically stable. Urgent cardiac surgery may serve as a bridge to multidisciplinary treatment in selected patients with HCC and intracardiac extension.

Apolygus lucorum is a major piercing-sucking pest in viticulture, yet its seasonal dynamics and outbreak risk in semi-arid wine-grape regions remain insufficiently understood. This study was conducted in a semi-arid wine-grape region of northwestern China during the 2024-2025 growing seasons. Adult density was monitored at 150 fixed sampling points across five landscape units. LOWESS-based phenological staging, stage-specific spatial interpolation, and an XGBoost-SHAP framework integrating meteorological, topographic, and grape phenological predictors were used to characterize spatiotemporal patterns and key predictors. A. lucorum density remained low in May, increased from June to July, peaked during August-September, and remained relatively high in October, with higher overall abundance in 2025 than in 2024. Spatial analyses revealed marked heterogeneity among landscape units, with high-density patches shifting across years and phenological phases. The XGBoost model showed good predictive performance, with an R2 of 0.878 on the independent test set and a mean GroupKFold cross-validation R2 of 0.869 &#xb1; 0.014. SHAP analysis identified grape phenology, elevation, relative humidity, sunshine duration, and temperature as the leading predictors of model-predicted density. PDP and ICE analyses showed higher predicted counts during later phenological periods, at lower elevations, and under higher relative humidity, particularly around 55%. Two-dimensional PDPs further indicated that high predicted densities mainly occurred under combinations of higher relative humidity, later phenological timing, moderate-to-high temperature, longer sunshine duration, and lower elevation. These findings provide a scientific basis for implementing precision-integrated pest management strategies in semi-arid viticultural regions, where monitoring relative humidity during critical phenological windows can serve as an early warning indicator for impending outbreaks.

Head movement is a fundamental component of gait control and environmental orientation during locomotion. Wearable inertial measurement units (IMUs) enable real-time inference of upcoming movement, and early detection of impending head turns during walking is critical for enhancing interactive systems. The study aimed to investigate whether multi-segment IMU data reliably detect and classify upcoming head turns and their direction before and during head turns while walking, and to hypothesize that neural networks effectively capture the temporal integration patterns of early pre-movement and active head turning in gait. Fifty healthy participants performed four head-turning directions (up, down, left, right) while walking, instrumented with eight IMUs placed on the head, chest, left wrist, lower back, and bilateral heels and toes. IMU signals were segmented around detected head turns and processed using a sliding-window strategy across two temporal windows: pre-turn and during-turn phases. Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) networks, including sliding-window variants, were trained for four-class classification. Head-mounted sensors achieved maximum accuracy of 98.91% (pre-turn) and 98.73% (during-turn). Distal segment performance was strong: the SW-LSTM at the right heel achieved 96.93% accuracy and 97.05% precision, while the SW-GRU at the left toe achieved 95.85% accuracy and 95.89% precision. Successfully highlighted the optimized sliding-window sizes for predicting pre-head-turning kinematics during walking from wearable IMU data. The crucial role of head and chest sensing for recognizing pre-head-turning kinematics and direction shows promise for gait applications. Real-world validation demonstrates robust performance across head-turning directions, with practical applications in gait-adaptive systems.