Mandibular canine distalization plays a key role in orthodontic treatment planning, particularly in cases involving premolar extraction. A three-dimensional symmetric finite element analysis (FEA) model with bilinear periodontal ligament (PDL) properties to evaluate the combined effects of five occlusal conditions-intercuspal position (ICP), incisal clench (INC), right unilateral molar clench (RMOL), right group function (RGF), and no occlusion-and three orthodontic force levels (0.98, 1.47, and 1.96 N) on PDL biomechanics. The effects were assessed by measuring hydrostatic stress as an indicator of capillary perfusion and maximum principal strain as a mechanical signal for tissue deformation and bone remodeling stimulus. According to the FEA results, a moderate force of 1.47 N produced a relatively favorable biomechanical response under nonocclusal conditions. Intercuspal position and incisal clench conditions were associated with elevated stress and strain concentrations in the PDL. The right unilateral molar clench condition preserved load-induced bilateral symmetry, whereas the right group function condition resulted in differential left-right biomechanical responses in the PDL under asymmetric occlusal loading conditions. These findings indicate that occlusal loading is a key mechanical factor influencing the biomechanical environment during orthodontic tooth movement. FEA simulations that consider occlusal loading can provide comparative biomechanical insights that can guide the selection of orthodontic forces and identification of mechanical risks.
Contact electrification (CE) remains a critical challenge in advanced material technologies where uncontrolled surface charging can compromise manufacturability, reliability, and performance of the materials for practical applications. Ultrathin glass with micrometer-scale thickness is a state-of-the-art specialty oxide material for flexible touchscreens in new-generation electronic devices. Despite extensive studies on CE on thermally grown oxide thin films, the physical and chemical properties of the stand-alone ultrathin oxide materials could be very different and thus lead to distinct CE behaviors. Such behaviors have not been experimentally investigated due to the challenge of their ultrathin form factor as well as the lack of experimental methods that would allow the successful study of CE on stand-alone ultrathin glass materials. Here, we, for the first time, visualize and quantify CE-induced surface charges on ultrathin glasses using sideband-mode Kelvin probe force microscopy (KPFM). To enable the KPFM measurement, we have established experimental strategies, including electrode preparation enabling the measuring circuit, and surface cleaning procedures improving surface activation and hydrophilicity. Nanosized atomic force microscopy (AFM) probes were used to scan and induce triboelectric charges on the stand-alone glass surfaces with a variety of thicknesses (30-100 μm) under ultrapure N2 conditions. Time-dependent measurements reveal the surface charges on a 30 μm-thick glass sample decay from 4.47 to 0.37 V in 240 min. Moreover, we found that electrostatic charges exhibit a capacitor-like discharging behavior primarily through the bulk material yielding a long relaxation time constant of ∼41 min, which is different from the lateral surface discharging behavior in a thermally grown SiO2 thin film reported previously. Furthermore, the thickness-dependent surface charging effect was characterized for the ultrathin glass substrates, where the change in contact potential difference between the charged and uncharged region (ΔVCPD) was found to remain nearly constant across this thickness range from 1.39 ± 0.17 V at 30 μm to 1.34 ± 0.29 V at 100 μm. A self-capacitance analytical model was developed and employed to estimate the corresponding surface charge density (σ), yielding comparable values of 136.26 ± 16.25 μC/m2 at 30 μm and 131.44 ± 28.41 μC/m2 at 100 μm. Additionally, the external bias applied to the AFM tips can be used to enhance, suppress, or invert the intrinsic CE response of glass materials. This work extends nanoscale CE characterization beyond oxide thin films to stand-alone oxide materials, providing a framework to understand and manipulate electrostatic charging in glass systems for practical applications.
Placental pathology has benefited greatly from the standardization of definitions provided by the Amsterdam consensus, however the quality of placental pathology reporting continues to suffer from a lack of unified and practical reporting standards and difficulty in applying the Amsterdam definitions to general clinical practice. A multidisciplinary Placental Pathology Reporting Task Force was formed to develop a standardized placental pathology reporting template based on a combination of evidence-based literature review and consensus expert opinion, and designed to complement the Amsterdam definitions. The goal of the task force was to create a practical, succinct, clinically informative, and easily customizable template that can be adapted to varying institutional preferences. The proposed standardized reporting template encompasses a wide breadth of common placental pathologic diagnoses and provides recommended diagnostic terminology, explanatory comments and practical tips, and notes to ease the application of definitions. Input from pathologists from different practice settings, obstetric providers, neonatologists, and patient advocates was integrated. The introduction of a standardized placental reporting template holds the potential to reform and advance placental pathology practice across the diverse range of settings in which it is currently performed. The proposed template is adaptable, allowing pathologists to include additional information beyond the recommended standard as needed/preferred. Widespread adoption of this framework will enhance the clinical utility and value of placental pathology reports by clinicians and patients, ultimately supporting more informed and appropriate management of neonates and future pregnancies.
High-throughput computational screening (HTCS) of gas adsorption in metal-organic frameworks (MOFs) typically relies on classical generic force fields which are computationally efficient but often fail to capture complex host-guest interactions. Universal machine learned interatomic potentials (u-MLIPs) offer near-quantum accuracy at far lower cost than density-functional theory (DFT), yet their large-scale application in adsorption screening remains limited. Here, we introduce an efficient hybrid screening workflow that merges classical generic force fields and u-MLIPs within a Monte Carlo scheme to accurately assess the adsorption performance of a large MOF structure database. As a proof-of-concept, this HTCS is applied to identify top-performing MOFs for selective ethylene capture under humid conditions, highly relevant to food-preservation packaging technologies. Our workflow demonstrates that accurate treatment of both host-guest energetics and framework flexibility, enabled by u-MLIPs, is essential to achieve reliable adsorption-performance rankings.
Orthodontically induced inflammatory root resorption (OIIRR) is a prevalent complication driven by excessive mechanical force, yet the underlying mechanisms linking mechanotransduction to osteoclast activation remain elusive. Here, we identify a novel signaling axis wherein sphingosine kinase 1 (SphK1) in cementocytes translates heavy orthodontic force into a pro-osteoclastogenic signal via mitophagy-mediated mitochondrial transfer. In vivo, heavy force induced OIIRR and upregulated mitophagy markers in cementocytes. In vitro, heavy compression force triggered SphK1-dependent mitophagy in IDG-CM6 cementocytes, as evidenced by increased mitophagosome formation, co-localization of mitochondria with lysosomes, and elevated PINK1/PARKIN signaling. Inhibition of SphK1, either pharmacologically or genetically, suppressed this mitophagic response. Conditioned media from force-loaded cementocytes enhanced osteoclast differentiation and glycolytic metabolism, effects that were abolished by SphK1 inhibition and rescued by a mitophagy agonist. Crucially, we demonstrated that heavy force promotes the transfer of mitochondria from cementocytes to osteoclast precursors, a process dependent on mitophagy. This transferred mitochondrial cargo functioned as a metabolic subsidy, boosting osteoclast bioenergetics and resorptive activity. Our findings unveil the SphK1-mitophagy-mitochondrial transfer axis as a fundamental mechanism of cementocyte-osteoclast communication, positioning SphK1 as a promising therapeutic target to prevent OIIRR.
Force-induced protein conformational changes govern many essential biological processes, yet their molecular mechanisms remain difficult to resolve. Von Willebrand factor (VWF), a central regulator of hemostasis, is activated by hydrodynamic forces in blood flow, but how mechanical signals propagate across its multidomain architecture is poorly understood. Here, we use flow molecular dynamics (FMD), a simulation framework that applies fluid forces via controlled solvent flow to interrogate mechanosensitive proteins. Using VWF as a model system, we reconstructed the complete mechanomodule (D'D3-A1-A2-A3; 1110 residues) with native glycosylation by integrating crystallographic data and ColabFold predictions. FMD simulations capture a force-driven transition from a compact, autoinhibited "bird's nest" ensemble to an extended, activated state, revealing asymmetric autoinhibitory strengths within the N'AIM and C'AIM modules of the A1 domain. By directly linking static structures to dynamic, force-regulated behavior, this work establishes a generalizable platform for dissecting protein mechanosensitivity and enabling the rational design of force-responsive therapeutics.
We consider an open, bounded, simply connected (Lipschitz) domain in R d , which contains a closed polyhedral surface or polygonal contour, referred to as the interface. From this interface, forces are exerted in the normal direction. The forces are continuously distributed over the interface, resulting in an integral expression. This features an important characteristic of the immersed interface method. Since the integral cannot be resolved exactly, one relies on numerical quadrature rules to approximate the integral. Therefore, we consider two different linear elasticity problems with forces over a curve or surface (interface) that is located within the (open) domain of computation: (1) The force is defined by an integral over the interface; (2) The force is defined by a quadrature approximation of the integral over the interface. We prove that the L 2 -norm of the difference between the solutions from the two elasticity problems is of the same order as the error of quadrature. The results are demonstrated for both bounded and unbounded domains. The proof that we establish relies on the use of: (i) fundamental solutions for linear elasticity, exhibiting singular behaviors (in particular around points of action) and not being in H 1 , and (ii) on the use of singularity removal principle and the Extended Trace Theorem. Convergence is demonstrated in the L 2 -norm on curves and manifolds. We show some numerical experiments on the basis of fundamental solutions with a Midpoint quadrature rule in an unbounded and a bounded domain. The numerical experiments confirm our theoretical results. We note that the difference between the interface integral and the quadrature rule over the interface holds for the exact solution in the bulk and not for any discretization carried out in the bulk. Hence, in the numerical finite element-based simulations, the numerical results contain an additional error due to the finite element approach.
We developed and analytically evaluated a novel physical-mathematical model aimed at quantifying and minimizing the systematic error (ERR) between true intraocular pressure (IOPT) and that measured by Goldmann applanation tonometry (IOPG), by incorporating patient-specific corneal biomechanical properties. We constructed a model based on physical force balance, simulating the applanation of the cornea as a deformable elastic shell influenced by intraocular pressure and external forces. Four distinct forces were mathematically defined and computed: F1 - intraocular pressure acting on the posterior corneal surface; F2 - elastic resistance of the corneal tissue to flattening; F3 - adhesive force due to tear film surface tension; F4 - the net force applied by the examiner and recorded by the GAT device. The model integrates key anatomical and biomechanical parameterscentral corneal thickness, mean apical curvature radius, and corneal elastic modulus-to quantify ERR as a function of individual variability. These parameters are derived from two sequential applanation measurements (IOPG 0 and IOPG 1 ), acquired through a custom-designed dual-zone applanation prism. Simulations demonstrated that ERR increases proportionally with central corneal thickness and elastic modulus, and decreases with increasing corneal curvature radius. For standard corneal values (thickness: 0.536 mm; curvature: 7.15 mm; elasticity: 0.16 MPa), the model closely approximates IOPT. Deviations from these reference values result in systematic over- or underestimation of IOPG. This analytical model provides a transparent, biomechanically grounded method for correcting GAT measurements and estimating true IOP with improved precision. It highlights the critical influence of patient-specific corneal properties and lays the foundation for personalized tonometry in clinical practice.
Continuous tool operation with a myoelectric prosthetic hand is considerably more complex than discrete grasping tasks. This complexity arises because the control system must maintain stable, adaptive, and coordinated motions under varying loads and unpredictable interactions. In human motor control, this stability is achieved through a biological sensorimotor closed loop, where tactile feedback continuously modulates neural signals to adapt to environmental changes. Inspired by these mechanisms for reducing grasp instability caused by external shocks, this study designed a multimodal controller termed the tactile, kinesthetic, and electromyography (EMG) bionic gripping controller (TKE-BGC). It integrates tactile, kinematic, and EMG information. Initially, multimodal data-encompassing tactile signals, joint angles, and EMG patterns-were collected from able-bodied users during tool manipulation via a data glove. Subsequently, the TKE-BGC model was trained on these data, utilizing a Transformer encoder to extract high-level features and a multilayer perceptron to predict joint angles in real time. Based on this controller, this paper presents a prosthetic control framework developed through human skill transfer. Unlike conventional fixed force or force follows strategies that struggle with dynamic impacts or tracking delays, this framework enables robust end-to-end adaptive control. Tested across 4 seen and unseen tool operation tasks, the proposed method demonstrated precise detailed performance. Specifically, it significantly reduced the number of tool drops and shortened task completion times compared to the baseline methods. Furthermore, it achieved human-like average contact forces and substantially lowered the user's physical workload, requiring noticeably less muscle effort than the force follows strategy (e.g., average EMG amplitude, 0.0023 versus 0.0124). By rapidly adjusting grip force through feedback and effectively mitigating instability, this research holds significant practical value in enhancing the daily independence of amputees and supporting their vocational rehabilitation and reemployment.
While advances have been made in mechano-active and gecko-inspired wound dressings, achieving dynamically coordinated adhesion-contraction coupling within a single-material, stimulus-free system with quantitatively programmable contractile output remains an unmet challenge. Here, we engineer bioinspired mechano-intelligent Janus bandages (MIBs) with dynamically coordinated adhesion-contraction for effective wound healing. The MIBs are fabricated through micromolding of poly(lactide-co-propylene glycol-co-lactide) dimethacrylates (PmLnD), featuring an interior surface with a gecko-mimicking wedged structure. Upon application, the MIBs recapitulate the gecko locomotion principle to achieve precise control of contractile forces with dynamically coordinated adhesion-contraction. The simply pre-strained MIB can precisely program its intrinsic contractile force, while adhesion strength proportionally responds to the contractile force through enhanced van der Waals interactions and interfacial friction. This coordinated mechanism promotes healing in rat and porcine full-thickness skin defect models by accelerating re-epithelialization and enhancing angiogenesis. Mechanistically, the MIBs reduce focal adhesion kinase (FAK) expression, thereby regulating downstream pathways related to wound healing progression, including nuclear factor kappa B (NF-κB), Wnt, and transforming growth factor-beta (TGF-β) pathways, enabling scar-attenuated wound healing. We envision that this Janus design, which integrates strain-programmable contraction with reversible gecko-inspired adhesion, offers a useful addition to current mechanobiological strategies for wound management and soft tissue repair.
To address the bottleneck problem of slow decomposition of returned maize straw under low-temperature constraints in the cold and arid regions of northern China, this study systematically explored the microbial decomposition-promoting mechanism of microbial inoculant M44 combined with three straw returning methods: deep plowing (DPR), deep scarification and mixing (SSR), and no-tillage mulching (NTR), by integrating field tillage and in-situ micro-zone degradation experiments. The results showed that different straw returning methods combined with inoculant M44 could effectively overcome low-temperature limitations, significantly increasing the straw degradation rate by 2.33-9.81 percentage points and shortening the half-life by 20.7-62.8 d. The core mechanism was that the "tillage-inoculant" interaction regulated the soil microenvironment, directionally shaped and enriched key functional microbial taxa with degradation ability (such as Pseudoxanthomonas, Devosia, Streptomyces, Pseudomonas, etc.) and their key ASVs (such as ASV6, ASV12, ASV412, ASV1546, etc.), reshaped the soil bacterial community structure, and synergistically activated the soil extracellular enzyme system (such as β-glucosidase, β-xylosidase, etc., with the comprehensive enzyme index increased by 0.74-1.06), thereby synergistically driving the rapid degradation of returned straw. The PLS-PM model further clarified that there were differences in the pathways driven by inoculant M44 for straw degradation under different returning methods. In the DPR and SSR treatments, bacterial community composition was the most important direct driving force for degradation, and key ASVs indirectly affected the degradation process by regulating bacterial composition and enzyme activity, while in the NTR treatment, extracellular enzyme activity became the core driving force for degradation, whose activity was directly driven by bacterial composition and diversity. This study revealed the hierarchical interaction driving mechanism of "key microorganisms-bacterial community structure-extracellular enzyme activity-straw degradation" at the field scale, providing an important scientific basis for optimizing the "tillage-inoculant" synergistic technology for straw resource utilization in cold and arid regions.
Femoral neck fracture fixation remains challenging, particularly for Pauwels type III fractures that require robust implants to withstand vertical shear forces. The femoral neck system (FNS) offers greater stiffness and more stable load sharing than multiple screw fixation; however, it has a lower load-to-failure than plate systems. We evaluated the torsional stability of the FNS using finite-element analysis. We analyzed a transcervical Pauwels type III femoral neck fracture without a fracture gap, fixed with one of three constructs: multiple screw fixation, a dynamic hip screw (DHS) with an antirotation screw, or an FNS. Finite-element simulations incorporated muscle forces during the leg-swing phase, with constraints applied at the fovea capitis. Cortical-cancellous interfaces were fully bonded, except at the reduced fracture interface where relative translation was allowed. The DHS with an antirotation screw had the highest equivalent von Mises stress and strain energy density (SED) (1130.11 MPa/1,000) and the greatest fragment displacement (0.44 mm). Multiple screw fixation produced the lowest SED (151.73 MPa/1,000), and the FNS showed similar displacement with an intermediate SED (201.96 MPa/1,000). In the FNS, peak stress localized near the lateral cortex of the proximal femur, with reduced stress at the barrel-screw interface. The FNS provides rotational stability for Pauwels type III fractures comparable with multiple screw fixation and reduces stress at the fracture site. The DHS with an antirotation screw was less stable during hip rotation. Given its greater compressive strength than multiple screw fixation, the FNS is the preferred fixation option.
Menopause consultations are increasingly common in general practice and workplace health settings, yet time and resource constraints limit clinicians' ability to provide comprehensive care. Group consultations (GCs) may offer a scalable alternative, particularly in occupational environments where access to women's health expertise may be limited. To evaluate the acceptability and perceived impact of a menopause GC series in a UK Armed Forces (UKAF) population, exploring outcomes for patients, medical services, and the wider organisation. A service evaluation of a five-session menopause group consultation series, held in-person at a Defence Primary Health Care Practice. Ten participants attended between two and five 90-minute sessions co-designed with subject matter experts. Quantitative measures included pre/post symptom questionnaires (GCS, Meno-D), and self-rated confidence and knowledge. Qualitative feedback was collected via focus groups, free text and email responses, and analysed thematically. Participants reported improved confidence (average increase 45%) and symptom reduction on both scales. Notably, some symptom scores increased, reflecting greater awareness rather than deterioration. Participants valued peer support, continuity, and holistic discussion. Administrative and booking barriers were noted. While estimated clinical time 'saved' (6.75 hours) did not exceed time spent (7.5 hours), participants strongly endorsed the approach. The group model positively influenced perceptions of employer investment and retention. Menopause GCs were acceptable and empowering for participants, with implications for workforce wellbeing and retention. With adaptation, this model could be applied to other occupational settings or health topics, balancing patient benefit with clinician time and cost.
Hemorrhage is the leading preventable cause of trauma death, and timely transfusion remains a major challenge in Canada, particularly in rural and remote regions where long transport times create "blood deserts." Whole blood has re-emerged as the gold standard for resuscitation, but donor limitations, short shelf-life, and cold-chain requirements restrict its universal deployment. Freeze-dried plasma (FDP) offers a complementary solution with unique advantages for Canadian prehospital and transport systems. FDP is pathogen-reduced, shelf-stable for up to two years at room temperature, lightweight, and rapidly reconstituted at the point of care. Evidence from military and civilian studies demonstrates its logistical feasibility and safety, particularly in settings with prolonged transport times. FDP has been successfully integrated into NATO and Canadian Armed Forces operations and is increasingly recognized internationally as a practical adjunct to whole blood. In Canada, heterogeneous access to prehospital transfusion, high wastage rates of thawed plasma, and the inequities faced by Indigenous and remote communities highlight the urgent need for alternative strategies. FDP and whole blood are not competing but rather they are complementary therapies in a prehospital transfusion system. FDP represents a scalable, equitable, and operationally feasible option to extend balanced resuscitation to patients in rural and remote Canada. A coordinated national strategy, including regulatory approval, pilot projects, and outcome evaluation through networks such as CAN-PATT, is essential to move FDP from battlefield innovation to civilian standard of care.
The dystrophic mdx mouse is a widely used model of Duchenne muscular dystrophy. Altered Ca2+ handling is a key feature, including increased Ca2+ leak through the ryanodine receptor (RyR1's), the primary Ca2+ release channel in skeletal muscle. Such leak has important downstream consequences for intracellular Ca2+ homeostasis. Here, we quantified basal compartmentalized Ca2+ levels in mdx muscle compared with wild-type (WT). Single extensor digitorum longus muscle fibers from WT and mdx mice were mechanically skinned. Transverse tubule Ca2+ dynamics were assessed using confocal microscopy with fluorescent Ca2+ indicators during caffeine-induced RyR1-mediated Ca2+ release. Sarcoplasmic reticulum (SR) and mitochondrial Ca2+ contents were quantified using established depletion protocols combined with force measurements. Consistent with previous reports, mdx fibers exhibited increased RyR1 Ca2+ leak. Absolute quantification revealed a reduction in SR Ca2+ content accompanied by a ~4-fold increase in mitochondrial Ca2+ content. These shifts indicate a redistribution of intracellular Ca2+, triggered by the RyR1 Ca2+ leak to lower SR Ca2+ content and increase the Ca2+ permeability of the t-system membrane, leading to an elevation in cytoplasmic and mitochondrial Ca2+ levels in mdx muscle. Redistribution of Ca2+ is a regulated process, proportional to RyR1 Ca2+ leak. In mdx muscle fibers, there is reduced SR and elevated mitochondrial and cytoplasmic Ca2+ compared to WT fibers. These alterations contribute to the dystrophic muscle pathology, likely through promotion of oxidative stress through increased reactive oxygen species production.
Sarcopenia-a debilitating consequence of global population aging characterized by the loss of muscle mass and function-demands in vitro platforms that enable a rigorous and quantitative assessment of muscle contractility. Pillar-displacement-based microphysiological systems are promising for this purpose but suffer from tension loss as tissues compact, creating variable boundary conditions and undermining reliability. We developed a monolithic, 3-dimensional printed Fast-Optimizing and Regeneration/Contraction-Evaluating platform featuring a detachable polydimethylsiloxane spacer that maintains a constant interpillar distance during long-term culture. The monolithic structure, fabricated by stereolithography, ensures high architectural reproducibility. Under the fixed-length boundary conditions, engineered muscles exhibited improved cellular alignment, enhanced myogenic differentiation, and more advanced structural maturation, resulting in markedly higher twitch and tetanic forces upon electrical stimulation. Together, these results establish the Fast-Optimizing and Regeneration/Contraction-Evaluating platform as a robust and reproducible muscle microphysiological system with fixed-length boundary conditions, enabling reliable, long-term quantitative evaluation of morphological and functional changes for tissue-engineering, drug-screening, and muscular-disease-modeling applications.
Molecular docking has emerged as a cornerstone methodology in computational drug discovery, enabling the prediction of ligand-receptor interactions with considerable accuracy and efficiency. This article provides a comprehensive overview of docking fundamentals, including its workflow, scoring functions, and various types, ranging from rigid to flexible and ensemble docking approaches. Docking serves as an essential tool for virtual screening, lead optimization, and structure-based drug design, significantly reducing experimental costs and accelerating the identification of therapeutic candidates. The review details contemporary scoring strategies such as force-field-based, empirical, knowledge-based, and consensus scoring, highlighting their respective strengths and documented limitations. Additionally, a comparative evaluation of widely used docking platforms such as AutoDock, MOE, GOLD, Glide, and MVD is presented, incorporating recent benchmarking results and practical considerations. Special emphasis is placed on the integration of molecular docking with machine learning, artificial intelligence, molecular dynamics simulations, and other computational methods. Innovations such as deep learning architectures, AlphaFold-based structural modeling, reinforcement learning, and cloud-based high-throughput screening are redefining the predictive power, scalability, and clinical relevance of docking. Applications extend across drug discovery, drug repurposing, natural product research, and personalized medicine. The article also discusses critical challenges such as protein flexibility and scoring inaccuracies, and reviews emerging hybrid solutions designed to enhance accuracy and reliability. The review underscores the transformative impact of molecular docking in modern drug development.
VEXAS syndrome (Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a recently described adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene. Its heterogeneous clinical presentation frequently overlaps with inflammatory, autoimmune, and hematological disorders, resulting in diagnostic delay. We report the first genetically confirmed case of VEXAS syndrome in Tunisia and highlight its clinical complexity, with particular emphasis on cardiac and ocular involvement, as well as therapeutic management in light of current literature. A 70-year-old man followed at a tertiary university hospital in Tunisia presented with recurrent fever, weight loss, inflammatory arthritis, recurrent myopericarditis, ocular inflammation, skin lesions, peripheral neuropathy, and cytopenias. Laboratory investigations showed severe macrocytic anemia and markedly elevated inflammatory markers. After extensive exclusion of infectious, autoimmune, and malignant etiologies, molecular analysis identified a pathogenic somatic UBA1 mutation (p.Met41Thr), confirming the diagnosis of VEXAS syndrome. High-dose systemic corticosteroid therapy resulted in rapid initial clinical and biological improvement; however, infectious complications and disease relapse occurred during dose tapering. This case highlights the multisystemic and progressive nature of VEXAS syndrome and reinforces the role of corticosteroids as first-line therapy, while underlining their limitations. Awareness of this emerging entity and early genetic testing are essential to optimize management and reduce morbidity.
Objective: To analyze the factors influencing early [postoperative prolonged ileus (PPOI)] and late [low anterior resection syndrome (LARS)] bowel dysfunction after primary cytoreductive surgery in patients with advanced ovarian cancer, and to evaluate the economic impact of postoperative bowel dysfunction. Methods: A retrospective study was conducted on 275 patients with advanced epithelial ovarian cancer who underwent cytoreductive surgery at the First Affiliated Hospital of Air Force Medical University from January 2020 to December 2024. Patients were grouped based on postoperative bowel dysfunction: PPOI group (n=59) and non-PPOI group (n=216). Among 119 patients who underwent rectosigmoid resection, 77 completed questionnaire assessment and were included in LARS analysis, categorized into LARS group (n=30) and non-LARS group (n=47). Perioperative clinical data were collected, and univariate and multivariate logistic regression models were used to identify risk factors for PPOI and LARS. Results: A total of 275 patients with a mean age of (56.7±9.1) years were included, of whom 21.5% (59/275) developed PPOI. Among 77 patients who completed LARS assessment [mean age (55.2±10.1) years], 39.0% (30/77) developed LARS. Multivariate analysis showed that preoperative prognostic nutritional index (PNI)≤45 (OR=3.059, 95%CI: 1.481-6.593), history of prior abdominal surgery (OR=2.511, 95%CI: 1.196-5.274), total psoas area index (TPAI)≤266.2 mm2/m2 (OR=7.725, 95%CI: 3.621-16.483), intraoperative rectal resection (OR=6.816, 95%CI: 3.143-14.782), and total pelvic peritonectomy (OR=2.947, 95%CI: 1.372-6.328) were independent risk factors for PPOI (all P<0.05). Total pelvic peritonectomy (OR=3.547, 95%CI: 1.048-11.612) was identified as a risk factor for LARS (P=0.036). Furthermore, the PPOI group had significantly higher hospitalization costs and longer hospital stays (all P<0.001). Conclusions: Poor preoperative nutritional status and specific surgical procedures are risk factors for PPOI after cytoreductive surgery in advanced ovarian cancer patients, with total pelvic peritonectomy being a common risk factor for both PPOI and LARS. Additionally, PPOI increases the economic burden of medical care. 目的： 分析晚期卵巢癌患者初始肿瘤细胞减灭术后早期［术后延迟性肠麻痹（PPOI）］及晚期［低位前切除综合征（LARS）］肠道功能障碍的影响因素。 方法： 回顾性纳入2020年1月至2024年12月空军军医大学第一附属医院收治的行肿瘤细胞减灭术的晚期上皮性卵巢癌患者275例。根据术后肠道功能障碍发生情况分组：PPOI组（59例）与非PPOI组（216例）；对其中行直肠乙状结肠切除的119例患者进行问卷评估，评估后77例纳入LARS分析，分为LARS组（30例）与非LARS组（47例）。收集患者围手术期临床资料，采用多因素logistic回归模型分析PPOI及LARS发生的危险因素。 结果： 共纳入275例患者，年龄（56.7±9.1）岁，其中21.5%（59/275）的患者发生了PPOI；完成LARS问卷的77例患者，年龄（55.2±10.1）岁，其中39.0%（30/77）的患者发生了LARS。多因素分析显示，术前预后营养指数（PNI）≤45（OR=3.059，95%CI：1.481~6.593）、既往腹腔手术史（OR=2.511，95%CI：1.196~5.274）、总腰大肌面积指数（TPAI）≤266.2 mm2/m2（OR=7.725，95%CI：3.621~16.483）以及术中直肠切除（OR=6.816，95%CI：3.143~14.782）、全盆腔腹膜切除（OR=2.947，95%CI：1.372~6.328）是晚期卵巢癌患者术后发生PPOI的危险因素（均P<0.05）。全盆腔腹膜切除（OR=3.547，95%CI：1.048~11.612）是患者术后发生LARS的危险因素（P=0.036）。此外，PPOI组住院费用更高、住院时间更长（均P<0.001）。 结论： 较差的术前营养状态及特定的手术操作是晚期卵巢癌患者术后PPOI的危险因素，全盆腔腹膜切除是PPOI与LARS的共同危险因素。同时，PPOI增加了医疗经济负担。.
Guidelines for airway management in trauma commonly recommend immediate or prophylactic definitive airway intervention for injuries deemed at high risk for rapid airway compromise-such as inhalation injury, expanding neck haematoma or severe maxillofacial trauma, even in the absence of overt respiratory compromise. Despite widespread clinical adoption, the supporting evidence for this practice and its impact on patient outcomes remains limited. This retrospective analysis linked prehospital and in-hospital data for injured Israel Defense Forces (IDF) personnel who met the IDF Medical Corps criteria for suspected impending airway compromise during an ongoing military conflict. Manual chart review was performed to identify eligible cases among patients evacuated by aeromedical transport. In-hospital data were then analysed to assess the duration of mechanical ventilation and patient outcomes. Of 491 suspected cases reviewed, 29 patients (5.9%) met inclusion criteria for suspected impending airway obstruction. The median age was 21 years and 85.7% sustained blast-related injuries. The most common indications for suspected impending airway compromise were facial burns (41.4%) and facial or airway deformation (24.1%). Prehospital definitive airway management was performed in 25 patients (86.2%), including 16 endotracheal intubations and 9 cricothyroidotomies. The remaining four patients were managed conservatively with supportive measures alone. Among those intubated, the median time to extubation was 2 days. All patients managed conservatively survived to hospital admission, but three were intubated on arrival. In this small cohort of battlefield injuries with short evacuation times, some patients meeting classic criteria for suspected impending airway compromise were initially managed without definitive airway intervention and survived to hospital admission. In-hospital ventilation durations were generally short but highly variable. Further research is needed to determine whether these traditional indications reliably predict rapid airway compromise or provide a procedural advantage that justifies immediate prehospital intervention.