The tongue plays a key role in speech and swallowing, and its intrinsic muscles enable fine coordinated movements. High-resolution ultrasonography is a non-invasive method that allows detailed visualization of tongue structures and blood vessels. This study investigated the morphology of the intrinsic tongue muscles and deep lingual artery by correlating the high-resolution intraoral ultrasonography with known anatomical structures. Ultrasonographic examinations were performed on 33 Korean adults (6 males and 27 females; mean age: 34.9 ± 12.3 years) using a B-mode system with a 15 MHz hockey-stick transducer. Five predefined areas on the dorsal and lateral tongue surfaces were systematically scanned. A total of 182 images were acquired to evaluate intrinsic tongue structures and the deep lingual artery. Muscle visualization rates were summarized descriptively, and Fisher's exact test was used to examine age-related differences in visualization status. The intrinsic tongue muscles (superior longitudinal, transverse lingual, vertical lingual, and inferior longitudinal muscles) were distinctly visualized in layered structure from surface inward. Muscle separation was clear on the dorsal surface, though vertical and transverse lingual muscles appeared in the same layer. Visualization detail decreased slightly in the tongue tip and lateral regions. The deep lingual artery was identified in 70.6% of participants, primarily in the anterior tongue, at a mean depth of 0.9 cm (range, 0.6-1.2 cm). An age-related trend toward lower visibility of the right vertical lingual muscle was observed in older participants (P = 0.123). High-resolution intraoral ultrasonography successfully provided detailed, anatomically consistent visualization of intrinsic tongue muscles and the deep lingual artery, supporting its utility for both clinical assessment and educational purposes.
This study aimed to evaluate the utility of the Kupffer phase in Sonazoid-enhanced ultrasonography (SZUS) for liver tumor ablation and to identify factors influencing tumor conspicuity on the Kupffer phase. Eighty-one patients with 128 liver tumors (95 hepatocellular carcinomas [HCCs] and 33 non-HCCs) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), B-mode planning ultrasonography (B-US), and SZUS-guided radiofrequency ablation (RFA) were included. Two radiologists scored tumor conspicuity on the hepatobiliary phase (HBP) of MRI, B-US, and the Kupffer phase using a 4-point scale. Tumor echogenicity on B-US was classified as hypoechoic or non-hypoechoic. This study analyzed tumor conspicuity across modalities, correlations between modalities, RFA technical success rates, and predictors of high Kupffer phase conspicuity. The mean tumor diameter was 14.2±7.0 mm, with no differences in size or location between HCCs and non-HCCs. Conspicuity scores on the Kupffer phase were significantly higher than those on B-US for both HCCs (2.87±0.85 vs. 1.79±0.71) and non-HCCs (3.06±0.79 vs. 2.00±0.75) (both P<0.001). The technical success rate of RFA under Kupffer phase guidance was 97.7%. Tumor conspicuity on the Kupffer phase showed a moderate correlation with that on HBP (r=0.436, P<0.001), and this correlation was stronger in non-HCCs (r=0.630, P<0.001). Multivariable analysis identified B-US hypoechogenicity (odds ratio [OR], 1.424; 95% confidence interval [CI], 1.176 to 1.724; P<0.001) and good HBP conspicuity (OR, 1.317; 95% CI, 1.087 to 1.596; P=0.005) as independent predictors of good Kupffer phase conspicuity. B-US hypoechogenicity and good HBP conspicuity are independent predictors of favorable tumor conspicuity on the Kupffer phase. Identifying these features may facilitate optimal patient selection for effective SZUS-guided RFA of tumors that are inconspicuous on B-US.
Placenta accreta spectrum (PAS), an abnormal placental invasion into the myometrium or beyond the uterine serosa, is associated with adverse pregnancy outcomes. Placenta previa is the most significant individual risk factor for PAS, and Ultrasonography (US) and Magnetic resonance imaging (MRI) are widely used to detecting PAS. However, limited data exist on the effectiveness of US and MRI in predicting maternal and neonatal morbidity. This study evaluated the utility of these imaging modalities, not only in detecting PAS but also in predicting adverse perinatal outcomes. This retrospective cohort study included 150 pregnant women with placenta previa who underwent US and MRI at a tertiary hospital between December 2019 and December 2023. PAS was diagnosed clinically or histopathologically after delivery. The predictive performance of US, MRI, and their combination was assessed using McNemar's test, receiver operating characteristic analysis, and trend analysis. Forty-one patients were diagnosed with PAS. The PAS group had significantly higher rates of prior caesarean section, maternal hemorrhagic outcomes, and neonatal complications than the non-PAS group. PAS-suspected on US group also showed increased estimated blood loss (EBL) and number of transfusion units administered, as well as a higher incidence of transfusion requirement, use of intrauterine balloon tamponade, hysterectomy, preterm birth before 37 weeks of gestation, neonatal ventilatory support and 1-minutes Apgar scores (AS) <7 compared to those with PAS-unsuspected on US group. PAS-suspected on MRI group had a significantly increased number of transfusion units administered and higher rates of hysterectomy, maternal ICU admission, preterm birth and neonatal complications. US plus MRI yielded progressively higher detection rates, outperforming either modality alone. A linear trend was observed in the increase of adverse perinatal outcomes when PAS was suspected on both US and MRI. US and MRI showed complementary strengths. US, but not MRI, is informative for predicting higher EBL, transfusion requirement, and use of intrauterine balloon tamponade, whereas MRI, but not US, predicts maternal ICU admission, preterm birth before 34 weeks of gestation, NICU admission, and 5-minute AS <7. Combining both imaging modalities yields better performance than either modality alone in detecting PAS and predicting adverse perinatal outcomes.
The increasing volume of geriatric surgical procedures presents a critical challenge: protecting the aging brain from perioperative complications such as postoperative delirium and postoperative cognitive dysfunction. Conventional anesthetic management, which relies primarily on systemic parameters like blood pressure, often overlooks age-related vulnerabilities, including impaired cerebral autoregulation and reduced cerebrovascular reserve. Transcranial Doppler ultrasonography (TCD) offers a valuable solution by providing real-time, noninvasive assessment of cerebral hemodynamics. This modality enables dynamic monitoring of key indicators, such as mean flow velocity and pulsatility index, to detect cerebral hypoperfusion, microembolic events, and blood flow variability-all of which represent significant risk factors for neurological injury. A major advantage of TCD lies in its capacity to guide individualized blood pressure management. By determining each patient's optimal mean arterial pressure, TCD assists clinicians in preventing both hypotension and hypertension, thereby surpassing the limitations of a one-size-fits-all approach. Despite remaining challenges-such as operator dependence and the need for larger-scale validation studies-the future of TCD appears promising. Integration with robotic systems and artificial intelligence is expected to improve automation and reliability. Ultimately, TCD is likely to become an integral component of multimodal intraoperative monitoring, facilitating a data-driven, brain-centered anesthetic strategy that enhances the safety and well-being of elderly surgical patients.
A few studies investigating the perioperative use of lung ultrasound (LUS) have shown loss of lung aeration with decline in diaphragmatic function after general anesthesia. We aimed to measure changes in lung aeration and diaphragmatic functions using LUS in patients undergoing elective laparoscopic cholecystectomy. Forty patients of American Society of Anesthesiologists I/II undergoing elective laparoscopic cholecystectomy under general anesthesia were enrolled. For all patients, LUS examination was performed at 5 time points: preoperative room, after intubation, after deflation of pneumoperitoneum, 30 min after extubation, and 24 h post-extubation. The aeration loss was assessed using the modified LUS score. The diaphragmatic excursion was also evaluated preoperatively, and at 30 min and 24 h post-extubation. A progressive increase in modified LUS score was seen after intubation, after deflation of pneumoperitoneum, 30 min postoperative, after extubation and 24 h post-extubation at postoperative anesthesia care unit (PACU) as compared to preoperative room (P < 0.0001). The maximum modified LUS score was observed postoperatively after 30 min: 8 (5, 10) and 24 h post-extubation in PACU: 8 (4.25, 11.0). No significant change in the diaphragmatic excursion or respiratory complications was observed. Our study found a progressive loss of lung aeration after the induction of general anesthesia in laparoscopic cholecystectomy, extending up to the 24-h perioperative period. However, diaphragmatic excursion remained unchanged. The study also suggests that LUS is a valuable tool for detecting perioperative atelectasis and quantifying the aeration loss.
Breast-conserving surgery (BCS) is increasingly preferred for early-stage breast cancer; however, conventional oncoplastic approaches may not adequately address large or irregular defects. Acellular dermal matrix (ADM), particularly paste-type formulations, offers a potential solution for volume replacement, though evidence regarding safety, integration, and imaging outcomes remains limited. This retrospective review included 74 patients who underwent BCS with intraoperative paste-type ADM between June 2022 and August 2023. MRI and ultrasonography evaluated ADM integration and postoperative morphology, and complications were recorded. Stratified statistical analyses examined associations among imaging results, clinicopathologic characteristics, ADM volume, and outcomes. Paste-type ADM demonstrated safe integration with a low complication rate (4.1%) and no severe events such as infection or extrusion. MRI showed favorable integration grades (G0–G1) in over half of the patients. Ultrasonography identified three post-ADM morphologies: mass-like, cystic, and gap-type, which were associated with initial ADM volume and patient characteristics. No clinical or imaging variables predicted adverse outcomes, and minor complications were managed conservatively. Paste-type ADM is a reliable, safe, and robust option for volume replacement in breast-conserving surgery, with favorable integration confirmed by MRI and ultrasonography. These findings support its broader use in oncoplastic breast surgery, improving reconstructive strategies and facilitating enhanced oncologic and aesthetic outcomes through multidisciplinary imaging surveillance.
Zygomaticotemporal nerve (ZTN) blocks are widely used for temporal procedures, yet incomplete anesthesia may occur when accessory ZTN branches (aZTN) are not accounted for. This study aimed to localize the emergence point of the aZTN (aEP) using the marginal tubercle (MT) as a palpable landmark and to provide in vivo ultrasound depth information relevant to safe, accurate needle placement. We dissected 36 hemifaces from 20, embalmed cadavers to identify the aZTN and measure the aEP relative to the MT and the lateral canthus (LC). In vivo ultrasonography was performed in 23 healthy volunteers to measure the depth from the skin surface to the superficial layer of the deep temporal fascia (sDTF) near the MT. The aZTN was identified in 7 of 36 hemifaces (19.4%), with the aEP clustering within a few millimeters of the MT and showing three vertical patterns (superior, same level, or inferior). Using the LC as a reference, the aEP was located 22.3 ± 2.4 mm lateral and 5.8 ± 2.7 mm superior to the LC. Ultrasonography showed a mean skin-to-sDTF depth of 5.92 ± 0.99 mm. Two specimens demonstrated a bone-emergent aZTN variant (mean MT-bony emergence distance, 4.2 ± 0.1 mm). In conclusion, MT- (and LC-) referenced mapping, combined with ultrasound-derived depth to the sDTF, provides practical anatomical guidance for localizing the aEP and may help refine future MT-centered approaches for addressing accessory ZTN pathways.
Chronic lower-extremity ulcers remain difficult to treat, particularly in patients with metabolic and vascular comorbidities. This multicentre case series describes four patients with chronic lower-extremity ulcers that persisted for at least 6 months despite conventional management. The study evaluated topical application of edelweiss callus culture extract-derived exosomes (P198 Exo-HL FILCORE SB PLUS, Primoris International Co., Ltd., Seoul, Korea) used as an adjunct to standard wound care. All ulcers had persisted for at least 6 months despite conventional management. After wound cleansing and debridement as required, exosomes (0.5-1.0 mL; approximately 0.1 mL/cm²) were applied directly to the wound bed at monthly visits, followed by non-adherent sterile dressings. Clinical progress was documented by serial photography and wound measurements. Arterial and venous Doppler ultrasonography was performed at baseline and at 3-month intervals to assess changes in perfusion and venous reflux. Across the series, all patients demonstrated progressive granulation and re-epithelialisation without treatment-related adverse events. Early size reduction was observed within 15 days in one case, complete granulation and re-epithelialisation occurred within 60 days in another, and near-complete closure was achieved over 5-7 months in a third. In a severe post-infective ulcer for which amputation had been recommended, complete closure was achieved over approximately 6 months. Doppler parameters improved in all cases, including reductions in resistive index and venous reflux time and/or increases in peak systolic velocity. This small, uncontrolled series suggests that topical exosome therapy may be a feasible adjunct in refractory chronic ulcers, with concurrent improvements in clinical healing and Doppler-assessed vascular dynamics. Larger controlled studies are required to define efficacy and optimal treatment schedules.
Thermal energy-based technologies are widely used for noninvasive body contouring; however, quantitative characterization of fascia-level heat propagation in body tissues during multi-wavelength diode laser irradiation remains limited. To assess fascia-level temperature kinetics and regional differences in deep-plane heating during stacking delivery of a multi-wavelength diode laser (Fortra, Classys Inc., Korea) in human cadaver tissues. Three fresh-frozen human cadavers underwent laser irradiation at the abdomen, anterior thigh, and lateral upper arm. Subcutaneous fat thickness was measured by ultrasonography. A single thermocouple was inserted to the muscle fascial plane to record fascia-level temperature over time, and infrared thermography of the exposed measurement field was performed after tissue exposure to identify the local thermographic peak. Deep fascial arrival time, peak fascial temperature, exposed-field thermographic peak temperature, and fascia-level cumulative equivalent minutes at 43°C (CEM43) were evaluated. Regional comparisons were descriptive, with exploratory nonparametric testing. Heat reached the muscle fascia fastest in the anterior thigh (4.9 ± 0.4 s), followed by the lateral upper arm (5.3 ± 0.5 s), and slowest in the abdomen (6.6 ± 0.6 s). These values represent mean ± SD of cadaver-level means. Regional differences in fascial arrival time were exploratory but reached significance (Friedman test, p = 0.049). Exposed-field thermographic peak temperatures were highest in the anterior thigh (70°C-72°C), followed by the lateral upper arm (68°C-71°C), and lowest in the abdomen (65°C-68°C). Under non-perfused ex vivo conditions, fascia-level thermal behavior during multi-wavelength diode laser irradiation varied by anatomical region. Greater subcutaneous fat thickness was associated with slower fascial heat arrival, but did not fully explain regional variation. These findings are descriptive and do not establish volumetric heat distribution, histologic injury, or in vivo safety thresholds.
Goal: To quantitatively assess the impact of incorporating radiologist-defined Region of Interest (ROI) information in training deep learning models for thyroid ultrasound image classification and lesion localization. We compared a conventional convolutional neural network (CNN) trained without ROI information, interpreted through Grad-CAM for attention visualization, to Faster R-CNN and YOLOv2 models trained with radiologist-validated ROI masks. We also introduced an adapted mosaic-based composite input, derived from mosaic augmentation but implemented as fixed 1 2 and 2 2 layouts, to improve class balance and spatial diversity in training. Models trained with ROI guidance achieved higher performance in both localization and classification compared to those trained without ROI. The average classification accuracy increased from about 80 in the baseline CNN to around 85 in ROI-guided models that shows an improvement of approximately 5 percentage points. The mean intersection over union between detected and radiologist-defined ROIs increased from approximately 33 to over 70. The adapted mosaic input further stabilized performance across epochs and improved sensitivity while maintaining comparable specificity. Incorporating radiologist-defined ROI information and structured mosaic inputs significantly improves both diagnostic accuracy and localization precision. These results demonstrate that integrating ROI-guided learning with context-preserving composite inputs provides a reproducible framework for developing reliable AI systems in thyroid ultrasonography.
Exosome-surface enhanced Raman spectroscopy-artificial intelligence platform (exosome-SERS-AI) is an innovative liquid biopsy method that acquires SERS signals from plasma exosomes and analyzes them using deep learning models to diagnose cancer. This study aimed to evaluate whether exosome-SERS-AI could increase the diagnostic accuracy of ultrasonography (US) for suspicious breast lesions. This prospective multicenter study enrolled 500 patients between November 2024 and December 2025. Eligible participants will be women aged ≥ 40 years who will undergo US performed by specialized breast radiologists and have suspicious breast lesions assigned to a Breast Imaging Reporting and Data System (BI-RADS) category 3-5 assessment. A 6 mL whole blood sample was collected from each participant. After plasma separation, SERS, which is highly sensitive to exosomes, was employed to measure Raman signals, and the acquired data were processed using artificial intelligence algorithms. Following sampling, all patients underwent US-guided core needle biopsy for breast lesions classified as BI-RADS category 4 and 5, and 12-months of follow-up US for lesions classified as BI-RADS category 3. Histopathological examination was used as the reference standard for BI-RADS 4 and 5 lesions, whereas stability on 12-month follow-up US was used as the reference standard for BI-RADS 3 lesions. The cohort is expected to have an equal distribution of benign and malignant cases. The following outcome measures were compared between US alone and the combination of exosome-SERS-AI with US: sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve. Enrollment is expected to be completed by 2025, and the study results are expected to be presented in 2026. This prospective multicenter study will evaluate the performance of exosome-SERS-AI compared to US in women with BI-RADS categories 3-5. Participant enrollment is ongoing. ClinicalTrials.gov Identifier: NCT06672302. Registered on November 4, 2024.
There is increasing use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP). While ioPTH has improved cure rate, there is little evidence to suggest effectiveness in primary hyperparathyroidism (PHP) with concordant preoperative localisation. This study aims to determine if ioPTH improves cure rates in such cases. A search of PubMed, Embase, and Cochrane databases identified studies that compared MIP with and without ioPTH, in patients with concordant preoperative imaging of ultrasonography and technetium-99m sestamibi (MIBI) scans. Inclusion criteria were comparative studies between years 2000 and 2023. Analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Primary outcome was the overall cure rate. Secondary outcomes analyzed include operative duration, and conversion to neck exploration. Six studies involving 884 patients were eligible for inclusion. The overall cure rate was 97.3%, higher in those that had ioPTH than without, but this was not statistically significant (98.3% vs 96.0%, P = .18). Operative duration was reported in 2 studies, showing significantly longer duration in the ioPTH group. Overall conversion rate to bilateral neck exploration was 6.64% in the ioPTH group, with a success rate of 4.80%. Use of ioPTH in MIP with concordant localization did not result in statistically significant higher cure rates. Operative time is potentially longer with use of ioPTH. It is difficult to justify the routine use of ioPTH for such cases based on cure rates alone; considerations should also be given to center-specific case volume, surgical experience, and overall cost outcomes.
Background: Although ultrasonography is useful for assessing soft-tissue injuries, its role in classifying tendinous mallet injuries remains underdefined. This study aimed to propose a modified ultrasonographic classification system that combines Wang's classification with additional subtypes emphasising lateral band involvement to improve diagnostic accuracy and prognostic assessment. Methods: A retrospective cross-sectional study was performed on 36 patients with acute closed tendinous mallet injuries of the fingers. All patients underwent ultrasonographic evaluation. Based on the modified classification, Wang Type B was subdivided into Subtype B1 (complete terminal tendon rupture) and Subtype B2 (rupture of either the radial or ulnar slip of the lateral band). Clinical outcomes were recorded at a minimum of 4 months of follow-up. Data on pinch strength, pain, extension lag and functional scores were analysed to compare outcomes across the three injury types. Results: Fifteen Type B1, eight Type B2, and 13 Type C injuries were identified. In all types, as the length of the injured tendon increased, pinch strength relative to the contralateral side was significantly weaker. Additionally, the injured tendon was significantly longer in Type C injuries than in Type B1 and B2 injuries. As the length of the injured tendon increased, pinch strength relative to the contralateral side decreased across all injury types. Nevertheless, the pain score, functional score and initial extension lag did not show statistically significant variations amongst injury types. Crawford criteria showed that Types B2 and C injuries were mostly graded as 'excellent' or 'fair', whereas Type B1 injuries were more often classified as 'poor' or 'fair'. Conclusions: The modified ultrasonographic classification provides a more detailed framework for assessing tendinous mallet injuries by integrating Wang's classification and distinguishing partial lateral band ruptures. This approach enhances diagnostic precision and may improve functional prognostication. Level of Evidence: Level IV (Diagnostic).
Large language model (LLM) proofreaders for radiology reports generate many false positives (FPs) due to the low prevalence of errors. This study aimed to determine whether an optimized LLM framework could improve both precision and cost-efficiency without compromising error detection capability. In this retrospective study, 1000 radiology reports (radiography, ultrasonography, computed tomography, and magnetic resonance imaging; 250 each) were sampled from the Medical Information Mart for Intensive Care III database. Two public chest radiography corpora (CheXpert and Open-i) served as external test sets. Three LLM frameworks were evaluated: single-prompt detector (framework 1); report extractor plus single-prompt detector (framework 2); and extractor, detector, and FP verifier (framework 3). Precision for each framework was assessed using positive predictive value (PPV) and detected errors per 1000 reports. Overall efficiency was estimated using model inference costs and reviewer labor costs. PPV increased from 0.063 (95% CI 0.036-0.101) in framework 1 to 0.079 (95% CI 0.049-0.118) in framework 2 and 0.159 (95% CI 0.090-0.252) in framework 3 (P<.001). Despite improved PPV, detected errors remained stable (detected errors per 1000 reports: 12-14). Human review burden decreased from 192 to 88 reports. Framework 3 also reduced model inference costs to US $5.57 per 1000 reports (vs US $9.72 and US $6.85 for frameworks 1 and 2; 42.6% and 18.5% reductions, respectively). External validation confirmed similar improvements. Qualitative analysis revealed that remaining FPs in framework 3 were largely confined to cases requiring deep clinical context (clinically equivalent rephrasing: 53%; unsupported discrepancy assertions: 43%). By eliminating structural FPs (eg, section mismatches and lexical errors: 0%), the framework effectively shifted the quality assurance burden to a smaller set of ambiguous cases, enabling a targeted human-in-the-loop workflow. The multipass LLM improved the precision and cost-efficiency of radiology report error detection in real-world, low-error prevalence settings. The framework demonstrates the feasibility of synergistic artificial intelligence-radiologist collaboration and provides a cost-effective and scalable approach to artificial intelligence-assisted quality assurance in both radiological practice and research.
As a significant public health issue, research on metabolic dysfunction-associated steatotic liver disease (MASLD) has increased; however, studies exploring the relationship between MASLD and depression are scarce. Thus, our objective was to examine the impact of depression on the subsequent risk of developing MASLD in a large cohort of Korean adults and to investigate the stratification of this association by sex and menopausal status. We utilized a large-scale, population-based cohort study in South Korea, specifically the Kangbuk Samsung Health Study. Hepatic steatosis was diagnosed using ultrasonography. Depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression (CES-D) score, and participants were categorized into no-depression (CES-D < 8, reference), sub-threshold depression (CES-D: 8-15), and depression (CES-D ≥ 16). Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Several interaction and stratification analyses were performed based on sex, age, and menopausal status. During the 1,016,691.99 person-years of follow-up, 170,981 Korean adults (men, 71,796 [42.0%]; women, 99,185 [58.0%]) were followed for a median of 5.4 years (maximum, 12.9 years). In total, 41,932 (24.5%) individuals with incident MASLD were identified. Compared with CES-D < 8, the aHRs (95% CIs) for incident MASLD were 1.03 (1.00-1.06; P = 0.045) for CES-D: 8-15 and 1.06 (1.01-1.11; P = 0.011) for CES-D ≥ 16 in men, and 1.05 (1.01-1.09; P = 0.027) for CES-D: 8-15 and 1.18 (1.13-1.24; P < 0.001) for CES-D ≥ 16 in women (P for interaction = 0.007). In women aged < 45, the risk of developing MASLD increased linearly with higher CES-D scores, indicating a positive association between depressive symptoms and MASLD incidence. Depression was associated with an increased risk of MASLD in both sexes and acted as a potential independent risk factor, particularly in women aged < 45. These findings suggest that screening for MASLD should be considered in younger women with depression.
Achilles tendon rupture (ATR) is a common injury, yet achieving optimal biological healing remains a challenge despite various surgical techniques. This study aimed to investigate the effect of atelocollagen patch augmentation on ATR repair. We hypothesized that atelocollagen patch augmentation would show superior structural and clinical outcomes compared with the standard repair group. In this prospective cohort comparison, 17 patients were enrolled to undergo Achilles tendon repair with atelocollagen patch augmentation, while 18 patients receiving standard open ATR repair served as the control group. A comparison of outcomes between the 2 groups was performed. Outcomes were assessed at 1, 3, 6, and 12 months postoperatively via ultrasonography and clinical measures, including the Achilles Tendon Total Rupture Score (ATRS), visual analog scale (VAS) for pain, and isokinetic muscle strength. Ultrasonographic evaluation focused on the cross-sectional area (CSA) and intratendinous morphology of the repaired tendon. Ultrasonographic evaluation revealed that the atelocollagen patch group had a significantly higher CSA ratio at 1 and 3 months postoperatively (p = 0.026 and p = 0.043, respectively), though this difference was not significant at 6 and 12 months. Morphology scores were also higher in the patch group at 3 and 6 months (p = 0.009 and p = 0.027, respectively). Clinical outcomes, including ATRS, VAS pain scores, and isokinetic muscle strength, showed no significant differences between groups at all follow-up points. No complications, such as rerupture, infection, or allergic reactions, were observed in either group. Atelocollagen patch augmentation provides early structural benefits in tendon healing after ATR repair; however, these benefits did not translate into superior clinical functional outcomes within the 12-month follow-up period. Further large-scale studies are warranted to confirm the long-term clinical efficacy and safety of this technique.
To compare the clinical and radiologic outcomes of incomplete rotator cuff repair with and without human dermal allograft patch in patients with large to massive rotator cuff tears. A retrospective analysis was performed on patients who underwent arthroscopic rotator cuff repair with footprint medialization between March 2013 and September 2022, with a minimum 2-year follow-up for clinical outcomes. Patients were included if they had a full-thickness rotator cuff tear measuring ≥3.0 cm and underwent incomplete repair due to excessive tension after medialization. Propensity score matching (1-to-1) was performed between the patch augmentation and incomplete repair-only groups by preoperative variables, including tear size, chronicity, and tendon quality. Clinical outcomes were assessed via visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and Single Assessment Numeric Evaluation score, along with active range of motion. Structural integrity was evaluated using magnetic resonance imaging at 6 months, ultrasonography at 1 year, and at final follow-up. Among 1129 patients, 174 met the inclusion criteria: 43 received human dermal allograft patch augmentation, and 131 underwent incomplete repair. Propensity score matching produced 36 matched pairs for analysis. At final follow-up, the patch augmentation group had significantly better outcomes, including lower visual analog scale for pain score (0.6 ± 0.9 vs 1.2 ± 1.3, P = .035), and higher American Shoulder and Elbow Surgeons (93.3 ± 4.5 vs 89.0 ± 6.6, P = .002), Constant (89.8 ± 4.9 vs 86.6 ± 7.3, P = .031), and Single Assessment Numeric Evaluation scores (90.6 ± 6.8 vs 84.7 ± 8.4, P = .002). Furthermore, 83.3% of the patch group and 77.8% of the control group achieved the minimal clinically important difference of 9.1 for the American Shoulder and Elbow Surgeons score. Both groups showed significant range of motion improvement with no intergroup difference. Magnetic resonance imaging at 6 months showed healing failure in 8.3% of the patch augmentation group versus 27.8% in the incomplete repair group (P = .063). At the final follow-up, retear rates reached 33.3% in the incomplete repair group but remained at 8.3% with patch augmentation (P = .009). Human dermal allograft patch augmentation in patients with large to massive rotator cuff tears led to lower retear rates and superior clinical outcomes compared with incomplete repair alone. Level III, retrospective comparative case-control study.
Supermicrosurgery, defined as the anastomosis of vessels smaller than 0.8 mm, represents a significant evolution in the field of reconstructive microsurgery. This review explores its technical foundations, clinical applications, and future directions, with a particular focus on lower extremity reconstruction. By utilizing perforator-to-perforator anastomosis and thin flap techniques, supermicrosurgery allows for reduced donor morbidity, minimized risk to major vessels, and improved aesthetic and functional outcomes. The integration of high-frequency ultrasonography and advanced microsurgical tools has enhanced preoperative planning and intraoperative precision. Despite a steep learning curve, supermicrosurgery is increasingly applied in oncologic, traumatic, ischemic, and diabetic foot reconstructions. Continued innovation in imaging, instrumentation, and robotic assistance suggests a promising future for this subspecialty.
According to GLOBOCAN 2022, China accounts for the highest number of new breast cancer cases and the second highest number of breast cancer deaths globally. As part of the national public health initiative, a population-based breast cancer screening program was launched in 2009, initially targeting rural women and later expanded to include rural and urban women aged 35-64 years from 2019 onwards. The screening approach in China relies on ultrasonography (US) and mammography. Although mammography is an evidence-based standard, US plays a major role due to limited mammography resources and a high prevalence of dense breasts. Understanding the real-world implementation of breast cancer screening programs in China may provide valuable insights for breast cancer screening practices in other countries. This review summarizes the implementation and achievements of China's breast cancer screening programs, evaluates the role of US within the current screening framework, and discusses the key challenges and future directions.
Nephrolithiasis is commonly observed in patients with gout; however, the role of asymptomatic hyperuricemia in stone formation remains unclear. This study evaluated the association between serum uric acid levels and nephrolithiasis in a large health screening population. We conducted a cross-sectional analysis of 31,198 Korean adults who underwent health checkups between 2010 and 2020. Clinical parameters included anthropometric measures, blood pressure, serum uric acid, renal and hepatic function markers, lipid profiles, glycemic indices, inflammatory biomarkers, serum calcium, and vitamin D3 levels. Nephrolithiasis was defined as the presence of at least one renal stone ≥5 mm detected by ultrasonography and/or kidney-ureter-bladder radiography. Hierarchical logistic regression models (unadjusted, age- and BMI-adjusted, and fully adjusted) were used to assess associations separately in men and women. Median serum uric acid concentrations were 6.0 mg/dL in men and 4.4 mg/dL in women. In men, higher serum uric acid levels were associated with nephrolithiasis across hierarchical models. In fully adjusted analyses, serum uric acid remained significantly associated with stone prevalence, and men in the highest uric acid quartile (≥6.9 mg/dL) had higher odds compared with those in the lowest quartile (adjusted OR: 3.546; 95% CI: 1.240-10.144). No statistically significant association was observed in women. Higher serum uric acid levels were associated with nephrolithiasis in men but not in women in this cross-sectional analysis. These findings contribute to the epidemiologic understanding of sex-specific differences in stone risk; prospective studies are needed to clarify causality and potential clinical implications.