Traumatic brain injury (TBI) disrupts central nervous system homeostasis, leading to extracellular matrix (ECM) softening and localized hypoxia and thus contributing to astrocytic activation and sustained neuroinflammation. But the interplay between ECM softening and hypoxia in regulating astrocytic activation and response remains elusive. To understand this, we developed an in vitro model incorporating tunable-stiffness hydrogels and a precise oxygen-control system to simulate the mechanical and hypoxic microenvironment of TBI. We characterized the activation-related proteins and cytokine production of astrocytes under the in vitro model, and found that soft ECM and hypoxia independently promote astrocytic activation and synergistically activate astrocytes via HIF-1α/YAP-NF-κB signaling, resulting in astrocytic redox imbalance and neuroinflammation. We further used scanning electrochemical microscopy (SECM) to track the dynamic changes in glutathione (GSH) efflux and membrane integrity in live astrocytes in situ under pathophysiological conditions of ECM softening and hypoxia. The SECM results show that the combined ECM softening and hypoxia progressively impair cellular membrane integrity and promote GSH efflux of astrocytes, corresponding to the early changes in astrocytic function and indicative of an early activation-primed state to exacerbate secondary injury of astrocytes. Last, we found that the lovastatin (a neuroprotective agent) treatment can effectively attenuate astrocytic membrane impairment and decrease GSH efflux, proving the potential of lovastatin to mitigate inflammation and preserve neuroregulatory function. Our work observes the in situ and early state changes of astrocytes under a combined mechanical-hypoxic microenvironment for the first time. The findings offer mechanistic insights into TBI pathogenesis and highlight promising strategies for early therapeutic intervention.
Lower leg soft-tissue injuries in older adults are common. These injuries can be complicated by frailty, comorbidities, and impaired healing; however, there is limited high-quality evidence to guide optimal management. This study aimed to establish a consensus-driven research agenda for lower leg soft-tissue injuries in older adults using a modified Delphi approach. An international three-round modified Delphi study was conducted, with clinicians involved in the management of lower leg soft-tissue invited to participate. In Round 1, participants submitted open-text responses identifying challenges in assessment and management. These were thematically grouped and converted into research questions. In Rounds 2 and 3, these were rated by participants and ranked using predefined consensus criteria. In Round 1137 participants generated 498 research items, which were refined into 30 research questions across 6 domains. In Round 2142 respondents rated the importance of each question using a Likert scale, with a predefined consensus threshold, resulting in 8 questions meeting the criteria. In Round 3168 respondents ranked these questions to establish research priorities. The final consensus highlighted research priorities relating to decision making between operative and non-operative management, comparative effects on wound healing and mortality, influence of comorbidities, prevention of operative complications, the role of standardised assessment and care pathways, impact of mobility and nutrition and optimal dressing selection. The priorities identified highlight critical evidence gaps and provide a framework to inform future studies and the development of care pathways for this vulnerable patient population.
While recent studies have characterized flap-based reconstruction in higher-acuity pediatric extremity tumor cases, the frequency and short-term outcomes of immediate soft-tissue reconstruction across the broader spectrum of pediatric limb-salvage extremity tumor surgery remain poorly defined. The ACS NSQIP-Pediatric database (2012 to 2023) was queried for pediatric upper extremity (UE) and lower extremity (LE) oncologic excisions using comprehensive CPT codes spanning all anatomic levels. We focused exclusively on tumors that required excision and were amenable to limb salvage. Immediate soft-tissue reconstruction was identified by concurrent reconstructive CPT codes. Primary outcomes were wound complications and overall morbidity. We identified 4500 limb-salvage cases (LE, 4295; UE, 205). Bone tumors comprised 94.8% of cases, with 87.7% undergoing simple excisions. Overall, 159/4500 (3.5%) underwent immediate reconstruction, including 134/4295 (3.1%) LE cases and 25/205 (12.2%) UE cases. Complications were more frequent in reconstructed than nonreconstructed cases (44/159, 27.7% vs. 104/4341, 2.4%; P<0.001). In the LE multivariable analysis, immediate reconstruction (OR=3.48, 95% CI: 1.56-7.75) and ASA III to IV classification (OR=2.17, 95% CI: 1.18-3.98) were independently associated with 30-day complications. Immediate soft-tissue reconstruction is uncommon in pediatric limb-salvage extremity tumor surgery. In the lower extremity cohort, immediate reconstruction was associated with higher rates of short-term morbidity. However, reconstruction was preferentially used in anatomically and surgically complex cases, and the available data cannot fully account for differences in case complexity. Accordingly, this should not be interpreted as evidence that reconstruction itself increases postoperative risk. These findings provide benchmark data for case selection, perioperative counseling, and future orthoplastic outcomes research.
TIGIT (T cell immunoreceptor with Ig and ITIM domains) has emerged as a key exhaustion marker of intratumoral natural killer (NK) cells, but results from clinical trials with TIGIT blockade have been largely negative. Recent data have suggested that a subset of TIGIT-expressing NK cells can show increased functionality. We hypothesized that there are differences in function between peripheral and intratumoral TIGIT-expressing NK cells in patients with sarcoma and preclinical sarcoma models, which undermine the efficacy of systemic TIGIT blockade. We sought to investigate differences in TIGIT+ NK cells using systemic versus intratumoral TIGIT-blocking strategies. Peripheral and intratumoral NK cells were analyzed from human patients and mice with osteosarcoma (OSA) and soft tissue sarcoma (STS). NK phenotype and function were evaluated using flow cytometry, immunohistochemistry, live-cell imaging, and RNA sequencing. Mouse antimouse-IgG1 TIGIT blockade was delivered systemically or intratumorally in flank models of OSA (K7M2) and STS (MCA-205). Clinical and genomic data were evaluated using Caris CODEai. Expression of the TIGIT ligand CD155 on myeloid and tumor cells was evaluated as a marker of TIGIT function. Using multiple readouts, TIGIT+ NK cells from the spleen of tumor-bearing mice or peripheral blood of patients with STS and OSA showed increased functionality compared with TIGIT- NK, while TIGIT+ NK cells from the sarcoma tumor microenvironment (TME) of mice and humans were dysfunctional, with upregulated senescence and inhibitory gene pathways. Systemic TIGIT blockade reinvigorated intratumoral NK cell function but inhibited peripheral NK cells, while intratumoral administration of TIGIT blockade significantly delayed tumor growth and prolonged survival with partial reversal of NK dysfunction in the TME. Clinical and genomic data demonstrated that more NK cell infiltration in human STS was prognostic of improved overall survival only when intratumoral CD155 expression was low, indicating that elevated CD155 expression is correlated with greater NK cell dysfunction. We identified a cross-species role of TIGIT expression dependent on location, where peripheral TIGIT+ NK cells showed evidence of enhanced functionality, while intratumoral TIGIT+ NK cells were dysfunctional. These differences impacted antitumor effects of TIGIT blockade, suggesting that intratumoral delivery of TIGIT blockade may be a novel translational strategy in high-risk bone and soft tissue sarcomas.
This study was performed to assess whether the Complexity INdex in SARComas (CINSARC) signature is applicable in dogs with soft tissue sarcomas (STSs) and how it compares to conventional histological grading in this regard. Twenty-four dogs with well-established low- or high-grade STSs were retrospectively evaluated between 2018 and 2023 at two referral centers. Formalin-fixed paraffin-embedded (FFPE) blocks were tested for the CINSARC signature, with the histological grade used as the endpoint. The CINSARC analysis classified the samples into two groups: 14 dogs classified as C1 (favorable prognosis) and 10 dogs classified as C2 (poor prognosis). All dogs with Grade I tumors and one dog with Grade III disease were classified as C1, indicating an almost perfect agreement (κ = 0.92; 95% CI: 0.75-1.00). This proof-of-concept study confirmed that CINSARC analysis can be performed on canine FFPE tissue blocks, even with highly degraded mRNA. CINSARC effectively classified dogs carrying STSs, highlighting that this signature appears to be consistent with conventional histopathology. However, it remains to be determined whether this classification has prognostic value in a larger cohort.
Management of open crural fractures is challenging and requires close interdisciplinary collaboration. Dutch guidelines recommend soft tissue coverage, ideally within 72 h, no later than 1-week post-injury. The guideline does not recommend centralization or volume per center. This poses significant challenges in clinical practice. This study assessed current practice in the Netherlands regarding case volume, organization of care and timing of procedures, while also exploring barriers and facilitators for fracture fixation and soft tissue closure (fix and flap) within 72 h. A national survey was conducted among plastic and orthopedic trauma surgeons, covering January-December 2024. The 54-item questionnaire addressed caseload, logistics, timing of coverage, and perceived challenges. All Dutch level 1 trauma centers were represented. All 11 of the level 1 centers in the Netherlands responded, in addition we got a response from 13 specialists working in level 2 centers. Eighteen Orthopedic trauma surgeons and 24 plastic surgeons responded. In 63% of centers, at least 10 open tibial fractures were managed annually; 28% reported treating over 20 open tibial fractures per year. Soft tissue coverage was performed within 72 h in only 6% of cases, and within one-week post-injury in 59% of cases. Although 59% of respondents regarded early soft tissue coverage sufficiently supported by evidence, numerous barriers were identified, including limited theater availability and inadequate prioritization of open fractures. Soft tissue coverage within 72 h for open tibial fractures is rarely achieved, mainly due to limited theater availability and prioritization issues. Differences in orthopedic trauma- and plastic surgeons' perspectives highlight coordination challenges. Reserved theater time, stronger evidence, and centralization of care could improve adherence. As early soft tissue coverage may reduce complications, hospital stay, and costs, our results warrant further research and active implementation.
This study aimed to analyze the functional adaptations of tongue base volumetric enlargement and reduction on the kinematics of oropharyngeal structures during respiration in a minipig model. Six same-sex sibling pairs of 8-to-9-month-old Yucatan minipigs were studied. Of each pair, one was diet-induced obese with a BMI>50 (obesity-associated volume enlargement) while the other was normal-weight and underwent partial ablation of the tongue base volume (volume-reduction). Real-time X-ray video fluoroscopic images (30 frames/s) were recorded under sedation, at baseline (before surgery) and 5 weeks postoperatively. Selected landmarks of the soft palate, epiglottis, tongue base, and pharyngeal wall were digitized frame by frame for 25-30 respiratory cycles. Directional movements and distance changes of these oropharyngeal structures were analyzed within the defined coordinate system using video-analysis software. Correlations between areas of airway spaces during respiration and biometric measurements of the dissected tongue at week 5 were included. During respiratory phases, movement distances of the soft palate and the pharyngeal wall were significantly larger in the volume-reduced group than in the volume-enlarged group at baseline (p<0.05). These moving distances were also larger compared to those of the volume-enlarged group at both time points. Similarly, distance changes during inspiration between structures (soft palate-pharyngeal wall, soft palate-tongue base, and epiglottis-pharyngeal wall) were significantly larger at week 5 than at baseline (p<0.05) in both groups. Positive correlations during respiratory phases were detected between tongue volume and velopharyngeal width in the volume-reduced group (r=0.86, p<0.05). Negative correlations occurred between retromolar space area and tongue thickness in the volume-enlarged group (r=-0.9, p<0.05). These results suggest that oropharyngeal spatial dynamics are enhanced in the tongue base volume-reduced minipigs, with altered moving patterns during respiration. In contrast, smaller distance changes observed over time in the volume-enlarged group suggest continuous airway narrowing and potential restriction of airway dynamics.
Entanglements are topological constraints that govern the dynamic mechanical behavior of polymer networks. Linear polymers inevitably entangle at relatively low molecular weights, whereas bottlebrush polymers-consisting of a long backbone densely grafted with many relatively short side chains-suppress entanglements, enabling solvent-free networks with tissue-like softness. Yet, the same steric crowding pre-strains the backbone and renders such networks brittle. Here, we report highly entangled bottlebrush elastomers that combine extreme softness and toughness. Using short polyethylene glycol side chains, we synthesize high molecular weight bottlebrush polymers (>3 × 106 g/mol) that remain amorphous at room temperature. We identify an entanglement threshold of 2.4 × 106 g/mol with an entanglement modulus of ∼1.3 kPa, nearly 1000 times lower than that of linear counterparts. While unentangled bottlebrush networks exhibit strain-stiffening, entangled bottlebrush networks display pronounced strain-softening followed by delayed stiffening due to entanglement slippage. Despite their low modulus (∼1 kPa), these elastomers stretch up to ∼1800% and show a fatigue threshold of ∼63 J/m2, comparable to natural rubber. Their intrinsic fatigue strength-fatigue threshold normalized by modulus-surpasses that of highly entangled linear polymer networks by >40-fold. These results establish a new class of soft yet tough polymer networks and provide a model system for understanding nonlinear mechanics in architecturally complex polymers.
Difficult airway remains a major cause of anesthesia-related morbidity and mortality despite advances in airway management. Conventional clinical predictors have limited predictive value. Airway ultrasound has emerged as a noninvasive tool that may improve preoperative airway assessment. The study aimed to evaluate the utility of ultrasonography as a preoperative assessment tool for predicting difficult airway and to compare its predictive accuracy with hyomental distance. This prospective observational study included 100 adult patients undergoing elective surgery under general anesthesia requiring endotracheal intubation. Preoperative airway assessment involved measurement of hyomental distance and ultrasonographic measurement of pretracheal soft-tissue thickness at the level of the vocal cords. After induction of anesthesia, direct laryngoscopy was performed and graded using the Cormack-Lehane classification. The mean hyomental distance was significantly lower in patients with difficult laryngoscopy. Pretracheal soft-tissue thickness measured by ultrasound was significantly higher in this group (P = 0.0001) and showed a stronger association with poor glottic visualization. Ultrasonographic measurement of pretracheal soft-tissue thickness is a reliable and superior predictor of difficult laryngoscopy and may enhance routine preoperative airway assessment and patient safety. Résumé Contexte:Les voies aériennes difficiles demeurent une cause majeure de morbidité et de mortalité liées à l’anesthésie, malgré les progrès réalisés dans la prise en charge des voies aériennes. Les prédicteurs cliniques conventionnels présentent une valeur prédictive limitée. L’échographie des voies aériennes est apparue comme un outil non invasif susceptible d’améliorer l’évaluation préopératoire des voies aériennes.Objectif:Évaluer l’utilité de l’échographie en tant qu’outil d’évaluation préopératoire pour prédire les voies aériennes difficiles et comparer sa précision prédictive à celle de la distance hyomentonnière.Méthodes:Cette étude observationnelle prospective a inclus 100 patients adultes devant subir une chirurgie programmée sous anesthésie générale nécessitant une intubation endotrachéale. L’évaluation préopératoire des voies aériennes comprenait la mesure de la distance hyomentonnière et la mesure échographique de l’épaisseur des tissus mous prétrachéaux au niveau des cordes vocales. Après l’induction de l’anesthésie, une laryngoscopie directe a été réalisée et classée selon la classification de Cormack-Lehane.Résultats:La distance hyomentonnière moyenne était significativement plus faible chez les patients présentant une laryngoscopie difficile. L’épaisseur des tissus mous prétrachéaux mesurée par échographie était significativement plus élevée dans ce groupe (P = 0,0001) et présentait une association plus forte avec une mauvaise visualisation glottique.Conclusion:La mesure échographique de l’épaisseur des tissus mous prétrachéaux constitue un prédicteur fiable et supérieur de la laryngoscopie difficile et pourrait améliorer l’évaluation préopératoire systématique des voies aériennes ainsi que la sécurité des patients.
To assess how the use of a silver beam filtration with deep learning reconstruction (DLR) impacts the unenhanced abdominopelvic CT in terms of soft tissues density, image quality and radiation dose. This study evaluated two unenhanced abdominopelvic CT acquisitions of 110 patients performed with a conventional filtration (group A) and a silver filtration (group B). The HU values of several soft tissues and extra corporeal air were recorded for each acquisition using an identical circular ROI. Interobserver agreement and subjective qualitative analysis of image were assessed. The student's paired t-test was used to evaluate differences between the two examinations in terms of HU values, SNR, CNR, DLP and CTDIvol. Statistical difference was considered as significant at p ≤ 0.05. The subjective image quality and interobserver agreement were judged excellent without significant difference between both acquisitions. We found lower HU values for the silver filter than for the conventional filter with a percentage decrease between 0.03 and 0.09% except for urine which was found at 38%. However, there was no statistically significant difference except for the subcutaneous fatty tissue and urine. The radiation dose was found to be significantly lower by 36% in the examinations done with silver filter when compared to the conventional filter. Implementing the silver filtration with DLR on non-contrast abdominopelvic CT acquisition achieves a significant dose reduction while preserving image quality, albeit a reduction of the HU value of soft tissues, more intense for positive low-density structure (urine/water). This fact must be taken into account in clinical routine especially in the context of indeterminate cyst or adrenal mass on non enhanced acquisition.
Extrapulmonary tuberculosis (TB) accounts for 15%-20% of all TB, but soft-tissue involvement of the extremities is distinctly uncommon. Concurrent forearm and bilateral psoas abscesses from drug-resistant Mycobacterium tuberculosis, in a patient without pulmonary disease, have not - to our knowledge - been described. A 16-year-old immunocompetent girl reported right-sided chest pain, a progressively enlarging swelling on the left forearm, anorexia, and weight loss over roughly 2 weeks. Fever, cough, and night sweats were absent, as was any known TB contact. On examination, the forearm lesion was firm and nontender; bilateral lower-abdominal tenderness in the iliac fossae was the only abdominal finding. Cross-sectional imaging identified a solitary forearm abscess together with bilateral psoas collections; magnetic resonance imaging of the lumbosacral spine additionally revealed vertebral-body destruction and paravertebral soft-tissue involvement consistent with Pott's disease. Chest radiography was unremarkable. GeneXpert MTB/RIF performed on pus aspirated from both sites confirmed M. tuberculosis complex with rifampicin resistance; a line-probe assay subsequently documented additional resistance to isoniazid and fluoroquinolones - fulfilling the definition of preextensively drug-resistant (XDR) TB. An all-oral modified longer regimen comprising cycloserine, linezolid, clofazimine, bedaquiline, and delamanid was initiated, with steady clinical recovery. Pre-XDR TB may manifest as disseminated soft-tissue disease at unconventional sites - forearm and paravertebral musculature - even when the lungs are radiologically clear. Early molecular resistance testing on pus aspirates shortened the interval to appropriate second-line therapy and likely shaped the favourable trajectory observed here. RésuméLa tuberculose extrapulmonaire (TB) représente 15 à 20 % de l’ensemble des cas de TB, mais l’atteinte des tissus mous des membres est nettement rare. L’association simultanée d’abcès de l’avant-bras et d’abcès bilatéraux du psoas dus à Mycobacterium tuberculosis résistant aux médicaments, chez un patient sans maladie pulmonaire, n’a – à notre connaissance – jamais été décrite. Une jeune fille immunocompétente de 16 ans présentait une douleur thoracique droite, une tuméfaction progressivement croissante de l’avant-bras gauche, une anorexie et une perte de poids depuis environ 2 semaines. La fièvre, la toux et les sueurs nocturnes étaient absentes, ainsi que tout contact connu avec la TB. À l’examen, la lésion de l’avant-bras était ferme et indolore ; une sensibilité bilatérale de la région abdominale basse au niveau des fosses iliaques constituait le seul signe abdominal. L’imagerie en coupe a identifié un abcès solitaire de l’avant-bras associé à des collections bilatérales du psoas ; l’imagerie par résonance magnétique du rachis lombosacré a par ailleurs révélé une destruction des corps vertébraux et une atteinte des tissus mous paravertébraux compatible avec la maladie de Pott. La radiographie thoracique était normale. Le test GeneXpert MTB/RIF réalisé sur le pus aspiré des deux sites a confirmé un complexe M. tuberculosis avec résistance à la rifampicine ; un test de sonde linéaire a ensuite documenté une résistance supplémentaire à l’isoniazide et aux fluoroquinolones, répondant ainsi à la définition de la tuberculose pré-extrarésistante (XDR). Un schéma oral modifié prolongé comprenant la cyclosérine, le linézolide, la clofazimine, la bédaquiline et le délamanid a été instauré, avec une récupération clinique satisfaisante. La tuberculose pré-XDR peut se manifester sous forme de maladie disséminée des tissus mous à des sites inhabituels – avant-bras et musculature paravertébrale – même lorsque les poumons sont radiologiquement normaux. Le dépistage précoce de la résistance moléculaire sur les aspirats de pus a réduit le délai d’instauration d’un traitement de deuxième ligne adapté et a probablement contribué à l’évolution favorable observée dans ce cas.
Objective: Ganglion cysts are benign soft-tissue tumors that are relatively rare in the foot. Although most foot ganglia are asymptomatic, cases of structural compromise and pathological fractures are rare. Patient: A 65-year-old woman presented with right lateral foot pain without direct trauma. Physical examination revealed a soft, non-erythematous mass between the fourth and fifth metatarsals. Imaging demonstrated a scalloping depression at the fourth metatarsal and a pathological fracture of the fifth metatarsal shaft. Results: A surgical excision was performed by tracing the cyst to the fourth metatarsophalangeal joint. The fifth metatarsal was stabilized using a four-hole plate. Bony union was achieved at six weeks with pain resolution. Conclusion: This case highlights the importance of considering the mechanical compression exerted by the cyst and possible osteoporosis as contributing factors. Complete excision with stalk removal combined with fixation is recommended to prevent recurrence and to optimize functional outcomes.
Stimuli-responsive shape-changing hydrogels are the most competitive candidates for artificial muscles, electronic skins, and soft robotics. However, existing actuating hydrogels often suffer a trade-off between actuation performance and mechanical strength, which greatly limits their application prospects as actuators under external force loads. Here, we adopt a cascade polymerization strategy to successively introduce electrical sensing and mechanically enhanced polymer network phases into sponge-like PNIPAM hydrogels to achieve PNIPAM-based photothermal-responsive actuating hydrogels with fast response, high strength, and self-sensing performance. The as-prepared hydrogel actuator can execute rapid actuation missions even under external loading far exceeding its own mass and generate differentiated electrical sensing signals according to the magnitude of the external load. Based on the corresponding relationship between the mass of the load and the actuation behavior (such as "0/1" encoding), we develop a novel material-based binary information encoding system. Furthermore, by manufacturing logic gates to analyze differentiated feedback sensing signals and integrating them with Internet of Things technology, a closed-loop logic control system is established for remote logic-based interactive communication. This study fills the gap of traditional hydrogels in load-bearing actuation and complex interactive applications and opens up a new direction for the next generation of smart soft materials.
Magnetic Resonance Imaging (MRI) is indispensable in clinical diagnosis and biomedical research due to its advantages such as non-ionizing radiation and high soft tissue resolution. As a core component of the MRI system, the performance of radiofrequency (RF) coils directly affects imaging quality. Wired RF coils are the standard configuration in clinical practice, but they have several limitations including cable constraints and high costs. Active wireless coils face technical challenges such as high system complexity, difficult clock signal synchronization and data throughput limitation. As a passive wireless signal transmission solution, the inductively coupled wireless coil (ICWC), serving as a complementary RF component, achieves signal and energy transmission through near-field magnetic coupling with the wired coil. They possess numerous advantages including localized reception unique advantages of non-ionizing radiation, high soft-tissue resolution, multi-parametric analysis, and metabolic information monitoring. Since the 1970s [1, 2], MRI has not only revolutionized the traditional medical understanding of human anatomy and pathological changes but also achieved groundbreaking advancements in numerous specialized subfields, such as neuroscience [3-5] and oncology [6-8]. sensitivity enhancement, cross-tissue/species transplantability, adaptability to different main magnetic fields, reduction of the g-factor, B1 + field shaping, cable-free advantages in special scenarios, design scalability, and cross-manufacturer compatibility. This review elaborates on the inductive coupling mechanism of ICWCs, the derivation of the SNR formula, potential causes of g-factor reduction, and recommendations for fabrication methods. Additionally, it systematically summarizes the application progress in scenarios such as invasive imaging, multi-site human imaging, animal imaging, and applications in special scenarios. Finally, it discusses the development prospects ICWCs in fields including neuroimaging, ultra-high/ultra-low field MRI, and X-nucleus MRI/MRS, as well as ICWCs' advantages and limitations, providing a reference for the innovation of MRI RF coil technology and the clinical translation of ICWCs.
Rehabilitation of partially edentulous patients following fibular free-flap reconstruction presents significant functional and biomechanical challenges due to altered soft tissue morphology, reduced vestibular depth, and compromised load-bearing capacity. In cases involving extensive tissue loss, fixed prosthetic designs may be limited in their ability to support the tongue and cheeks, while implant-assisted removable partial dentures (IARPDs) offer better hygiene access and prosthetic flexibility. This case report describes a prosthetically driven approach that integrates CBCT-guided planning with advanced conventional prosthodontic techniques. After the fibula and overlying skin graft had sufficiently healed, a customized impression protocol was used to accommodate the irregular, highly resilient grafted soft tissues. Denture tooth placement was guided by the neutral zone concept to ensure functional harmony with the surrounding muscles. A radiographic splint with barium sulfate markers enabled prosthetically guided implant planning, resulting in the placement of three implants using a fully guided approach. A removable partial denture retained by stud attachments was selected, given the extent of tissue loss and the need for improved peri-implant hygiene. Intraoral activation of the attachments stabilized the distal extension during functional loading. Because the grafted tissues were mobile, a functional impression was performed to accurately capture the prosthetic-bearing area and facilitate relining, as conventional selective pressure techniques are insufficient in such conditions. The definitive prosthesis demonstrated improved retention, occlusal harmony, and functional stability, resulting in greater patient comfort and masticatory efficiency. This case highlights the potential value of prosthetically driven planning, functional impression techniques, and neutral zone-guided tooth placement in supporting functional rehabilitation and favorable clinical outcomes in reconstructed mandibles after oncologic resection.
Cooperative dynamics in soft materials such as colloidal suspensions, gels, and polymers stem from complex surface interactions and structural heterogeneities, driving behaviors such as yielding, failure, and avalanches. In X-ray photon correlation spectroscopy (XPCS), these dynamics manifest as localized decorrelation bursts in the two-time intensity correlation function, whose physical significance has remained difficult to quantify with traditional models that assume uniform and random motion. Here, we develop a deep-learning framework that detects and tracks such bursts as individual dynamical events. Combining theoretical validation with XPCS measurements of dense colloidal suspensions, we show that cooperative rearrangement regions (CRRs) are organized into temporally correlated hierarchies and cascades, with event durations and recurrence patterns that depart from homogeneous relaxation models. The results reveal a multiscale pathway for structural relaxation in dense colloids and demonstrate that intermittent features in XPCS encode physically meaningful cooperative dynamics. Our approach provides a route to quantifying avalanche-like and heterogeneous relaxation in soft, glassy, and disordered materials. We introduce an AI-powered framework that interprets intermittent bursts in two-time correlation functions as spatiotemporal "objects". Leveraging deep learning, it detects and tracks CRRs, extracting their occurrence times and durations to support detailed analysis. Validated through theory and experiment, this approach reveals the hierarchical and cascading nature of CRRs, offering new insights into relaxation dynamics in dense colloidal suspensions. It provides a robust tool for investigating complex behaviors in disordered systems.
A 79-year-old asymptomatic woman was referred for a large adrenal incidentaloma found on imaging for painless hematuria. Computed tomography (CT) showed a hyperenhancing mass of the left adrenal gland with central necrosis, calcification, mass effect, and measuring 9.1 × 8.3 cm. Biochemical evaluation revealed markedly elevated 24-hour urine and plasma metanephrine and normetanephrine levels, strongly suggesting pheochromocytoma. On the morning of surgery, a dedicated adrenal-protocol CT confirmed the large left pheochromocytoma and incidentally detected a previously unrecognized partially calcified soft-tissue mass in the anterior mesentery. The patient underwent uncomplicated left laparoscopic, hand-port-assisted, transabdominal adrenalectomy. Using the same hand-port incision, the mesenteric mass was removed and frozen section analysis revealed mesenteric metastasis from midgut carcinoid tumor. The primary small bowel carcinoid tumor and mesentery were then resected en bloc, followed by primary intestinal anastomosis. She recovered well and was discharged after 48 hours. Final pathology confirmed pheochromocytoma coexisting with metastatic midgut carcinoid tumor. This case highlights the rare coexistence of 2 distinct neuroendocrine tumors, underscores the importance of careful review of imaging in patients with pheochromocytoma for unanticipated findings, and demonstrates the value of intraoperative frozen section analysis combined with a tailored, minimally invasive surgical approach.
Children must feel seen, safe, and supported! Laura Gould, MS, joins host, Raisa Amiruddin, MBBS, to discuss the value of soft language, gentle validation, and impacts from giving children a voice in their own care. Discover how simple human connection transforms imaging suites into warm safe spaces for kids.
Current nonsurgical vagus nerve stimulation (VNS) approaches often suffer from broad current spread, high electrode-skin impedance, and unintended stimulation of surrounding tissues, which can reduce efficacy and cause side effects. Here, we present a wirelessly operable, skin-attachable VNS patch with three-dimensional liquid-metal electrodes that mimic the low modulus of biological tissues, developed as a minimally invasive platform for investigating the biological mechanisms underlying VNS in a mouse model of depression. The soft, low-modulus three-dimensional liquid metal electrodes gently penetrate the skin, bypass the stratum corneum, and improve electrode-tissue coupling while minimizing tissue damage compared with conventional planar or rigid electrodes. To comprehensively assess therapeutic effects, we conducted behavioral tests, neural probe-based brain signal analysis, dendritic spine density measurements, and blood and inguinal lymph node profiling in depression model mice. VNS increased plasma serotonin levels and increased dendritic spine density, indicating improved neuroplasticity. Corticosterone-induced depressive mice exhibited elevated CD4+ and B220+ cells, which normalized with VNS. These results establish an animal-level proof-of-concept that minimally invasive VNS can engage key neural and immunological pathways relevant to depression, providing a foundation for future neuromodulation strategies.
Optical coherence tomography (OCT) is a noninvasive optical imaging technique to image soft tissue and thin bony structures with high resolution, approaching that of histology. This review summarizes recent progress in the clinical application of OCT for tympanic membrane and middle ear disease. Recent reports from clinical trials show that OCT is having a meaningful impact on the diagnosis of fluid in the middle ear. In parallel with this, numerous groups are obtaining previously unattainable normative data in vivo on human middle ear structures. OCT is also starting to be used for functional assessments of the middle ear in the clinical setting by detecting sound and pressure-evoked motion. OCT allows real-time noninvasive radiation-free structural and functional imaging of the tympanic membrane and middle ear at the point of care. As artificial intelligence becomes more commonplace in medicine, it is likely that OCT will become a key technology for the otolaryngologist. The data provided by OCT can be used to train machine learning algorithms for the segmentation of ear structures, which will ultimately support the automated diagnosis of ear disease. This will also aid in objectively tracking disease progression over time. Thus, OCT presents much promise for our field by revolutionizing office-based otological diagnostics.