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Based on upper echelons theory, this paper analyzes the influencing mechanism between executives' self-compassion attributes (common humanity, self-kindliness, mindfulness,) and firm performance, and the mediator effect of firm strategic inertia. The empirical analysis of the sample data of 332 valid questionnaires from the architectural design industry in China shows that: (1) the common humanity and mindfulness of executives positively promote firm strategic inertia; (2) the self-kindliness dimension of executives inhibits firm strategy inertia; (3) strategic inertia hinders the development of firm performance in highly variable industries; (4) strategic inertia plays a partial mediating role between executive self-compassion attributes and firm performance.

Idiopathic scrotal calcinosis (ISC) is a rare, benign condition characterized by painless, calcified nodules within the scrotal dermis. Although typically asymptomatic, progressive growth and cosmetic concerns often lead patients to seek surgical intervention. We report a 35-year-old male with multiple asymptomatic scrotal nodules progressively enlarging over 3 years. Physical examination revealed firm, subcutaneous nodules ranging from 2 to 20 mm. Laboratory investigations, including serum calcium, phosphate, and parathyroid hormone, were unremarkable. Histopathological examination confirmed the diagnosis of ISC, revealing basophilic calcified deposits within a fibrous stroma without cystic epithelial lining, consistent with dystrophic calcification. A "pinch-and-punch" excision technique was performed under regional anesthesia supplemented by tumescent local infiltration. Individual nodules were elevated by pinching the overlying scrotal skin, followed by targeted removal using 2-4 mm disposable biopsy punches. No sutures were required. The procedure was completed with minimal bleeding and no intraoperative or postoperative complications. Complete epithelialization occurred within 1 week via secondary intention. At 3-month follow-up, no recurrence was observed and the patient reported high satisfaction with the aesthetic outcome. The pinch-and-punch excision technique-distinguished by its combination of the tissue-elevation pinching maneuver, tumescent infiltration for hydrodissection, and sutureless wound management-is a safe and cosmetically favorable approach to ISC, particularly for patients with multiple nodules. Histopathological confirmation remains essential. Further prospective studies with longer follow-up are warranted.

Thyroid dysfunction and Helicobacter pylori (H. pylori) infection are both highly prevalent in Pakistan. Several studies have proposed a potential immunological link between H. pylori infection and autoimmune thyroid disease, though evidence remains controversial. Given the cross-sectional design of this study, causal relationships cannot be inferred; the objective was to determine whether a statistically significant association exists between H. pylori infection and thyroid dysfunction in adults attending a tertiary care hospital in Karachi, Pakistan. A cross-sectional study was conducted over four months at Civil Hospital Karachi. Adult patients presenting with gastrointestinal symptoms were enrolled using consecutive sampling. H. pylori infection was confirmed using an immunochromatographic stool antigen test. Thyroid dysfunction was assessed by measuring thyroid-stimulating hormone (TSH) levels using the Electrochemiluminescence Immunoassay (ECLIA) technique, with normal TSH defined as 0.4-4.0 mIU/L; values outside this range indicated thyroid dysfunction. Statistical analysis was performed using SPSS version 23.0, applying chi-square tests and binary logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported; significance was set at p&#x2009;<&#x2009;0.05. Sample size was calculated based on an estimated H. pylori prevalence of 50% with a 95% confidence level and &#xb1;&#x2009;6% margin of error, yielding 267 participants. A total of 267 participants were included. Thyroid dysfunction was identified in 19.3% of participants based on abnormal TSH levels. Although thyroid dysfunction was observed at a numerically higher frequency among H. pylori-negative participants, this difference was not statistically significant (OR&#x2009;=&#x2009;1.376, 95% CI: 0.747-2.537, p&#x2009;=&#x2009;0.305). H. pylori infection was more prevalent in male participants. Constipation was prevelant in hpylori positive patients but neither constipation nor diarrhea showed a statistically significant association with H. pylori infection. In this cross-sectional study, no statistically significant association was observed between H. pylori infection and thyroid dysfunction. These preliminary findings do not support a significant association between the two conditions in this population; however, given the study's methodological limitations, they are insufficient to make a definitive recommendation regarding routine thyroid screening in H. pylori-infected patients. Larger prospective studies incorporating thyroid autoantibodies, fT3/fT4 levels, and H. pylori strain typing are needed before any firm clinical conclusions can be drawn. Not applicable.

Nodular fasciitis rarely arises from the masseter muscle and is frequently misdiagnosed as soft tissue sarcoma. A 43-year-old male presented with a rapidly enlarging, painless swelling below the right mandibular angle over 2 months. Clinical examination revealed a firm, mobile mass without skin fixation or lymphadenopathy. Ultrasound and magnetic resonance imaging were performed, followed by fine-needle aspiration cytology and excisional biopsy. Ultrasound demonstrated a well-defined, hypoechoic lobulated lesion (23&#x2009;&#xd7;&#x2009;13&#x2009;&#xd7;&#x2009;8&#x2009;mm) within the superficial masseter, showing mild internal vascularity and no bone involvement. Magnetic resonance imaging revealed an iso- to slightly hypointense T1 signal, hyperintense T2/ short tau inversion recovery signal, and homogeneous postcontrast enhancement with smooth margins, features suggestive of a benign myofibroblastic lesion. Excisional biopsy confirmed the diagnosis of nodular fasciitis. This case indicates that masseteric nodular fasciitis, a rare benign lesion, may present with imaging features of small size, smooth margins, homogeneous enhancement, and mild vascularity in the context of trauma history. Recognition of this self-limited myofibroblastic proliferation can prevent unnecessary radical surgery and guide conservative management.

Perimenopause is associated with an increased risk of depressive symptoms, potentially related to hormonal fluctuations during the menopausal transition. Although hormone replacement therapy (HRT) is widely used for vasomotor symptoms, its potential effects on depressive symptoms remain uncertain. This meta-analysis evaluated the association between HRT and depressive symptom severity in perimenopausal women. We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to December 23, 2025 for randomized controlled trials evaluating HRT in perimenopausal women with depressive symptoms. Eligible studies included comparisons of HRT versus placebo, HRT versus HRT combined with antidepressants, and comparisons between different HRT regimens. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Prespecified subgroup analyses were conducted according to hormone type and route of administration. Risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Twelve randomized controlled trials were included. In placebo-controlled comparisons, HRT was associated with a small reduction in depressive symptom severity (SMD&#x202f;=&#x202f;-0.23, 95% CI -0.43 to -0.03). Subgroup analyses suggested larger effect estimates for tibolone or selective tissue estrogenic activity regulator-based regimens; however, tests for subgroup differences were not statistically significant, and the number of studies within subgroups was limited. No clear differences were observed according to route of administration. Evidence from comparisons involving active treatments was limited and did not support firm conclusions. Reported adverse events were generally mild to moderate. HRT may be associated with a modest reduction in depressive symptoms in perimenopausal women; however, the magnitude of effect is small and the certainty of evidence is limited. Evidence comparing different HRT strategies remains insufficient to draw firm conclusions. Further well-designed, adequately powered randomized controlled trials are needed to clarify comparative efficacy and long-term safety.

Acute heart failure (AHF) remains a leading cause of hospitalization and mortality despite therapeutic advances. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown benefits in chronic HF, but their role when initiated during hospitalization for AHF remains uncertain. A literature search was conducted across main databases through September 10, 2025 to identify randomized controlled trials (RCTs) evaluating in-hospital initiation of SGLT2 inhibitors in patients with AHF. Primary outcomes were all-cause death and worsening HF; secondary outcomes included cardiovascular death, HF rehospitalization, and safety endpoints. Random-effects model was used to estimate risk ratios (RRs) with 95% confidence intervals (CIs). Eight RCTs including 4,096 patients were analysed with a weighted median follow-up of 60 days. In-hospital initiation of SGLT2 inhibitors significantly reduced all-cause death (RR 0.61, 95% CI 0.47-0.81) and worsening HF events (RR 0.67, 95% CI 0.48-0.94) compared to control group. The risk of cardiovascular death was significantly lower with SGLT2 inhibitors (RR 0.68, 95% CI 0.47-0.99). No significant effect on HF rehospitalizations was observed (RR 0.87, 95% CI 0.70-1.09). Safety outcomes, including acute kidney injury, hypotension, hypoglycemia, urinary tract infection, and serious adverse events were comparable between groups. Trial sequential analysis confirmed firm evidence for mortality reduction, while further trials are needed for worsening HF. In-hospital initiation of SGLT2 inhibitors in patients with AHF lowers mortality and worsening HF without increasing adverse events. Further evidence from large scale RCTs with longer follow-ups is required to reach a definitive conclusion. Acute heart failure is a serious condition that often leads to repeated hospitalizations and a high risk of death. We reviewed all available clinical trials to understand whether starting a class of medications called SGLT2 inhibitors during the hospital stay can help these patients. Across eight trials involving more than 4,000 patients, in-hospital treatment with SGLT2 inhibitors lowered the chances of death and reduced episodes of worsening heart failure. Importantly, these medicines did not increase side-effects such as kidney problems, low blood pressure, or infections. Although they did not significantly reduce hospital readmissions, the overall benefits were consistent and appeared within weeks of treatment. These findings support starting SGLT2 inhibitors safely during hospitalization for acute heart failure to improve patient outcomes.

The epidemiological, clinical and anatomopathological findings of oesophageal pythiosis in two dogs in northeastern Brazil are described. During the study period, 7696 canine tissue samples were evaluated, of which 33 cases of pythiosis were diagnosed (31 intestinal and two oesophageal), with oesophageal involvement accounting for 0.03% of all samples and 6.1% of pythiosis cases. The first dog was a 3-year-old female American Pit Bull Terrier, which was referred with a 2-month history of dysphagia, salivation, regurgitation, weight loss and swelling in the ventral aspect of the cervical region. The second dog was a 3-year-old female mixed breed dog, which was referred with a 30-day history of anorexia, dysphagia, constant salivation, regurgitation, polydipsia and weight loss. Necropsies revealed firm light-yellow multinodular masses extending longitudinally through the oesophageal wall, involving the cervical to mid-oesophagus in case 1 and the middle to distal third in case 2, with a transmural fistulous tract in the latter. Histologically, granulomatous inflammation and necrosis, with intralesional hyphae that failed to stain with haematoxylin and eosin, were observed. Immunohistochemistry (IHC) for Pythium insidiosum revealed strong immunolabelling of the hyphae. The diagnosis of pythiosis was based on the epidemiological, clinical and anatomopathological findings, and confirmed by IHC. Oesophageal pythiosis should be considered as a differential diagnosis in dogs with chronic digestive clinical signs. Histological evidence of granulomatous inflammation associated with unstained hyphae may represent an important diagnostic clue and should prompt further investigation by microbiological, immunohistochemical or molecular methods.

This study investigated the effects of head movements and postural stability on sound localization performance in normal-hearing adults and explored age-related differences between individuals aged 20-30 and 30-40 years. A total of 102 participants were divided into two groups: Group 1 (n = 56, 20-30 years) and Group 2 (n = 46, 30-40 years). Using a virtual reality system, localization performance was assessed under three different postural conditions and two listening conditions (head-immobile and head-mobile). Localization errors were measured at a 55-cm distance across four azimuth angles (right-front, left-front, right-back, left-back). Primary outcome measures included Azimuth Error, Front-Back Confusions, and Overall 3D Error. Incorporating head movements resulted in a statistically significant improvement in localization performance across all surface conditions (p < .001). In the head-mobile condition, the sitting posture yielded significantly lower Front 3D Error compared to both firm (p = .005) and foam surfaces (p = .007). Age-related differences were found to influence localization performance across varying levels of postural stability. Group 2 demonstrated significantly higher localization errors than Group 1 in the sitting condition (e.g., Head-Immobile Overall 3D Error: p = .021) and on the foam surface (e.g., Head-Immobile Overall 3D Error: p = .046). Conversely, no significant differences were found between the groups for any parameter on the firm surface. These findings indicate that head movements substantially enhance spatial hearing accuracy. However, localization performance is modulated by postural stability and age. Increased postural challenge appears to impose a dual-task cost, revealing subtle early age-related changes in the cognitive-motor mechanisms underlying auditory-spatial integration.

This exploratory study investigated how people who have had abortions responded to three abortion plotlines from US television. We selected three contemporary plotlines (from the shows Station 19, P-Valley, and Shrill) that depicted characters with diverse abortion experiences across race, age, and type of abortion, each featuring normalising messaging about abortion. We partnered with a research recruitment firm to recruit 30 participants who had at least one abortion in the last five years. After consenting to participate in the study, participants received a link to watch the abortion storyline and then answer three open-ended questions, followed by a demographic survey. We conducted a thematic qualitative analysis of responses. Many participants expressed positive reactions to the abortion plotlines and meaningful connections to the fictional characters who had had abortions. Some also expressed judgement of a character's reasons for having an abortion. Many reported that watching these clips reaffirmed the rightness of their own abortion decisions. Participants expressed more concern about the emotional resonance of the plotlines than the medical, political, or demographic accuracy. We argue that these clips provide a new interpretive lens through which to view abortions as normal, supported, and sometimes even powerful.

Intra-abdominal desmoid tumours are rare, benign yet locally aggressive fibroblastic neoplasms that often mimic malignancies such as gastrointestinal stromal tumours (GIST) on imaging, making preoperative diagnosis challenging. We present the case of a woman in her mid-30s with a 6-month history of recurrent colicky abdominal pain and intermittent non-bilious vomiting during abdominal pain. Examination revealed a firm, mobile, non-tender mass in the right iliac fossa. Colonoscopy showed a submucosal caecal lesion without ulceration, and contrast-enhanced CT revealed a well-defined, heterogenous, enhancing lesion arising from the caecum suggestive of caecal GIST. Intraoperatively, a firm caecal mass with mesenteric fibrosis and terminal ileal dilatation was found. A limited right hemicolectomy was performed after a frozen section showed a spindle cell tumour. Immunohistochemistry demonstrated nuclear &#x3b2;-catenin positivity with negative C-kit (CD117), discovered on GIST 1 (DOG1), and desmin, confirming mesenteric desmoid fibromatosis. Surgery remains the mainstay of treatment in symptomatic cases.

Home-based medical care (HBMC) is an important care model for older adults with complex health conditions and functional limitations that can potentially prevent institutionalization. Historically, HBMC has comprised small, independent provider organizations. It is unknown whether consolidation observed in other health care sectors has similarly affected HBMC. We used the American Academy of Home Care Medicine's national provider directory to identify a cohort of practices billing traditional, fee-for-service Medicare for HMBC in 2022. Using Pitchbook Inc., we identified whether an acquisition occurred for each of these practices and categorized acquisition types as private equity (PE) firm buyouts, health system acquisitions, and other corporate acquisitions. We described most recent acquisition timing from 2012 to 2024 for this cohort of practices and compared 2022 practice characteristics by most recent acquisition status and type as of 2022, using this as a proxy to describe current practice ownership. The majority of HBMC practices in our cohort with any acquisition were acquired in 2022, with the greatest number of recent private equity firm buyouts in 2021. Among 2308 HBMC practices serving 476,088 Medicare fee-for-service patients in 2022, 12.6% of patients received care from PE-acquired practices, 2.4% from health system-acquired practices, and 5.0% from other corporate-acquired practices. Acquired practices were generally larger and cared for patients with slightly higher hierarchical condition category (HCC) scores who were less often high-needs qualified. Performance measures did not differ meaningfully between acquired and non-acquired practices. A significant share of HBMC patients is cared for by practices that have been acquired, with further investigation warranted to understand potential effects on patient selection and care quality.

This study aims to report the clinical diagnosis and management of a 5-year-old child with developing complex odontoma in the left maxilla, and to review the literature regarding its clinical features, imaging findings, and pathological characteristics, so as to provide clinical insights for early diagnosis and individualized treatment of pediatric maxillary developing complex odontoma. A 5-year-old male presenting with a "left maxillary mass" was evaluated. Clinical examination assessed facial morphology and dental development. Panoramic radiography and cone-beam computed tomography (CBCT) were used to determine the lesion's location and imaging characteristics. The surgically resected specimen was sent to the Ningbo Clinical Pathological Diagnosis Center for gross and histopathological examination. Postoperative follow-up was conducted for 24 months to monitor wound healing, dental development, and potential recurrence. We implemented a proactive monitoring approach, which included regular follow-up visits every three months during the first year. During these visits, we assessed the growth and development of the surrounding teeth and evaluated the edentulous area for any signs of potential complications. Clinical examination revealed a left maxillary mass without significant facial asymmetry, and the child was in the stage of dental development. Imaging confirmed an expansive lesion in the left maxilla. Pathological examination identified a 4.5&#x2009;&#xd7;&#x2009;4&#x2009;&#xd7;&#x2009;0.5&#x2005;cm grayish-white to reddish, firm tissue, leading to a final diagnosis of developing complex odontoma. The lesion was completely removed via curettage. At the 24-month follow-up, no recurrence was observed, the surgical site had healed well, dental development was normal, and no complications such as secondary caries were noted. Pediatric maxillary developing complex odontoma often presents with subtle symptoms and atypical imaging features, leading to delayed diagnosis. Multimodal imaging combined with pathological examination enables accurate diagnosis. Complete excision via curettage, accompanied by long-term follow-up, effectively restores maxillary structure and function, supports normal dental development, and reduces recurrence risk, making it a viable treatment strategy for pediatric maxillary developing complex odontoma.

Male breast carcinoma (MBC) is a rare malignancy and often presents at an advanced stage due to low awareness and social stigma. Management is largely extrapolated from female breast cancer and must be individualized, particularly in elderly patients.&#xa0;An 87-year-old male patient presented with a painless left breast lump since three months and an ulcer over the nipple for since one month. Examination revealed a firm retroareolar mass with a healed ulcer over the lower aspect of the nipple and no palpable axillary lymphadenopathy. Imaging suggested a suspicious lesion, and core needle biopsy confirmed invasive ductal carcinoma. Staging workup with fludeoxyglucose-18 (FDG) positron emission tomography-computed tomography (PET-CT) showed no distant metastasis.&#xa0;The patient underwent a modified radical mastectomy with axillary lymph node dissection. Histopathology revealed Grade II invasive ductal carcinoma with nodal involvement (pT4bN1a, Stage IIIB). Immunohistochemistry demonstrated estrogen and progesterone receptor positivity, human epidermal growth factor receptor 2 (HER2) negativity, and a low proliferative index, consistent with a luminal A subtype.&#xa0;Following multidisciplinary tumour board discussion, adjuvant chemotherapy was omitted, considering advanced age and performance status. The patient was treated with tamoxifen and adjuvant chest wall + axillary radiotherapy. At follow-up, he remains disease-free with a good quality of life.&#xa0;This case highlights the importance of early suspicion in male breast lesions and emphasizes individualized management integrating tumor biology, stage, and patient factors.

Mucosal neuromas are benign proliferations of peripheral nerves that most commonly occur as part of multiple endocrine neoplasia type 2B (MEN2B), a hereditary syndrome associated with germline mutations of the RET proto-oncogene. MEN2B is characterized by mucosal neuromas, medullary thyroid carcinoma, pheochromocytoma, intestinal ganglioneuromatosis, and marfanoid habitus. Oral mucosal neuromas often represent the earliest manifestation of the syndrome and therefore have important diagnostic significance. However, isolated mucosal neuromas occurring in the absence of MEN2B are extremely rare, particularly within the oral cavity. This case report describes a 25-year-old female who presented with a solitary, firm, painless mass on her right posterior hard palate. Radiographic examination revealed no osseous involvement. Following an excisional biopsy, microscopic examination revealed unencapsulated proliferation of tortuous and haphazardly arranged neural bundles within a collagenous stroma. Immunohistochemical analysis demonstrated strong and diffuse positivity for S-100 protein, confirming the diagnosis of mucosal neuroma. Comprehensive systemic evaluation, including endocrine assessment, biochemical testing, and thyroid ultrasonography, revealed no evidence of MEN2B. The patient demonstrated satisfactory postoperative healing with no recurrence during eight months of follow-up. Thus, this case highlights an exceedingly rare presentation of a solitary mucosal neuroma at an unusual site occurring in the absence of MEN2B. While mucosal neuromas are typically pathognomonic for MEN2B, solitary forms are rare, particularly when located on the hard palate. This report adds to the limited literature on non-syndromic oral mucosal neuromas and emphasizes the importance of clinicopathologic correlation and long-term surveillance.

Carcinoma ex-pleomorphic adenoma (CXPA) is a malignant tumour originating from the epithelial components of a primary or recurrent pleomorphic adenoma (PA). The minor salivary gland of the palate is not a common site of occurrence of this tumour. Approximately 6% of PAs have the potential to transform into CXPA. It is typically a high-grade tumour, and disease-related death is often observed due to distant metastases. A 52-year-old man presented with a seven-year history of a painless palatal mass which started insidiously and progressively increased in size over the years. There was no history of trauma, toothache, and no history of swelling in other body parts. His medical history was not significant for any disease, and there was no history of irradiation or surgery. Examination of the oral cavity revealed a non-ulcerated palatal swelling, measuring 10 &#xd7; 8 &#xd7; 5&#x2009;cm, non-tender, firm, not freely mobile, and adherent to the underlying structures. An ovoid tan brown firm tissue was received which measured 9 &#xd7; 7 &#xd7; 5&#x2009;cm and weighed 140&#x2009;g. Transections show yellow-white homogeneous to nodular areas. Microscopy showed the co-existence of a PA with an area of transition to a carcinoma. Pathological assessment is the gold standard for making a diagnosis, and the main histopathological finding in CXPA is the co-existence of the benign characteristics of PA with malignant changes in the epithelial components of the tumour.

Peri-implant mucogingival deficiencies, characterized by a shallow vestibule and insufficient attached mucosa (AM), can compromise plaque control and maintenance. Periosteal fenestration offers a graft-free alternative but remains limited by technique sensitivity and restricted surgical access. This report introduces a hybrid diode laser-assisted periosteal fenestration protocol (Hu-PF) designed to improve clinical applicability while preserving biological safety. The Hu-PF protocol separates surgical functions by restricting diode laser use to controlled soft-tissue dissection and performing definitive periosteal fenestration mechanically under irrigation. A representative case, supplemented by additional clinical examples, is presented to illustrate the procedural workflow. The technique enabled predictable vestibular deepening and increased AM, with stable outcomes observed during follow-up. In the representative case, AM increased by approximately 6&#xa0;mm at 1 week and stabilized at approximately 4&#xa0;mm at 18 months, with maintained results at 3 years. The Hu-PF protocol represents a clinically applicable modification of periosteal fenestration-based vestibuloplasty that improves surgical operability while preserving biological safety, providing a practical graft-free option for peri-implant mucogingival management. The Hu-PF technique facilitates vestibuloplasty in anatomically challenging sites where periosteal suturing or graft stabilization is difficult, such as posterior regions or areas with prosthetic restorations. The protocol confines diode laser use to controlled soft-tissue dissection for hemostasis and visibility, whereas definitive periosteal fenestration is performed mechanically to stabilize the mucogingival junction without graft harvesting. The technique enables predictable vestibular deepening and maintenance of attached mucosa, with stable outcomes observed during follow-up. Patients with dental implants may have insufficient firm gum tissue and a shallow vestibule, making oral hygiene difficult and increasing the risk of inflammation. Traditional grafting can improve these conditions but requires a donor site and complex handling. Periosteal fenestration is a graft-free alternative, but it can be difficult to perform in areas with limited access. This report introduces a practical hybrid approach (Hu-PF) that uses a small diode laser only for soft-tissue separation to improve visibility and control bleeding, whereas a rotary instrument is used under water cooling to safely create a small periosteal window. By separating these steps, the technique maintains the handling advantages of the diode laser while reducing the risk of heat damage to bone. The approach enables increased vestibular depth and firm gum tissue, with stable outcomes over time. Hu-PF may be a useful option when grafting is not desirable or when advanced laser equipment is not available.