Supported standing is widely used in children and adolescents with severe cerebral palsy (CP) as part of rehabilitation programs aimed at maintaining musculoskeletal health and enabling participation. Despite its frequent clinical use, quantitative biomechanical evidence describing knee joint loading under different positioning conditions remains limited, particularly in individuals classified as GMFCS IV-V. The primary objective of this study was to quantify knee joint loading during supported standing across predefined combinations of verticalization angle and hip/knee flexion. The secondary objective was to investigate interaction effects between these variables and to assess whether increasing hip/knee flexion is associated with a linear reduction in knee joint loading. Twenty-six children and adolescents with CP (GMFCS IV-V; age 6-17 years) participated in the study. Measurements were performed using a standardized back-supported standing device. Knee joint loading was measured using integrated pressure sensors across six verticalization angles (0°, 30°, 45°, 60°, 75°, 90°) combined with four hip/knee flexion angles (0°, 15°, 30°, 45°). Forces were normalized to body weight (%BW). Statistical analysis was performed using repeated-measures analysis of variance. Knee joint loading increased consistently with greater verticalization across all tested hip/knee flexion conditions (p < 0.001). A non-linear pattern was observed across flexion angles. Interaction effects between verticalization and hip/knee flexion were observed. Knee joint loading did not decrease linearly with increasing flexion; instead, the lowest loading was observed at approximately 15° hip/knee flexion, whereas both full extension and 45° flexion resulted in higher loads. Verticalization angle represents a key factor influencing knee joint loading during supported standing in children and adolescents with severe CP. Knee joint loading increases with greater verticalization, while hip/knee position shows a non-linear influence. The absence of a linear reduction in loading with increasing flexion highlights the presence of interaction effects between positioning variables and supports individualized positioning strategies in supported standing programs.
In horses, standing arthroscopy offers a valuable alternative to general anesthesia for the reduction of anesthetic-associated risks, and provides improved visualization in joints where access is facilitated by weightbearing. These techniques are particularly advantageous for patients with increased anesthetic risk or financial limitations. To the authors' knowledge, the removal of osteochondral fragments from the distal interphalangeal joint in a standing, sedated horse using small-diameter arthroscopic equipment has not been previously reported. A 7-year-old American Quarter Horse-Thoroughbred cross presented on referral for treatment of osteochondral fragmentation in the right fore distal interphalangeal joint. A standing arthroscopic approach to the distal interphalangeal joint was performed. In a weight-bearing position, debridement of the dorsal osteochondral fragments from the second and third phalanx was successfully completed, using a 2 mm NanoNeedle scope and 3.2 mm high-flow 10- degree cannula (Arthrex®). At one year follow-up, the horse had returned to competition and was sound at veterinary examination. This case demonstrates the feasibility of standing NanoNeedle arthroscopy of the equine coffin joint with improved maneuverability, surgical ergonomics, and reduced iatrogenic injury compared to a standard rigid arthroscope. The successful execution of this technique effectively expands our collection of standing arthroscopic procedures in the equine patient.
Background and Objectives: Enhanced Recovery After Surgery (ERAS) pathways are increasingly used in spine surgery, but uptake in adolescent idiopathic scoliosis (AIS) remains heterogeneous across institutions. Evidence in pediatric deformity surgery supports shorter recovery with protocolized care, yet real-world comparative data combining ERAS and the erector spinae plane block (ESPB) remain limited. This study aimed to compare early postoperative outcomes between a historical standard-care pathway and a structured ERAS+ESPB pathway in adolescents undergoing posterior spinal fusion for AIS. Materials and Methods: A single-center retrospective time-based comparative cohort study design included consecutive AIS patients (<18 years) treated between 1 January 2024 and 31 December 2025. The standard-care pathway was applied to patients operated on before 1 June 2025 (n = 34), whereas the ERAS+ESPB pathway was applied to those operated on from 1 June 2025 onward (n = 35), following formal institutional implementation. Outcomes included postoperative pain assessed using the visual analog scale under two functional conditions-at rest in the supine position and during standing/mobilization-at POD0, POD1, POD2, POD3, discharge, and 2-week follow-up; postoperative nausea at POD0-POD3; and length of stay (LOS). Between-group pain comparisons used Welch's t-test; nausea used Fisher's exact test; LOS used the Wilcoxon rank-sum test. Results: At POD0, supine pain was lower in ERAS+ESPB (1.50 ± 0.55) than in standard care (3.20 ± 1.50; p < 0.001). From POD1 onward, supine pain did not differ significantly between groups. Among assessable patients, standing pain was lower in ERAS+ESPB at POD2 (3.05 ± 1.53 vs. 4.50 ± 1.05; p = 0.020), POD3 (2.82 ± 1.62 vs. 4.17 ± 1.03; p = 0.006), and 2-week follow-up (1.45 ± 0.80 vs. 2.26 ± 0.93; p = 0.006). Nausea was lower in ERAS+ESPB at POD0 (11.4% vs. 35.3%; p = 0.024) and POD2 (8.6% vs. 32.4%; p = 0.018), with no significant differences at POD1 or POD3. LOS was shorter in ERAS+ESPB (5.41 ± 1.10 vs. 8.32 ± 2.06 nights; p < 0.001). Conclusions: In adolescents undergoing posterior spinal fusion for AIS, an ERAS-based perioperative pathway incorporating ESPB was associated with improved early postoperative recovery, particularly in terms of immediate postoperative pain, pain during mobilization, early postoperative nausea at selected time points, and length of hospital stay. Prospective multicenter studies are needed to confirm these findings and clarify the independent contribution of individual pathway components.
Sit-to-stand (STS) is a fundamental functional task frequently impaired after stroke and widely used in rehabilitation to assess motor control and balance. While lower-limb kinematic and muscular asymmetries during STS have been documented, the contribution of trunk muscle coordination to compensatory strategies has received limited attention. We investigated STS performance in seven individuals with chronic right-sided hemiparesis under two conditions (free arms and crossed arms) to characterize phase-dependent kinematic asymmetries and side-dependent trunk muscle modulation relevant to rehabilitation practice. Optoelectronic motion capture was synchronized with bilateral surface electromyography, providing time-aligned kinematic and neuromuscular signals for sensor-based assessment of STS. Participants exhibited prolonged and highly variable STS durations, along with ankle asymmetries during the rising and lowering phases and hip asymmetries during upright standing, indicating increased reliance on the less impaired limb. Electromyography revealed side-dependent modulation of trunk muscles, notably latissimus dorsi, erector spinae longissimus, and multifidus, characterized by a prolonged relative contribution on the more impaired side. These findings suggest that altered trunk muscle modulation contributes to compensatory STS strategies after stroke and highlight the importance of trunk-focused neuromuscular assessment to guide individualized rehabilitation interventions aimed at improving symmetry, postural stability, and movement efficiency.
Locomotive syndrome (LS) is a major cause of mobility impairment and loss of independence in older adults. Abdominal morphology and patterns of body fat distribution are thought to affect physical function; however, their relationships with the severity of LS in women with osteoporosis remain insufficiently characterized. Standing sacral-abdominal wall distance (SAD) is considered an indicator of compromised trunk support mechanisms, whereas the android/gynoid fat ratio (A/G ratio) primarily reflects body fat distribution patterns. This retrospective cross-sectional study included 221 women aged 65 years or older attending an osteoporosis outpatient clinic. LS was assessed using the stand-up test, the two-step test, and the Locomo 25 questionnaire according to official criteria. The most severe stage among the three tests was defined as the overall LS stage, and participants were classified into LS stage 0-1 and LS stage ≥ 2 groups. Associations of SAD and the A/G ratio with LS were examined using multivariable logistic regression analysis adjusted for age, skeletal muscle mass index (SMI), femoral neck T-score, and the Controlling Nutritional Status (CONUT) score. Among the participants, 93 (42.1%) were classified as having LS stage ≥ 2. The LS stage ≥ 2 group had a significantly greater SAD than the LS stage 0-1 group (median, 167.3 mm vs. 154.6 mm; p < 0.001), whereas no significant difference was observed in the A/G ratio (p = 0.054). In multivariable analyses (n = 208), SAD was independently associated with LS stage ≥ 2 (odds ratio per 1 mm increase, 1.035; 95% confidence interval, 1.016-1.054; p < 0.001), corresponding to an odds ratio of 1.41 per 10 mm increase. The A/G ratio also showed an independent association, while no significant interaction between SAD and the A/G ratio was observed. In women with osteoporosis, SAD was independently associated with LS severity, reflecting mobility impairment from a perspective distinct from body fat distribution. SAD may serve as a simple and clinically useful indicator for assessing the risk of severe LS.
Background and Objectives: Postoperative pain after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) shows substantial interindividual variability, particularly during early mobilization. Although preoperative psychological vulnerability has been associated with less favorable pain trajectories in prior AIS research, evidence focused on the acute postoperative phase remains limited. This preliminary study evaluated whether preoperative psychological factors are associated with acute postoperative pain intensity, with separate assessment of resting and standing pain. Materials and Methods: A single-center retrospective cohort study included consecutive adolescents with AIS (<18 years) who underwent primary elective posterior instrumented spinal fusion between 1 January 2024 and 31 December 2025. Preoperative psychological variables were collected using validated instruments (STAIC-State, STAIC-Trait, Pain Catastrophizing Scale, HAQ/FDI, and inverted SRS-22). Pain intensity (VAS 0-10) was recorded at postoperative day (POD) 1, POD2, POD3, discharge, and 2-week follow-up in supine and standing positions. Derived endpoints included peak in-hospital standing pain, in-hospital standing pain burden (AUC), and standing-rest pain gaps. The prespecified inferential analysis used a linear mixed-effects model with fixed effects for time, position, preoperative STAIC-State, and position × STAIC-State interaction, with a patient-level random intercept. Results: Thirty-five patients were analyzed (mean age 15.2 ± 3.4 years; 62.9% female), with complete pain data at all timepoints. During hospitalization, standing pain was descriptively higher than resting pain (largest mean difference at POD2: 0.73 VAS points), with convergence at week 2 (both 1.52). In mixed-model analysis, pain significantly decreased at week 2 versus POD1 (β = -1.261, 95% CI -1.853 to -0.669; p < 0.001). Preoperative STAIC-State was not independently associated with postoperative pain (β = 0.030, 95% CI -0.065 to 0.124; p = 0.545), and no significant position × STAIC-State interaction was found (β = -0.008, 95% CI -0.079 to 0.064; p = 0.836). Conclusions: In this retrospective preliminary AIS cohort, postoperative pain improved significantly over time, while movement-evoked pain remained relevant during early recovery. In this preliminary cohort, no clear association was detected between preoperative state anxiety and acute postoperative pain intensity, supporting the need for broader multidimensional prognostic models in future prospective multicenter studies.
Background/Objectives: The significant negative correlation between protein and oil content in soybean seeds is a long-standing bottleneck for conventional breeding. Its root cause lies in insufficient understanding of related molecular regulatory processes. Methods: We selected the CSSL_R19, a chromosome segment substitution line, to thoroughly investigate the intrinsic effects of the substituted segment on the high seed storage protein (SSP) and low fatty acid (FA) phenotype. Transcriptomic, proteomic, and metabolomic analyses were performed on the recurrent parent and R19. Results: A total of 1821 differentially expressed genes (DEGs), 12 differentially expressed proteins (DEPs), and 10 differentially accumulated metabolites (DEMs) were detected. Subsequently, an integrative examination of the data demonstrated that 28 DEGs, 5 DEPs, and 4 DEMs participated in biological processes such as carbohydrate metabolism, lipid degradation, as well as protein synthesis and transport. Mechanistically, down-regulation of PGM reduces the carbon source supply for FA synthesis; up-regulation of LOX, LACS, ACX, and KAT promotes FA degradation. SRP, SAR1, and HSP70 are involved in the synthesis and transport of SSP. Crucially, qRT-PCR validation performed on all 28 core DEGs showed that their expression trends were highly consistent with the transcriptome data, confirming the reliability of the findings. Conclusions: In conclusion, we propose a potential regulatory network that enhances SSP accumulation and reduces FA content. Altogether, these findings advance our understanding of storage compound accumulation in soybeans and guide future breeding strategies.
Virtual dissection tables such as Cadaviz offer interactive, 3D visualization of anatomical structures, potentially enhancing comprehension and engagement in medical education. This study examines how first-year MBBS students with diverse academic standings perceive the effectiveness of Cadaviz in supporting their anatomy learning. A cross-sectional survey was conducted with 220 first-year MBBS students at Sree Balaji Medical College, Chennai. Participants were stratified into Below-Average, Average, and Above-Average groups based on internal assessment scores. Perceptions of Cadaviz were assessed using a 20-question Likert-scale questionnaire covering effectiveness, engagement, interactivity, accessibility, usability, and perceived role of Cadaviz alongside traditional dissection. Data were analyzed descriptively and via one-way ANOVA to compare mean Likert Scale Scores across performance strata. Cadaviz was perceived as an effective anatomy learning tool, with below-average students reporting the greatest benefits in understanding structures, comprehension, and learning efficiency (p = 0.043-0.005). While traditional cadaveric dissection remained preferred, Cadaviz was valued as a supplement, enhancing engagement, interactivity, and self-paced learning. Students highlighted its accessibility, flexibility, and user-friendly interface, with fewer technical difficulties. Cadaviz fostered inclusive, learner-centered education, promoting active participation, conceptual understanding, and confidence across all academic strata, particularly supporting students needing additional reinforcement.
Over the past years, burn care has evolved from a discipline focused on survival to one centered on restoring long-term health, function, and quality of life. Significant advances in critical care, early excision and grafting, infection control, and metabolic support have transformed survival outcomes for even the most severe injuries. As a result, the field now faces a new frontier: understanding and managing the long-term physical, psychological, and systemic sequelae of survival. This review traces the evolution of burn care over the last century and outlines the challenges and priorities for the next 25 years. The first era of progress, defined by innovations in resuscitation, surgery, and critical care, has given rise to a growing cohort of long-term survivors. Research over the past decade has revealed that major burns induce chronic multisystem alterations, including metabolic, cardiovascular, neurocognitive, and immunological dysfunctions. Emerging concepts such as burn-associated heart failure exemplify this shift from acute to chronic disease understanding. Looking ahead, the future of burn medicine lies in personalized and lifelong care, supported by translational research, digital health, regenerative therapies, and interdisciplinary collaboration. Overall, burn care stands at a pivotal crossroads. By integrating precision medicine, rehabilitation science, and psychosocial care, we aim to move the field from survival toward sustained, holistic recovery over the next 25 years.
Exercise adaptation and training maladaptation arise from overlapping metabolic, redox, inflammatory, endocrine, and tissue-remodeling processes, so the translational question is not whether biomarkers change but when, where, and for which decision they become informative. This narrative review develops a decision-linked framework for minimally invasive biomarkers across the recovery-overload continuum and treats biomarker meaning as a molecule-matrix-time-decision relationship rather than as a stand-alone peak. The framework is organized around five coupled layers: stimulus architecture, signaling and release biology, sampling matrix and pre-analytics, bout-relative kinetics, and the monitoring decision to be supported. Current evidence indicates that no single biomarker reliably separates productive remodeling from delayed recovery, tissue strain, non-functional overreaching, or early maladaptation. Classical chemistry remains useful for bounded tasks, especially delayed tissue strain and stress reactivity; cfDNA appears promising for rapid load sensitivity; targeted metabolite panels are strongest for recovery phenotyping; and circulating RNAs and extracellular-vesicle cargo add mechanistic depth but remain constrained by pre-analytical fragility and incomplete standardization. The central practical implication is that overload is better interpreted as progressive loss of signal resolution than as threshold-crossing and that sparse temporally staggered panels are more likely to aid monitoring decisions than isolated markers or untimed high-dimensional profiles. Progress will depend on purpose-specific panels, transparent analytical standards, and prospective validation against symptoms, performance, and established measures across sex, hormonal, circadian, and training contexts.
Joubert syndrome (JS) is a rare ciliopathy characterized by cerebellar and brainstem malformations and the molar tooth sign on magnetic resonance imaging. Motor impairment is primarily driven by axial hypotonia, impaired postural control, and disrupted respiratory-postural integration. Longitudinal reports describing structured neurorehabilitation with standardized functional outcomes remain limited. We report a female child with prenatally suspected vermian hypoplasia and postnatally MRI-confirmed Joubert syndrome. Subsequent molecular testing performed at the age of 3 years and 11 months identified heterozygous variants in the B9D2 gene associated with Joubert syndrome. Early development was marked by axial hypotonia, global motor delay, impaired trunk stabilization, sleep-disordered breathing, and early hip migration. At 2.5 years of age, following motor plateau under conventional therapy, a structured 12-month rehabilitation programme was introduced, combining Vojta-based reflex locomotion, respiratory therapy targeting thoraco-diaphragmatic synchronization, daily home-based practice, and supported standing. After 12 months, gross motor function improved substantially, with GMFM-88 increasing from 12% to 52% (+40 percentage points). PEDI scaled scores improved across all domains, with mobility increasing from 8 to 40, self-care from 15 to 45, and social function from 25 to 50. Ataxia severity decreased from 22 to 15 on the modified Brief Ataxia Rating Scale, consistent with improved trunk stability and coordination. Postural and respiratory organization improved, reflected by a reduction in the subcostal angle from 137° to 90°, an increase in sacral slope from 5° to 10°, and increased expiratory pressure from 10 to 25 mmHg. Caregiver-reported assessment combined with structured clinical observation indicated improved functional visual performance, including enhanced visual attention, visuomotor coordination, and environmental visual interaction. Structured neurorehabilitation was associated with substantial functional improvement across motor, postural, and respiratory domains. These findings support the clinical relevance of mechanism-oriented neurorehabilitation and standardized longitudinal outcome assessment in Joubert syndrome.
Venous leg ulcers are the most severe manifestation of chronic venous insufficiency, and their treatment is based on compression therapy, whose effectiveness depends on the magnitude of the pressure and the biomechanical properties of the system. Doubts persist about the actual correlation between interface pressure, bandage stiffness and clinical outcomes in real-world practice. To compare the clinical efficacy and biomechanical behavior of different multicomponent compression systems in venous leg ulcers, analyzing the relationship between interface pressure, static stiffness, edema reduction and variation in the wound area. This is a prospective, observational and multicenter study in six districts/health areas of Andalusia, in adults with active venous ulcers attended by Advanced Practice Nurses in Complex Chronic Wounds. Several multi-component compression systems were applied, and interface pressure was monitored using Tight Alright® at three points on the leg for 96 h, recording final pressure, static stiffness, perimeters and ulcer area. All systems achieved a reduction in leg circumference, more marked at the proximal points, evidencing an overall decongestant effect. The correlation between final pressure and edema reduction was weak, and relevant differences were observed in the reduction in ulcer area, with Urgo K2 and CPK Compress 2 standing out with decreases of more than 50% compared to medium or low yields of other systems with comparable pressures. The static stiffness analysis showed specific patterns according to system and leg size, as well as a heterogeneous longitudinal distribution of pressure. The efficacy of compression in venous ulcers depends on both the interface pressure and the design and biomechanical behavior of the system, with clinically relevant differences between multicomponent dressings. Multipoint pressure and stiffness monitoring provides useful information to optimize system selection and support decisions based on biomechanical parameters and standardized clinical outcomes.
Early diagnosis of ovarian cancer remains one of the most important unmet needs in gynecologic oncology because survival is strongly stage-dependent and most patients still present with disseminated disease. Conventional non-invasive tools, particularly CA-125, transvaginal ultrasound, and composite triage algorithms, remain clinically useful but are limited by suboptimal sensitivity for stage I disease and by reduced specificity in premenopausal women and in benign inflammatory or endometriosis-associated conditions. Circulating tumor DNA (ctDNA) has therefore emerged as a candidate biomarker capable of extending liquid biopsy beyond conventional serology. In ovarian cancer, however, ctDNA implementation is constrained by low tumor shedding in early-stage disease, marked biologic heterogeneity across histotypes, clonal hematopoiesis-related background noise, and major pre-analytical and analytical sources of variability. This narrative review, informed by structured searches of PubMed, Scopus, and Web of Science, examines the evolving evidence for ctDNA mutations, methylation-based assays, multi-omic platforms, and machine-learning models across three distinct clinical contexts: population screening, preoperative triage of adnexal masses, and post-treatment assessment of molecular residual disease. We also discuss positive predictive value, false-positive harms, health-economic implications, standardization initiatives, and ongoing prospective studies. Overall, current evidence suggests that the most plausible near-term role for liquid biopsy in ovarian cancer is not as a universal stand-alone screening test, but as an integrated component of risk stratification and disease-monitoring frameworks that combine molecular signals with clinicopathologic and imaging data.
Peen forming is a dieless manufacturing process used to shape large, thin aerospace panels through controlled shot impacts that induce residual stresses and curvature. Despite long-standing industrial use, process monitoring still depends largely on indirect proxies such as Almen intensity and coverage, limiting spatially resolved deformation assessment and hindering closed-loop control. In parallel, vision-based artificial intelligence (AI) has enabled adaptive monitoring and feedback in smart-manufacturing domains such as welding, additive manufacturing, and sheet forming. This review examines how such sensing and learning strategies can be transferred to adaptive peening forming. We compare six vision sensing modalities and assess major AI model families for surface mapping, temporal prediction, robustness, and deployment maturity. The synthesis shows that progress is primarily constrained by limited validated datasets, harsh in-cabinet sensing conditions, scarce closed-loop demonstrations, and weak validation on curved aerospace geometries. We conclude that the sensing and AI foundations for adaptive peen forming are already emerging, but industrial translation now depends on stronger experimental validation, standardized benchmarking, robust multi-sensor integration, and edge-capable feedback pipelines.
Occupational sedentary behavior presents a public health risk, yet current interventions often rely on subjective self-reports or context-blind prompts. This study validates a privacy-preserving, edge-computing time-of-flight (ToF) sensor that detects postural states and quantifies therapeutic exercise gestures in real time. The dual-sensor architecture distinguishes between sitting, standing, and absence, while capturing rapid sit-to-stand repetitions suitable for active-break interventions. In this paper, a laboratory study (N = 7) evaluated the system against ground truth comprising activPAL3 accelerometry and video analysis. Across 378 postural events, the sensor achieved high temporal fidelity (mean absolute error < 1.6 s) and 100% sensitivity in counting exercise repetitions. The system differentiated workstation occupancy from physical absence. These findings demonstrate that ToF sensing matches the accuracy of video analysis without privacy concerns while offering the contextual awareness required for just-in-time, adaptive workplace interventions.
Background/Objectives: Culturally responsive care requires both intercultural communication competence (ICC) and empathy; however, these constructs are often examined separately in nursing research. This study aimed to (i) describe nurses' ICC and empathy levels, (ii) test the association between ICC and empathy, and (iii) examine group differences by selected demographic and professional variables. Methods: A quantitative, cross-sectional correlational design was conducted with 300 nurses recruited from state and private hospitals. ICC was measured using the Arasaratnam Intercultural Communication Competence Scale (cognitive, affective, and total), and empathy was assessed using the 18-item Jefferson Scale of Empathy (compassionate care, perspective taking, standing in the patient's shoes, and total). Data were analyzed with descriptive statistics, Pearson correlations, independent-samples t-tests, and one-way ANOVAs with Scheffé post hoc tests (α = 0.05). Results: Both ICC and empathy were above the scale midpoint. Cognitive ICC (M = 4.71, SD = 1.42) exceeded affective ICC (M = 4.35, SD = 1.34), and total empathy was high (M = 4.50, SD = 0.90), with compassionate care as the highest subscale (M = 4.60, SD = 1.10). ICC total was moderately correlated with total empathy (r = 0.607, p < 0.05); affective ICC correlated with compassionate care (r = 0.455) and perspective taking (r = 0.493). Male nurses reported higher ICC than female nurses (p < 0.05), while empathy did not differ by gender. Younger nurses (20-29) scored higher in ICC and empathy than older groups, and nurses with ≥28 years of experience also showed elevated levels. Nurses who willingly chose nursing had higher ICC and empathy across dimensions (all p < 0.001). Hospital type showed minimal differences except for "standing in the patient's shoes" (private > state, p = 0.04). Conclusions: ICC and empathy were generally high and interrelated among nurses, with meaningful variation across workforce characteristics. Training should emphasize experiential and reflective approaches to strengthen affective ICC and perspective taking, while organizational strategies should foster intrinsic motivation and support professional development across career stages.
Cervical spondylosis is a common cause of spinal cord dysfunction, and anterior cervical discectomy and fusion (ACDF) is widely employed when conservative treatment fails. Conventional implant systems such as the cervical cage with plate (CCP) and zero-profile stand-alone cage (ZPSC) are commonly used to enhance spinal stability and promote fusion, but they are associated with complications including dysphagia and adjacent segment degeneration. To address these limitations, a novel flexible plate cage system (FPCS) has been developed to optimize biomechanical performance while minimizing surgical risk. In this study, a finite element model of the C3-T1 cervical spine was constructed to simulate ACDF at the C5-C6 level using CCP, ZPSC, and FPCS implants. Under standardized loading conditions, von Mises stress was analyzed in the bone, intervertebral disc, endplates, cage, and screws, using the mean of the top 5% stress values to ensure accuracy. All surgical models showed increased stress compared to the intact reference spine. The ZPSC model exhibited the highest stress in the cage and screws, suggesting a more concentrated load path. The CCP model showed a more evenly distributed stress profile, particularly affecting the inferior adjacent segment. The FPCS model demonstrated moderate cage stress, reduced screw stress, and the highest plate stress, indicating a design that effectively redirects mechanical load from the screw-bone interface toward the anterior plate. This may be related to the unique structural configuration of the FPCS, which secures screws horizontally into the anterior vertebral body without penetrating the endplates. These findings suggest that the FPCS may offer a biomechanically favorable alternative to existing ACDF implants.
Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy, far less frequent than its counterpart in the bladder, but with a more aggressive course, worse prognosis and unique diagnostic challenges. Despite the histological and molecular similarities between upper and lower tract urothelial tumours, UTUC has many key distinct traits, both clinical and genomic, and must be viewed as a separate entity from bladder urothelial carcinoma (BUC). Ureteroscopy with biopsy is the only means to obtain tissue for histo-logical confirmation of diagnosis and more accurate tumour grading, but is not always feasible or preferable because it carries the risk of potentially severe complications. Aside from the widely available but poorly sensitive urine cytology, a large variety of urine-based diagnostics are increasingly investigated as non-invasive alternatives to ureteroscopy. Fluorescence in situ hybridization (FISH) is the most widely used molecular assay for the diagnosis and monitoring of UTUC, but has failed, as of yet, to display a comparable diagnostic accuracy to the existing gold standards of computed tomography urography (CTU) and ureteroscopy. We herein aimed to comprehensively review all published data on the performance of FISH for the detection of UTUC, in comparison to urine cytology and other assays, while further commenting on the existing challenges and future perspectives in the field of urine-based diagnostics. Across all studies (n = 29) which were included in this review, the sensitivity and specificity of FISH ranged from 36.8% to 100.0% (mean: 75.5%; median: 78.9%) and 34.4% to 100.0% (mean: 84.9%; median: 89.9%), respectively, in the overall patient population, while in the low- versus high-grade subgroups, the sensitivity of FISH ranged from 30.0% to 90.0% (mean: 55.6%; median: 60%) versus 50.0% to 100.0% (mean: 77.9%; median: 78.8%). Furthermore, FISH showed superi-or sensitivity and similar or lower specificity in comparison to cytology, in the over-whelming majority of studies, while Xpert®BC Detection showed the highest sensitivity values among all evaluated assays, reaching 100% even in the low-grade subgroup, albeit at the cost of a significantly reduced specificity. Despite the adequate overall sensitivity and specificity of FISH, its suboptimal performance in the detection of low-grade UTUC seems to preclude its use as a stand-alone screening test.
Lupus nephritis (LN) stands out as one of the most critical complications of systemic lupus erythematosus (SLE), affecting almost 60% of the patient population. Even though more therapies have been made available for LN in the past decade, clinical outcomes remain less than ideal: nearly 10% to 30% of LN cases still advance to end-stage kidney disease (ESKD), still making the management of LN a clinical challenge. Therefore, the primary aim of treatment of LN is simple: to halt the progression toward chronic kidney disease (CKD) and prevent renal failure. In this review, we briefly describe the immunopathological basis of LN, which provides the scientific rationale for new drug development. We will focus on the current in-use medications, especially on proliferative LN, building on the legacy of the 20th century, and we will outline new emerging targeted and innovative therapies. We will also present the standard-of-care as informed by international guidelines and review the management of special groups, including children and pregnant women.
Pythiosis is a neglected infectious disease caused by the aquatic oomycete Pythium insidiosum and remains underrecognized in cattle, particularly in tropical regions. Here, we report the first molecularly confirmed outbreak of bovine pythiosis in the Amazon biome, affecting more than 400 animals raised under extensive production systems and areas with prolonged exposure to standing water. Clinically affected cattle presented ulcerative and exudative cutaneous lesions, predominantly involving the distal limbs. Given the diagnostic challenges associated with pythiosis, etiological confirmation was achieved through quantitative PCR (qPCR) targeting the internal transcribed spacer (ITS) region of P. insidiosum, providing rapid and specific molecular detection during the outbreak investigation. Therapeutic interventions were implemented as part of routine field management, including intramuscular triamcinolone combined with topical copper sulfate; this regimen was associated with clinical improvement in a substantial proportion of affected animals, though treatment efficacy was not formally evaluated. The outbreak occurred in flood-prone pastures during the rainy season, highlighting the role of aquatic environments in pathogen transmission. These findings expand the current understanding of bovine pythiosis in tropical ecosystems and underscore the importance of molecular diagnostics, outbreak surveillance, and a One Health approach for the identification and management of water-associated pathogens in livestock.