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Advances in the realism of synthetic media created with generative adversarial networks (GANs), diffusion models, and face manipulation tools has created an increased demand for well-established deepfake detection systems that can detect many different types of manipulation artifacts. However, most single model deepfake detectors are not very robust because they rely on specific forensic cues and do not adapt well to shifts in how synthesis occurs. We present DeepFakeBuster as a confidence-calibrated adaptive ensemble for deepfake image detection by fusing together heterogeneous deep learning models built around detecting complementary forensic cues e.g., spatial inconsistencies, boundary artifacts, noise residuals, semantic consistency, and frequency-domain features. In contrast to traditional ensemble approaches that use static averaging of detector outputs, our proposed framework utilizes reliability aware adaptive fusion where the contribution of each detector to the fused output is adjusted dynamically through the use of reliability priors derived from validation and input-specific confidence estimates. Our experimental evaluation on a dataset comprised of 192,000 authentic and manipulated images shows that our ensemble significantly outperforms both individual constituent detectors as well as static fusion baselines, with an overall accuracy of 97.8% for the evaluated conditions. Additionally, an interpretable forensic analysis module provides visual and quantitative indicators associated with manipulation-sensitive regions. The findings suggest that confidence-aware heterogeneous ensemble learning represents a promising direction for robust deepfake detection.

Spinal Stereotactic Body Radiotherapy (SBRT) is among the most complex treatments currently delivered. A multi-centre dosimetry audit evaluated the accuracy of spinal SBRT treatment delivery and the impact of different dose reporting modes (DRM). The audit used anthropomorphic phantoms containing alanine in the Planning Target Volume (PTV) and Gafchromic™ EBT3 film in the axial plane, with a combination of onsite and remote audits due to Covid travel restrictions. Centres used their local planning protocol and technique to create a clinically acceptable treatment plan, following national guidance. Fifty-nine plans from 44 treatment planning systems at 41 centres were analysed. The mean PTV dose difference was 1.2% [-6.5-8.5%] with alanine and 1.0% [-7.0-8.5%] within the 100% isodose for film. Alanine measurements were, on average, higher than the calculated dose for all plans, but lower for the Dw,m specifically. For alanine and film, the choice of DRM was statistically significant.The mean distance to agreement and average Centre of Dose difference for films was 0.82 mm [0.35-1.7 mm] and 0.78 mm [0.1-1.7 mm] respectively. The choice of DRM was not significant for either metric. This audit demonstrated that the majority of centres are delivering spinal SBRT consistently, with acceptable dosimetric and geometric accuracy. However, it also highlighted the challenges of verifying doses reported in Dm,m and Dw,m, as there was a statistically significant difference with the measured dose when stratified by DRM.

Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder with fatal consequences for maternal and foetal health, including placental abruption, foetal growth restriction, and foetal death. Its global prevalence is estimated at 2-8%. While many aspects of PE pathogenesis are well-characterised, those pertaining to its immunology are less well understood. This review examines three interconnected aspects of the maternal immune microenvironment-toll-like receptors (TLRs), B1 cells, and feto-maternal microchimerism-and their role in PE pathogenesis. While each has been studied independently, no prior review has examined these three components as an interacting system. TLRs function as endogenous danger-molecule sensors, with pathological activation of TLR7 and TLR9 facilitating overzealous pro-inflammatory signalling, endothelial injury, and defective spiral-artery remodelling. B1 cells differentiate into a pathogenic phenotype during pathological pregnancies, secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AA), associated with vasoconstriction and hypertension. Feto-maternal microchimerism generally serves to induce maternal immune tolerance towards foetal antigens. In PE pregnancies, increased trafficking of foetal cells has been shown to release cell-free foetal DNA into the maternal circulation, resulting in excessive activation of TLR-mediated sterile inflammation. This review explores the evidence for how these three factors may interact to create a positive feedback loop.

Sight loss will affect an estimated 2.7 million people in the UK by 2030 and is associated with substantial reductions in quality of life, mobility, independence, and poorer mental health. Our own research has demonstrated that depressive symptoms are highly prevalent among blind and partially sighted people yet often remain unrecognised and untreated. To effectively disseminate our research to healthcare professionals, we involved members of the public with lived experience of sight loss in an art installation. The aim of this project is to evaluate the feasibility and value of using such an arts-based approach as a method for involving blind and partially sighted individuals in dissemination, and here we reflect on what all stakeholders learnt from the process. We recruited eight blind and partially sighted storytellers to share themes from our research using narratives of their own lived experience, focusing on the emotional impact of sight loss and professional interactions. Audio-recorded stories and accompanying portraits were developed into Eight Voices in Darkness, a sound installation designed to reflect both the literal and metaphorical darkness associated with vision impairment and depression. The installation was exhibited publicly over three days alongside workshops for eyecare professionals and mental health practitioners. Visitor and participant feedback (n = 92) was analysed using Pendleton's reflective framework to explore what went well, what did not, and what was learned. Visitors consistently reported an enhanced understanding of the mental health consequences of sight loss, valuing the authenticity, emotional resonance, and individuality conveyed through the artistic format. Many indicated intentions to adopt more empathetic, patient centred practices, improve accessibility, and initiate conversations about mental health. Storytellers highlighted the value of being heard and connecting with others' experiences. Researchers and the artist reflected on the strengths of partnership with the charity, the power of the immersive format, and challenges relating to managing expectations. The process generated important insights into involving the public in dissemination through art, including ethical editing, audience preparation, and sustaining involvement. Involving people with lived experience in arts-based dissemination offers a powerful and engaging method for disseminating research findings to professionals to improve healthcare. Future work should refine practical elements and enhance coproduction. Many people in the UK live with sight loss, which can make every aspect of everyday life harder, including tasks like reading and mobility. Our research showed that sight loss can also impact mental health, and that many people with sight loss do not get the emotional support they need, partly because some eyecare professionals do not realise how common mental health problems are among this group. Our aim was to involve patients and the public, specifically blind and partially sighted people, in sharing our research effectively so that vision-related professionals and the public could learn how sight loss affects mental health. We created an art project called Eight Voices in Darkness. Eight individuals talked about the key topics noted in our previous body of research on sight loss and mental health: how their sight loss affects their feelings, challenges faced, and support required. Their stories were recorded, along with a portrait photo of each person. An artist turned these stories into an art installation. In a quiet, dark theatre, visitors could sit and listen to short parts of each person’s story. Over three days, almost 200 people visited. Many said the experience helped them understand sight loss in a new and powerful way and they would try to be more kind, patient, and willing to talk about mental health in the future. The storytellers also said it felt good to be listened to. This project showed that art is a valuable mechanism to involve individuals with lived experience in sharing research with professionals and the public to improve healthcare. Research teams must consider practical and ethical considerations when individuals’ stories are harnessed to share research findings and allow sufficient time and resources.

While defocus incorporated multiple segments (DIMS) spectacle lenses are clinically proven effective in slowing myopia progression, the long-term, real-world patient experience is poorly understood. This study aimed to provide both quantitative and qualitative analyses of the wearer experience in a long-term cohort of DIMS wearers. This retrospective, convergent parallel mixed-methods study included 63 former child participants (now aged 17-23 years) who participated in the previous DIMS spectacle lenses clinical trial 8-10 years earlier. Data were collected 2 years after the final clinical trial concluded. A quantitative online questionnaire assessed wearer experience, while in-depth, semi-structured phone interviews explored the lived wearer journey. Predictors of satisfaction were identified using multiple linear regression and qualitative transcripts were analysed using a systematic thematic approach. Quantitative analysis revealed high satisfaction, with 88.9% of wearers satisfied or very satisfied and 90.4% believing in the efficacy of DIMS spectacle lenses. Regression analysis identified Maintenance and Durability as the strongest predictors of long-term satisfaction, alongside positive perceptions of appearance (adjusted R2&#x2009;=&#x2009;0.50, p&#x2009;<&#x2009;0.001). Qualitative analysis revealed a patient journey defined by parent-driven initiation, a manageable sensory adaptation period and strong perceived efficacy based on personal experience. However, only one-third of participants had continued DIMS use; a decision driven overwhelmingly by the high cost of the spectacles. DIMS spectacle lenses provide a highly positive long-term wearer experience. However, the high cost of the spectacles creates a dominant socioeconomic barrier to treatment continuity, highlighting a critical gap between clinical success and access outside the trial setting.

The accuracy of predicting ice phase changes on transmission lines is influenced by the interaction of various meteorological factors. However, existing models, which ignore the interactions between multiple physical fields, result in insufficient prediction accuracy and other issues. To address this, a multi-physical field coupling ice phase change prediction model has been developed. First, by setting up multi-physical field coupling boundary conditions, the model simulates various meteorological conditions to create a three-dimensional geometric model of ice phase changes on transmission lines. Then, different kernel functions are selected to verify the reliability of the support vector machine (SVM) prediction algorithm. Finally, the multi-physical field coupling model is used for ice phase change prediction experiments, and its effectiveness is verified through comparison with actual measurement data and SVM prediction data. The experimental results show that the model has an average prediction accuracy of 98.12% and an average precision of 98.54%, significantly improving upon traditional methods. This model provides high-precision decision support for the early warning and protection of ice disasters on transmission lines, making it highly valuable for engineering applications.

Standard of care RPT may result in dose-limiting side effects of the salivary glands include sialadenitis and xerostomia that are inconsistent with outcomes from external beam for equivalent ADs. This work develops a parametrizable 'Macro-to-Micro' (M2&#x3bc;) model that demonstrates the consideration of small-scale dosimetry in comparison to conventional methods that typically assume uniform voxel or organ-level uptake. Anatomical features of the salivary gland are represented by annular structures (a centralized branching network of ducts, including excretory, lobar, interlobular) and small-scale voxels (intralobular ducts and acinar cells) with dimensions set to reproduce ex-vivo murine histopathology measurements and scaled up in size for extrapolation to humans. Simulations were performed by scoring and recording S-value histograms to the target ductal and acinar cells, for two beta emitters (177Lu, 131I) and one alpha emitter (225Ac). Four idealized activity distributions were created to assign activity to surface and volumes of the annuli, and GEANT4 v11 was used for radiation transport calculations. Comparisons against whole gland uniform spherical self-dose S-value calculations were conducted to validate the radiation transport and to highlight differences between M2&#x3bc; and conventional dosimetry approaches. Analyses for both models showed greater S-value variation in comparison to the homogeneously distributed activity S-value calculation. The most notable result was that the calculated S-values differed between different branches, depending on the geometric size of the annuli. For the surrounding acinar cells, S-values from ductal cells decreased as a function of distance from the branching structures. High variability of S-values, depending on ductal cell dimensions as well as within the acinar cell distribution of the salivary gland highlights the potential clinical utility of small-scale approaches to RPT salivary gland dosimetry, contingent on clinical translation and validation. To this end, future work should further refine the model and incorporate small-scale activity distributions from pre-clinical and translational studies.

Community Advisory Boards (CABs), adopted from the HIV response, have become the most institutionalised form of community engagement in tuberculosis (TB) research. However, little work has examined the historical-political processes shaping their development or how these dynamics influence community participation in TB research governance. This qualitative study draws on 28 semi-structured interviews with TB advocates, community engagement practitioners, and TB CABs representatives across countries and levels of global health governance. Using the metaphor of "space" drawn from participatory development, the analysis examines how CABs have emerged, evolved, and operated within TB research over time. CABs were initially mobilised by HIV activists to create spaces within TB research, as broader TB social movements had proven difficult to cultivate. As the CAB model became increasingly institutionalised as a formal engagement mechanism, they were intended to become sites for nurturing TB advocates and enabling their participation in research decision-making. However, sustaining these activist ambitions remained precarious as TB CABs were under-resourced and their knowledge transmission emphasised the technical over the radical, narrowing engagement into more operational and manageable forms. Within these tightly managed spaces, the difficulty of demonstrating the value of CABs reflects how the struggle for power redistribution has shifted from the politics of representation to that of evidence. TB CABs embodies communities' agency and creativity to insert and assert their voice within a biomedical landscape that structures their participation unequally. Reframing CABs as political and relational spaces rather than instrumental mechanisms may strengthen their transformative potential within TB research and policy.

Microfluidic devices enable the study of cellular properties in a highly controlled environment while allowing close observation. One important aspect of a plant cell's environment is the influence of neighboring cells on cell growth through chemical signals and mechanical forces. However, while the use of microfluidics in plant cell biology has expanded in recent years, very few systems provide cell-cell contact together with long-term growth and imaging. Here, we develop a microfluidic device that uses arrays of cylindrical cups to gently capture and confine multiple protoplasts into stable aggregates, generating a constrained microenvironment with cell-to-cell contact. The device addresses a key challenge wherein aggregating cells can create hypoxic, media-starved environments that rapidly lead to cell death. The porous micro-post design supported sustained media flux through confined aggregates, reducing limitations typically associated with dense cell clustering. The platform maintained sterile culture conditions and enabled convenient media switching, as demonstrated by hormone treatment and salt-stress assays. Protoplasts from Arabidopsis thaliana and Zea mays remained viable for more than two weeks. Over this period, cells showed growth, cell wall formation, and cell divisions, with divisions occurring significantly more frequently in crowded aggregates than in isolated cells. This aggregates-on-chip platform provides a controlled and live-imaging system for studying how cell-cell contact and microenvironmental cues influence plant protoplast behavior. By integrating physical confinement, continuous perfusion, and chemical perturbation, the device offers a technical advance for long-term studies of plant cell growth, regeneration, division, and stress responses.

The coronavirus disease 2019 (COVID-19) pandemic created ethical and legal tension for healthcare workers (HCWs), who had to balance professional obligations with personal safety, family responsibilities and resource limitations. The concept of 'duty to care' re-emerged as a contested ethical construct during periods of workforce vulnerability and healthcare scarcity. This article examines the ethical and juridical dimensions of HCWs' duty of care during the COVID-19 pandemic, focusing on the South African constitutional framework, occupational health obligations and professional regulation, and whether this duty is absolute or subject to reasonable limits. The discussion is situated within South Africa's healthcare response to the COVID-19 pandemic and the ethical expectations placed on clinicians in high-risk and emergency settings. A narrative review was conducted using PubMed, Google Scholar and grey literature. Sources included peer-reviewed ethical analyses, legal frameworks and policy documents. A thematic synthesis analysed moral theory, legal duty, reciprocity and public health ethics. The duty of care is substantial but not limited. South African law supports coexistence of rights rather than hierarchical obligations. Ethical analysis shows that proportionality, reciprocity and reasonable risk mitigation conditions professional duty. Employers must ensure adequate protection, transparent triage systems and psychosocial support. Failure to ensure reciprocity risks moral coercion and workforce attrition. The pandemic highlighted the need to define the thresholds where professional obligation yields to legitimate self-protection. The duty of care should be reconceptualised as a conditional, relational obligation grounded in constitutional values and public health ethics, with clear risk thresholds and enforceable reciprocal protections. This article contributes to post-COVID-19 pandemic ethics literature by clarifying between the duty to treat, care and serve, proposing a Decatrad of operational reforms, reframing the duties as conditional, reciprocal and legally bounded.

The prevention of medical errors depends on effective communication and teamwork between nurses, yet traditional nurse call systems create inefficiencies that result in higher staff workloads. Further research is needed to evaluate how digital health care technologies affect nursing workflows and whether they contribute to staff workload. This study aimed to evaluate whether a smartphone app using Bluetooth Low Energy (BLE) Mesh-based signal communication could enhance nurse-to-nurse communication, decrease response times, and improve teamwork as measured by the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ). We conducted a between-subjects (independent groups) interventional study on an acute care ward, with 3 intervention days (BLE Mesh app use) and 3 nonintervention days administered on alternating days. Thirty nurses (15 per condition) participated, with no nurse contributing observations to both conditions in the final analysis. Response times were tracked, and the T-TPQ was used to evaluate Situation Monitoring and Mutual Support perceptions at the end of each shift. The app shortened the total response duration from a per-nurse median of 38.5 (IQR 31.0-58.5) seconds in the control condition to 19.5 (IQR 18.5-23.5) seconds in the intervention condition (n=15 per condition; Mann-Whitney U test=217.5; P<.001; rank-biserial r=-0.93). The app reduced the time it took for staff to confirm nursing actions, search for items, and request care assistance. A total of 40 nurses participated, generating 48 questionnaire responses; after exclusions, 30 nurses (15 per condition) were analyzed. T-TPQ confirmed significant improvements in Situation Monitoring (3.04 vs 3.39; P=.001) and Mutual Support (3.01 vs 3.31; P=.003). Post hoc power ranged from 87% to 92% (Cohen d>1.0), supporting the interpretability of these results. BLE Mesh technology reduces basic signal communication delays, which shortens nurse response times and enhances team performance through improved Situation Monitoring and Mutual Support, according to our research. The study demonstrates how this technology delivers functional benefits that enhance nursing communication to produce superior team-based care outcomes.

Real-world evidence (RWE) plays an expanding role in regulatory, health technology assessment (HTA), and lifecycle decision-making, prompting a rapid increase in guidance documents intended to support its generation and use. This commentary argues that additional guidance is not redundant; rather, it is necessary to sustain consistency, credibility, and confidence as RWE methods become more specialized and operationally complex. Recent advances, including pragmatic and registry-based trials, hybrid randomized-real-world designs, external control arms, artificial intelligence and machine learning applications, digital health data, synthetic controls, and data tokenization, have outpaced the scope of many existing frameworks. Although recent reporting initiatives and international harmonization efforts have improved transparency and reproducibility, important gaps remain in implementation-focused guidance on issues such as causal inference, dynamic borrowing, linkage validation, algorithm auditability, reproducibility, and distributed data environments. The need is further amplified by heterogeneity across regulatory and HTA agencies, where differing evidentiary expectations can create uncertainty and inefficiency, and by the limited availability of context-appropriate guidance for low- and middle-income countries, where structural data and infrastructure constraints may hinder RWE generation and use. Future progress should emphasize targeted, modular, and potentially "living" guidance that is updated as methods evolve, while also improving uptake of existing frameworks through clearer reporting expectations, education, and stakeholder collaboration. More guidance, when focused and implementation-oriented, can better translate methodological principles into decision-grade RWE.

This study aimed to create machine learning algorithms using the Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) Database that can predict readmissions or post-discharge mortality within 30 days of cardiac surgery. Data from 54 public and private Australian hospitals from January 2017 to December 2021 were included in this study. Only coronary artery bypass grafting (CABG), valvular heart surgery, or aortic surgery cases were included for analysis. The primary outcome of this study was the performance of our machine learning models measured using sensitivity, specificity, positive and negative predictive values, accuracy, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve. Of the 178,252 patients in the database, 61,721 CABG, valvular heart surgery, and aortic surgery cases were identified. The incidence of 30-day readmission or post-discharge mortality was 10.3% (6,351/61,721). The best-performing model was the deep neural network (AUROC, 0.615). A calibrated version of this model predicted one in five patients at higher risk of readmissions or post-discharge mortality compared with the lowest risk group (2.4&#xd7; increase in incidence rate and an odds ratio of 2.7 [2.2-3.2]). Using machine learning, models developed from the Australian ANZSCTS Database demonstrated limited predictive ability for readmissions or post-discharge mortality. The ANZSCTS Database may require additional informative variables before models become sufficiently accurate. Individual hospitals or small hospital networks may be best placed to incorporate routinely collected information (such as electronic medical records) alongside ANZSCTS data to create more accurate models.

Highly repetitive short arms of human acrocentric chromosomes have remained largely inaccessible to studies of meiotic recombination and de novo mutation. Integrating long-read and complementary sequencing approaches, we created 156 phased short arms and assessed 107 transmissions from 23 samples in a four-generation human pedigree. We observed a significant depletion of p-arm allelic recombination, although one ectopic recombination was identified between chromosomes 13 and 21, mediated by a large segmental duplication near the SST1 array. In contrast, 18 maternal-biased q-arm allelic recombination events were significantly enriched near the centromere. Relative to autosomal euchromatin, acrocentric short arms showed a 10-fold higher single-nucleotide variant rate, with a distinct mutation spectrum marked by reduced C>T but increased C>G and A>C mutations. These findings suggest that acrocentric sequence composition biases and limited allelic recombination contribute to an elevated mutation rate and promote distinct mutational processes linked to mismatch repair defects and oxidative DNA damage.

Transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (PAR) with an enlarged left ventricular outflow tract (LVOT) remains challenging due to inadequate anchoring. A 74-year-old woman with severe PAR and an enlarged LVOT (perimeter 93.7 mm), deemed high risk for surgery, underwent TAVR using a 30-mm self-expanding valve. A modified noncoronary sinus pivot implantation (NCPI-plus) technique was performed, deploying the valve above the virtual annular plane on the noncoronary sinus side to create a supra-annular pivot point. Postprocedural imaging and 12-month follow-up confirmed stable anchoring and excellent valve function without regurgitation. The NCPI-plus technique provides stable anchoring for TAVR in PAR patients with dilated LVOT, by using the supra-annular pivot point on the noncoronary sinus side as its core design to prevent downward valve displacement during deployment. The NCPI-plus technique offers a feasible anchoring strategy for TAVR in PAR patients with enlarged LVOT.

Bacteria are frequently attacked by viruses, known as phages, and rely on diverse defence systems to survive. While phages can evade defences by covalently modifying their DNA, these non-canonical nucleobases create molecular signatures that bacteria can exploit. Here, using structure-guided discovery, we identified two widespread families of anti-phage DNA glycosylases, Dag1 and Dag2. Although DNA glycosylases are classically associated with DNA repair, Dag1 and Dag2 act as antiviral effectors that selectively target phages carrying modified guanine bases. Guided by the conserved glycosylase fold, we uncovered numerous defence-associated glycosylases that collectively form a diverse repertoire of enzymes targeting chemically modified phage DNA. We further identified a distinct glycosylase superfamily that protects against phages carrying modified thymidine bases. Together, these findings establish DNA glycosylases as a versatile class of bacterial immune proteins and highlight structure-guided discovery as a powerful strategy for uncovering hidden antiviral defences.

Cancer is one of the most hazardous illnesses, which has been increasing the rate of mortality. In both men and women, lung cancer is recognized as the most widespread form of malignancy. The formation of unregulated cell growth in the lungs creates lung cancer. The earlier stage identification of lung cancer is complex, owing to its asymptomatic nature and long processing time. To solve these difficulties, a novel hybrid approach named Kronecker Mobile Forwarded Harmonic Network (KMFHNet)-based lung cancer detection is devised in this research. The proposed model integrates MobileNet for efficient spatial feature extraction, Deep Kronecker Network (DKN) for higher-order feature interaction, and forward harmonic analysis for enhanced frequency-domain representation. The CT lung image is provided as the input, and noise reduction is effectively achieved using the Sobel filter. Moreover, the lung lobes from the images are segmented with the utilization of the proposed Tversky- Dense-Res-Inception Net (DRI-Net), where the Tversky Similarity modifies the loss function. Image augmentation, such as sharpening, resizing, zooming, and shifting, is utilized for increasing the image size. After extracting the essential features, KMFHNet is employed to detect lung cancer. The effectiveness of the proposed model for lung cancer detection is validated by its high-performance metrics, including 92.55% accuracy, 91.38% recall, 90.89% precision, and an F1-score of 89.79%. The robustness and reliability of the KMFHNet framework for early-stage lung cancer identification are confirmed by these results.

Bird feathers serve numerous essential functions, with water repellency being particularly critical, as many other feather functions depend on remaining dry. Despite its importance, significant gaps remain in our understanding of the mechanisms underlying feather water repellency. This property arises primarily from feather microstructure. Feather morphology varies widely among bird species. However, the functional consequences of this variation for feather wettability remain poorly understood. Advances in computer-aided 3D modeling enable us to investigate such structure-function relationships with unprecedented precision. In this study, we created 3D feather models from micro-computed tomography scans of a Seaside Sparrow feather and systematically altered its morphology, specifically barbule density, to observe how feathers interact with water droplets using computational fluid dynamics simulations. We quantified the spatio-temporal distribution of droplet behavior, measured spreading radii during interactions, and assessed final contact angles for feathers with varying barbule densities. We validated our simulation results with barbule-density estimates and static contact-angle measurements on contour feathers from four New World sparrow species, including the Seaside Sparrow, spanning a gradient in water exposure. Together, computational and experimental results demonstrate that higher barbule density reduces water repellency. Collectively, these findings highlight how feather microstructure directly governs feather wettability.

Peri-implant soft tissue thickness is a critical determinant of esthetic outcomes and long-term implant stability, particularly in the anterior maxilla. A 28-year-old systemically healthy male presented with a missing maxillary central incisor and a thin gingival biotype. Following implant placement, a modified split flap-roll technique was performed. The surgical approach involved splitting the flap into epithelial and connective tissue components, followed by mobilization and rolling of the connective tissue into a labial pouch to enhance tissue thickness. Soft tissue thickness increased from less than 2&#xa0;mm pre-operatively to approximately 4&#xa0;mm at 3 months, with stable maintenance of approximately 3&#xa0;mm at 9 months. Improved gingival contour, emergence profile, and uneventful healing were observed throughout the follow-up period. The modified split flap-roll technique may serve as an alternative approach for peri-implant soft tissue augmentation. Within the limitations of this case report, favorable clinical outcomes were observed; however, further controlled studies are required to establish its predictability and clinical effectiveness. Modification of an existing roll flap technique Eliminates the need for a secondary donor site Allows soft tissue augmentation using a pedicled approach May provide an alternative option in selected cases KEY POINTS: The modified split flap-roll technique increased peri-implant soft tissue thickness from less than 2&#xa0;mm to approximately 4&#xa0;mm at 3 months, with stable maintenance at 9 months. The technique utilizes a pedicled connective tissue component, eliminating the need for a secondary donor site and potentially reducing patient morbidity. This approach may provide an alternative soft tissue augmentation option for selected esthetic-zone implant cases. Dental implants placed in the front part of the upper jaw require healthy and adequate gum tissue to achieve a natural appearance and long-term stability. In some patients, the gum tissue around an implant is thin, which can affect both esthetics and treatment outcomes. This case report describes a modified surgical technique used to increase the thickness of the soft tissue around a dental implant without taking tissue from another area of the mouth. A 28-year-old patient with a missing upper front tooth and thin gum tissue underwent implant placement combined with a split flap-roll procedure. During surgery, tissue from the same surgical site was carefully separated, rolled, and repositioned to create additional volume around the implant. The soft tissue thickness increased from less than 2&#xa0;mm before treatment to approximately 4&#xa0;mm after 3 months and remained stable at approximately 3&#xa0;mm after 9 months. Healing was uneventful, and the final esthetic result showed improved tissue contour and implant appearance. This technique may offer a less invasive alternative to conventional connective tissue graft procedures while avoiding the discomfort associated with a second surgical donor site.