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Under weak grid scenarios, wide variations of grid impedance distort resonance characteristics of LCL-type grid-connected inverters. Digital control delays introduce phase lag, which easily causes damping polarity reversal in conventional capacitor-current-feedback active damping strategies. From the perspective of impedance stability, this paper reveals that control delays produce frequency-dependent resistive components in equivalent damping impedance. The analytical boundary of positive-negative resistance transition is derived, which dominates the weak-grid adaptability of inverters. Accordingly, an impedance reshaping strategy based on phase-lead delay compensation is proposed. Embedded in the feedback loop, the phase-lead network extends the valid positive-resistance frequency region and decouples the inherent coupling between LCL resonance frequency and sampling frequency. The critical frequency is lifted from [Formula: see text] to above [Formula: see text], and the system maintains a stability margin over 45° within 0-10 mH grid inductance range. A quasi-proportional-resonant cascaded current regulator is further designed to suppress background harmonic interference. Simulation and experimental tests on a 5 kW prototype verify the superior performance. When grid inductance steps from 0 to 8 mH, grid-connected current THD remains below 2.8%, and transient response completes within two fundamental cycles. This study provides theoretical guidance and practical solution for stable grid integration of high-penetration renewable energy systems.

Mixed ionic-electronic transfer (MIET) reactions, such as the oxygen reduction reaction (ORR) at oxide surfaces, are of paramount importance to manifold technologically highly relevant processes, and fundamental understanding must be developed to improve performance and tailor highly efficient electrodes and catalysts. Understanding such complex multi-step reactions requires the study of kinetic processes, underlying thermodynamic properties, i.e., ionic and electronic defect concentrations, and electrostatic surface effects. However, conventional techniques struggle to uncover the complete picture within the same sample/measurement. Here, we overcome this limitation by introducing bias-triggered conductivity relaxation (BCR) as a novel tool to investigate MIET reactions on oxides. It is based on alternating out-of-plane coulometric titration/polarization and in-plane electrical conductivity relaxation measurements, providing simultaneous electronic, ionic, and extraordinarily rich surface kinetics information. This innovative combination of electrical and chemical driving forces synergizes information depth, with enhanced time resolution, versatility, and speed, yet it lifts the weaknesses of the individual approaches, while remaining cost-effective and surprisingly simple. Furthermore, BCR allows to disentangle overpotential induced electrostatic modifications of the surface kinetics in a unique manner. We showcase the advantages of BCR in this work by studying the ORR in model (La, Sr)FeO3-δ thin film electrodes and reporting on their thermodynamic and kinetic properties.

Excessive or improper nitrogen (N) fertilization can disrupt calcium (Ca) nutrition in apple trees and induce Ca-related physiological disorders, yet its effects on Ca availability and partitioning remain unclear. This study evaluated the impact of different N fertilization regimes on soil Ca availability, Ca partitioning, and Ca bioavailability in fruit tissues of 10-year-old 'Fuji' apple trees, using Ca fractionation analysis combined with multi-criteria decision-making (TOPSIS). High N applied as a single dose (H1) significantly reduced soil water-soluble and exchangeable Ca, while increasing Ca oxalate (CaOx) accumulation in fruit pedicels, particularly at maturity. Although total CaOx in fruit flesh decreased, its relative proportion increased, indicating enhanced Ca sequestration. In contrast, split application of moderate N (M3) maintained more stable soil Ca availability, reduced CaOx accumulation, and improved Ca allocation to fruit tissues. Integrated evaluation ranked treatments as M3 > M1 > H3 > H1. Overall, moderate and split N fertilization reduced Ca sequestration into CaOx, enhanced Ca availability, and improved Ca distribution in fruit tissues, providing a physiological basis for optimizing N management to mitigate Ca-related disorders and improve fruit quality.

In our earlier report of headache prevalence among children (6-11 years) and adolescents (12-17) in Zambia, we defined undifferentiated headache (UdH) conventionally as mild headache lasting&#x2009;<&#x2009;1&#xa0;h. However, we recognised diagnostic uncertainties, which also occurred in our similar studies elsewhere in sub-Saharan Africa (Ethiopia and Benin). Here we use a modified definition of UdH, making new estimates of prevalence accordingly, and estimates based on these of headache-attributed burden. The study was part of the global schools-based programme conducted by the Global Campaign against Headache. In a cross-sectional survey using the standardised protocol of the global programme, the child and adolescent versions of the HARDSHIP questionnaire, translated into the local languages, were completed by pupils in mediated sessions within their classes in nine schools representative of Zambia's urban/rural divide. Headache diagnostic questions were based on ICHD-3 except for UdH, which we redefined as mild or moderate headache lasting&#x2009;<&#x2009;1&#xa0;h. Enquiry included multiple aspects of attributed burden. Of 2,759 potential participants, 2,089 (615 children [29.4%], 1,474 adolescents [70.6%]) completed questionnaires (participating proportion 75.7%). The unfeasibly high observed prevalence of migraine reported earlier (51.6%, including probable migraine) was reduced by redefining UdH to 42.9%, still highly questionable. Nonetheless, burden measures clearly distinguished migraine from tension-type headache (TTH) and UdH. Migraine headache was the most intense, most frequent and longest lasting, but proportion of time in ictal state (pTIS) was only 1.3%. However, pTIS was much greater among those with probable medication-overuse headache (7.9%) or other headache on &#x2265;&#x2009;15 days/month (9.0%). Headache accounted for an estimated loss of 3.5% of school time in those affected, migraine having twice the impact of TTH or UdH, while H15&#x2009;+&#x2009;accounted for >&#x2009;15% of lost school time. Almost one in six parents (15.9%) lost time from their own work. Migraine had greater impact than TTH and UdH on both emotional impact and quality-of-life scores. Headache, prevalent among children and adolescents in Zambia, is associated with burdens that include lost school time, with, potentially, lifelong negative impact. These findings are of importance to national educational and health policies. Our modified definition of UdH was a step towards diagnostic veracity, but did not resolve the diagnostic difficulties among young people. Future studies might consider further modifications, but full review of the ICHD criteria for migraine in these age groups is needed.

We report a first-principles study of Eu nano-sheets of varying thickness supported on a rutile TiO2 surface, focusing on the influence of spin-orbit coupling (SOC) and sheet thickness on the Eu 4f electronic structure and its catalytic implications. Using both collinear and non-collinear density functional theory with on-site Coulomb corrections (DFT + U) and van der Waals dispersion, we construct and relax interface models comprising single atoms, monolayers, bilayers, and quadruple layers of Eu. Layer-resolved density of states (DOS) analysis reveals that SOC lifts the degeneracy of the Eu 4f states, broadening their spectrum and shifting the principal DOS peaks closer to the Fermi level. For example, in the single-atom Eu configuration, SOC shifts the maximum 4f DOS peak from -0.759 eV to -0.063 eV while increasing the spectral width from 0.133 eV to 0.680 eV. A clear correlation emerges between the Eu-O interfacial distance and the localisation of the 4f states, with thicker Eu nano-sheets exhibiting sharper and more deeply bound electronic states. These results suggest that ultra-thin Eu configurations with SOC-broadened 4f states may enhance electron transfer to adsorbed intermediates, making them promising candidates for catalytic processes such as water splitting, hydrogen evolution, and hydrocarbon reforming.

The periorbital region and midface age as a continuous anatomic unit. Standard approaches addressing these regions separately may overlook their functional linkage. We describe a combined transcutaneous lower blepharoplasty and midface lift using multi-directional barbed polydioxanone (PDO) threads via a shared subciliary incision. This preliminary prospective consecutive case series was conducted at a single plastic surgery clinic between October 2022 and May 2023 to evaluate the early clinical outcomes and safety of combined transcutaneous lower blepharoplasty with multi-directional PDO thread midface lift. The study included 84 patients undergoing combined lower blepharoplasty and midface suspension using Sihler Thread&#xae; (multi-directional barbed PDO). Standardized pre- and postoperative photographs (4 months) were evaluated by three blinded physician evaluators. Outcomes included perceived age (pragmatic early aesthetic endpoint) and supportive validated/commonly used scales (Global Aesthetic Improvement Scale [GAIS] and a standardized infraorbital/tear-trough grading tool (Allergan Infraorbital Hollows Scale [AIHS]). Mean perceived age decreased from 57.0 &#xb1; 7.5 years preoperatively to 50.0 &#xb1; 6.6 years at 4 months (mean reduction 7 years; p < 0.001; 95% CI 6.2-7.8). The combined approach added approximately 5-7 min and required no additional incisions. No major complications (hematoma, infection, permanent nerve injury, thread extrusion/migration) were observed. Combined transcutaneous lower blepharoplasty with multi-directional PDO thread midface lift via a shared incision is technically feasible and associated with early (4-month) improvement. Because perceived age is subjective and follow-up is short, results should be interpreted as preliminary; controlled comparative studies with longer follow-up and objective grading are warranted.

In 2023, a majority (86%) of open-heart surgeries was performed at Thorax Centrum Twente (TCT) via a full median sternotomy. Currently, there is no consensus on postoperative sternal precautions following full median sternotomy. Research from the USA and Canada suggests that existing restrictive sternal precautions may not be necessary. More lenient sternal precautions, such as the "Keep Your Move in the Tube" principle, have shown positive outcomes, with no significant complications. Patients following this approach experienced fewer mobility issues and reported improved quality of life and reduced anxiety. This study explores the potential benefits of fewer restrictions, which could reduce patient anxiety and lead to fewer follow-up visits. This study aims to determine whether the Thoracic Surgical Rehabilitation Experts Twente (T-REX Twente) sternal precautions have a small positive effect on the Modified MacNew Quality of Life after Myocardial Infarction questionnaire (QLMI-2), physical activity, and reduction of movement-related anxiety in patients after full median sternotomy, compared to standard restrictive sternal precautions. It also assesses whether the T-REX sternal precautions result in no negative effects on pain, wound healing, or postoperative complications. This prospective, randomized, controlled, single-blind study will include adult patients undergoing full median sternotomy at TCT between June 2024 and June 2026, all participating in outpatient cardiac rehabilitation. Exclusion criteria include intensive care unit stays over 72&#xa0;h, delirium, dementia, severe cognitive impairments, language barriers, or treatment by an external referring cardiologist. The control group will adhere to current restrictive sternal precautions, whereas those in the intervention group will follow the T-REX sternal precautions, which allow lifting, pushing, or pulling as long as arm movement remains within a defined "tube." The primary endpoint is the change in QLMI-2 from baseline (T0) to start of phase II cardiac rehabilitation (T4). The T-REX Twente sternal precautions may improve quality of life, physical activity, and reduce movement-related anxiety, supporting the idea that less restrictive postoperative sternal precautions can enhance patient outcomes. CCMO Trial Register NL78107.100.23, registered on 29 February 2024. gov: NCT06115759.

Pre-performance routines (PPR) are widely used to optimize athletes' attentional, emotional, and physiological readiness before action. Motor imagery (MI), the mental simulation of an action, is an important part of PPR. Yet, how the content of MI within these routines shapes performance remains unclear. This study examined the functional effects of distinct MI types embedded in PPR on subsequent weightlifting performance. A sample of 120 national-level CrossFit&#xae; athletes performed clean and snatch lifts under four randomized conditions following a baseline recording session: Motivational General MI (MG-MI) focusing on physiological activation, Motivational Specific MI (MS-MI), Cognitive Specific MI (CS-MI) involving imagery of technical skills, and a control condition without imagery. Power output, barbell trajectory, and self-reported levels of motivation, fatigue, and difficulty were recorded. Results revealed that MG-MI and MS-MI significantly enhanced power and technical accuracy compared to all other conditions (p&#xa0;<&#xa0;0.001), whereas CS-MI markedly impaired performance (p&#xa0;<&#xa0;0.001). Subjective measures were unaffected, excluding motivational or fatigue-related influence. These results demonstrate that the functional direction of MI may determine its short-term efficacy within PPR. CS-MI involving imagery of technical skills might interfere with motor fluency through excessive conscious control. By delineating how CS-MI and both MG-MI and MS-MI components differentially affect expert motor behavior, this study offers evidence-based guidance for designing more effective PPR in sports.

Chiang, YC, Lin, WC, Weakley, J, and Chiang, CY. Variable resistance training improves velocity and power output by reducing concentric deceleration in the back squat. J Strength Cond Res 40(7): e663-e669, 2026-Free-weight resistance training (FWT) presents constant resistance, potentially causing a sticking region that negatively affects velocity and power outputs. We aimed to compare FWT with 15, 25, and 35% variable resistance training (VRT) using elastic bands on back squat kinetics and kinematics in the concentric phase. Twenty resistance-trained men performed back squats at 90% of their one-repetition maximum across the 4 conditions in a counterbalanced order in a single session. Resistance in VRT conditions was normalized to ensure the average resistance was equivalent to the FWT condition. Kinetic and kinematic data in the concentric phase were recorded using force plates and linear position transducers. One-way repeated-measures analysis of variance with Bonferroni post hoc comparisons compared dependent variables between conditions. Significance was set at p &#x2264; 0.05. No significant differences were found between conditions for peak velocity, peak power, peak force, or mean force in the concentric phase. However, a dose-response relationship was observed for other variables. Increasing the VRT percentage led to a significant reduction in sticking region duration, particularly at 25% and 35%VRT, and a significant decrease in force at zero velocity. Conversely, mean concentric velocity, velocity at sticking region onset, and mean concentric power all increased with higher VRT percentages. In conclusion, VRT enhances back squat concentric mean velocity and power output by reducing force at zero velocity and increasing velocity at sticking region onset, representing an effective alternative to FWT for improving these specific performance characteristics.

To analyze the epidemiological characteristics and incidence of mirror-image dextrocardia in pregnant women and fetuses before and after the lifting of coronavirus disease (COVID-19) control measures in China on December 7, 2022. We retrospectively collected data on the number of pregnant women who underwent prenatal ultrasound examinations and incidence of mirror-image dextrocardia in fetuses at three hospitals in Xi'an during three time periods: before the COVID-19 pandemic (January to April 2019), during the COVID-19 control measures (January to April 2022), and after the lifting of COVID-19 restrictions (January to April 2023). We then conducted an online epidemiological survey among pregnant women across China and collected the names of pregnant women with fetal mirror dextrocardia, as well as the following clinical information: age, location (province and city), gestational week at which mirror-image dextrocardia was detected, last menstrual period date, date of first pregnancy diagnosis, obstetric history, conception method, estimated due date, ultrasound diagnosis result, and genetic testing result. COVID-19-related information was also recorded. Between January and April 2019 (pre-pandemic), 9,112 pregnant women underwent prenatal ultrasound examinations at 3 hospitals in Xi'an. Between January and April 2022 (COVID-19 control measures period), 11,071 pregnant women underwent prenatal ultrasound examinations, and 1 case of fetus with mirror-image dextrocardia was identified (incidence rate, 0.9/10,000). Between January and April 2023 (after the lifting of COVID-19 restrictions), 11,516 pregnant women underwent prenatal ultrasound examinations, and 21 fetuses with mirror-image dextrocardia were detected, with an alarming incidence rate of 18.2/10,000. After the lifting of COVID-19 restrictions, the incidence of mirror-image dextrocardia in fetuses in Xi'an showed a significant increase (8-20-fold higher) compared to that observed in both the pre-pandemic and strictly controlled pandemic periods. An online investigation showed that 111 cases of fetal mirror-image dextrocardia were detected in 22 other provinces of China after the lifting of COVID-19 restrictions. All pregnant women with fetal mirror-image dextrocardia had a history of SARS-CoV-2 infection after the lifting of COVID-19 restrictions, which coincided with the early stages of embryo development, approximately 4-6&#xa0;weeks after their last menstrual period. Our data showed that the increase in cases of fetal situs solitus with dextrocardia coincided temporally with the outbreak of COVID-19 in China. This temporal overlap may suggest a potential association between the two events.

Predicting postoperative return to sport (RTS)/return to exercise (RTE) is challenging, particularly given the unclear impact of preexisting mood conditions. In sport/exercise participants who underwent spine surgery, the authors sought to evaluate the relationship between preoperative depression and postoperative sport/exercise participation and establish a threshold depression score predictive of RTS/RTE. A retrospective cohort study (2011-2022) was conducted of sport/exercise participants who underwent degenerative spine surgery. Moderate/severe depression was defined as a score &#x2265; 10 on the Patient Health Questionnaire-9 (PHQ-9). Primary outcomes were 1) RTS/RTE (yes/no), time to return (months), frequency of participation (hours and days per week); and 2) optimal PHQ-9 score predicting RTS/RTE. Secondary outcomes were patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Multivariable regression controlled for age, sex, BMI, use of narcotics, surgical procedure, and preoperative PROM scores. Of 737 patients surveyed on sports/exercise participation, 150 (20.4%) reported preoperative sport/exercise. The mean patient age was 56.3 &#xb1; 13.8 years, and the mean follow-up was 6.0 &#xb1; 2.1 years. Thirty-four (22.7%) patients had moderate/severe depression. Common sports/exercises were hiking (55.3%), weight lifting (46.0%), and running/jogging (40.7%). Of the 150 patients, 127 (84.7%; 64.7% depressed vs 90.5% nondepressed, p < 0.001) returned to sport/exercise within 8.9 &#xb1; 3.7 months (13.0 &#xb1; 19.3 vs 8.1 &#xb1; 12.2 months, p = 0.147) postoperatively. Compared with their presymptom baseline, depressed patients engaged in fewer days (2.5 &#xb1; 1.9 vs 4.2 &#xb1; 1.4 days, p = 0.011) and hours (5.1 &#xb1; 4.8 vs 10.1 &#xb1; 7.3 hours, p = 0.047) of sport/exercise weekly, compared with their presymptom baseline. Preoperative depression predicted longer time to RTS/RTE (HR 0.6, 95% CI 0.4-1.0; p = 0.043). A PHQ-9 score of 7.2 (AUC 0.71, p = 0.001) predicted failure to RTS/RTE. Preoperative depression predicted worse long-term ODI (&#x3b2; 15.0, 95% CI 4.2-25.8; p = 0.007) and NDI (&#x3b2; 17.3, 95% CI 0.94-33.7; p = 0.039) scores. Sport/exercise participants undergoing degenerative spine surgery with moderate/severe depression were less likely to return to sport/return to exercise, returned later, and failed to regain presymptom levels of participation. Even mild depression (PHQ-9 score 7-9) predicted failure to return to sport/return to exercise. To facilitate successful return to sport/return to exercise, surgeons should screen all patients for depression and consider referring those with even mild depression for preoperative psychiatric optimization.

Integrating neural and muscular signals into wearable robotics enables adaptive assistance during real-world tasks. This study proposes a multimodal neural interface for passive exoskeletons that combines electroencephalography (EEG) and electromyography (EMG) signals to classify motor gestures and estimate real-time cognitive and muscular effort, supported by finite-element-based biomechanical modeling. The system was implemented on the Ottobock Shoulder X passive exoskeleton&#xa9; and validated using synchronous EEG-EMG acquisition via the LiveAmp platform&#xa9;, a commercially available platform that was not developed specifically for this study. A hybrid CNN-LSTM architecture with deep fusion was employed to enhance robustness and responsiveness under realistic operating conditions. This study proposes a multimodal neural interface for the software-level adaptive assistance of passive upper-limb exoskeletons. While the physical device maintains a static mechanical profile, the proposed digital framework achieves adaptation by interpreting the user's physiological and motor states. Ten healthy participants performed three functional tasks (screwing, moving the box, and lifting the box) under five assistive conditions. Finite element modeling (FEM) was used to characterize the torque-angle relationship of the passive exoskeleton and to support the interpretation of experimentally observed assistive torque profiles. The FEM model, used as an offline biomechanical analysis tool to aid in the interpretation of experimental results, has not been integrated into the real-time control loop. Results showed an average classification accuracy of 90%, an F1-score of 0.85, and inference latency below 180 ms, confirming real-time applicability. Cognitive indices such as the Cognitive Load Index (CLI) and Frontal Asymmetry Index (FAI) enabled adaptive modulation of assistance strategies without requiring active actuation, thereby preserving the device's intrinsic passive nature. Comparative torque analysis highlighted the ergonomic benefits of passive systems in mid-range postures, while Finite Element Method (FEM) supported analysis clarified their limitations under highly dynamic loads compared to active solutions. These findings advance multimodal brain-machine interfaces for wearable robotics by integrating physiological sensing, deep learning, and biomechanical modeling, offering a safe, energy-efficient, and adaptive approach with potential rehabilitation, occupational ergonomics, and human-robot applications.

Heterogeneous hydrogels capable of complex, programmable deformation are highly desirable for soft actuators, yet general strategies that simultaneously impart structural anisotropy, rapid responsiveness, and mechanical robustness remain limited. Here, a gradient anisotropic natural rubber-poly(N-isopropylacrylamide) (NR-PNIPAM) composite hydrogel is developed through a simple one-pot polymerization strategy by coupling pH-regulated colloidal stability with gravity-directed redistribution of natural rubber latex particles. Under an optimized pH window, NR nanoparticles gradually migrate during gelation and are fixed as a continuous gradient within the PNIPAM network, generating built-in structural asymmetry for nonuniform deformation. Meanwhile, NR nanoparticles act as soft reinforcing domains to improve mechanical strength, while water-soluble graphene nanosheets provide efficient photothermal conversion for remotely-controlled near-infrared (NIR)-responsive actuation. Benefiting from this synergistic design, the hydrogel exhibits programmable bending and localized folding with high actuation rates of 129&#xb0; s-1 and 46&#xb0; s-1, respectively, along with a tensile strength of 0.32 MPa and an active lifting capability exceeding 70 times its own weight. The material further enables biomimetic gripping and lifting under NIR stimulation. This work establishes a general route to robust gradient hydrogels by integrating colloidal regulation, structural anisotropy, and photothermal actuation, offering a versatile platform for high-performance soft intelligent systems.

A 55-year-old patient presented with persistent back pain after a lifting injury. Later, buttock pain and hypaesthesia of the left knee developed. MRI revealed a lesion at lumbar vertebral body L3, histologically confirmed as a conventional chordoma. Chordomas are rare, locally aggressive tumors of notochordal origin with a high recurrence rate and require specialized treatment. A two-stage en-bloc spondylectomy with dorsal decompression and anterior cage implantation was performed on the patient. Postoperatively, there were motor deficits in hip flexion and knee extension, while distal strength and sensation were preserved. Due to the R1 resection, an additional proton radiation therapy is actually planned. Persistierende R&#xfc;ckenschmerzen nach Hebetrauma &#x2013; von der Bagatelle bis zum seltenen Fall. Ein 55-j&#xe4;hriger Patient stellte sich nach einem Hebetrauma mit persistierenden R&#xfc;ckenschmerzen vor. Im Verlauf traten neue Ges&#xe4;ssschmerzen und eine Hyp&#xe4;sthesie am linken Knie auf. In der MRT zeigte sich dann eine Raumforderung im Lendenwirbelk&#xf6;rper 3. Histologisch wurde die Diagnose eines konventionellen Chordoms gestellt. Chordome sind seltene, lokal aggressive Tumoren notochordaler Differenzierung mit hoher Rezidivrate, die eine spezialisierte Therapie mit radikaler lokaler Resektion erfordern. Es erfolgte eine zweizeitige En-bloc-Spondylektomie mit dorsaler Dekompression und anteriorem Cage-Einsatz. Postoperativ bestanden beim Patienten motorische Einschr&#xe4;nkungen der H&#xfc;ftflexion und Knieextension, distal waren Kraft und Sensibilit&#xe4;t erhalten. Aufgrund einer R1-Resektion ist aktuell eine erg&#xe4;nzende Protonenbestrahlung geplant. Schl&#xfc;sselw&#xf6;rter: R&#xfc;ckenschmerzen, Red Flags, Tumor, Chordom.

Facioscapulohumeral muscular dystrophy (FSHD) is a rare, progressive genetic disorder characterized by asymmetric muscle weakness and functional decline. Although it is one of the most common muscular dystrophies, its economic burden in the United States (US) is largely unknown. This study aimed to provide an initial, conservative estimate of annual medical claims costs and identify comorbidities disproportionately affecting individuals with FSHD in the US. This retrospective, 1:5 matched case-control study analyzed de-identified claims data from Medicare and commercially insured enrollees from 2018 to 2021. Medical and prescription costs were aggregated and described as means with 95% confidence intervals. T-tests with Bonferroni correction and chi-square tests were used to compare comorbidity prevalence. The study included 383 individuals with FSHD and 1915 matched controls. The mean annual medical claims cost for the FSHD cohort was $19,370 per person with commercial insurance and $11,704 with Medicare, compared with $5250 among controls. Individuals with FSHD also incurred higher prescription claims costs in commercial and Medicare subgroups without comorbidities. The prevalence of cerebrovascular disease (10.18% vs 4.44%) and ear disorders (8.09% vs. 3.39%) was significantly greater in the FSHD cohort (P<0.05). This exploratory study provides the first US-based description of the direct medical costs of FSHD, demonstrating a substantially higher healthcare burden than that of matched controls. Because the study design likely underestimates costs, the true economic impact may be even greater. These findings establish a critical foundation for future research into the lifetime medical, nonmedical, and caregiver-related costs of FSHD, and highlight the urgent need for effective therapies and supportive care strategies. Facioscapulohumeral muscular dystrophy (FSHD) is a rare muscle disease that causes progressive weakness in the face, shoulders, upper arms, core, and legs. Over time, it can make everyday tasks such as lifting, walking, or speaking more difficult. While FSHD is one of the most common muscular dystrophies, little is known about its financial impact on people living with the condition and the healthcare system in the United States. To better understand this burden, this study evaluated medical insurance claims for individuals with FSHD and compared them with those of individuals without FSHD. We examined costs from both commercial insurance and Medicare between 2018 and 2021. Individuals with FSHD had substantially higher medical costs than those without the condition. Average annual medical claims were $19,370 for those with commercial insurance and $11,704 for those on Medicare, compared with $5250 for matched individuals without FSHD. Individuals with FSHD also had more prescriptions and were more likely to have claims for other health problems, such as stroke-related conditions and ear disorders. These results show that FSHD is associated with a meaningful financial burden on the healthcare system. Because this study was based on claims data and likely underestimates the full cost of care, the real burden may be even higher. Understanding these costs is an important first step toward improving care, planning support services, and encouraging investment in better treatments for people living with FSHD.

Submental "double-chin" deformity is multifactorial and may reflect the volume and boundaries of preplatysmal fat, variability in platysmal decussation, and aging-related changes at the cervicomental angle. U-shaped cogged thread lifting is increasingly used as a minimally invasive option for submental contouring, yet the mandibular angle/antegonial notch region contains facial vessels and nerve branches that can be injured when the cannula or thread deviates into a deeper plane. To describe cadaveric anatomical observations relevant to submental U-shaped cogged thread lifting and to propose a fixation concept using a regionally condensed fibrous layer beneath the platysma near the mandibular angle (herein referred to as the "subangular deep fascia"), representing a functional fascial interface rather than a formally defined anatomical layer, to reduce off-target traversal and potential injury. Cadaveric thread simulations were performed to reproduce common U-shaped submental thread trajectories. Layer-by-layer dissections were used to identify the relationship of the simulated thread path to the platysma, facial artery/vein at the antegonial notch region, parotid tail, sternocleidomastoid muscle, and superficial sensory nerves. Representative photographs were compiled as figures. When the trajectory was directed toward a posterior mastoid fixation, the thread pathway tended to approach deeper tissue planes near the mandibular angle, placing it in close proximity to vertically ascending facial vessels; a representative specimen demonstrated direct arterial penetration. A relatively thick and resistant fibrous layer was consistently appreciable beneath the platysma near the mandibular angle, which may represent a regional fascial condensation rather than a distinct named anatomical structure, and provided a plausible alternative fixation point. Conceptually, a subangular deep fascia fixation corridor allows the thread to remain predominantly preplatysmal while limiting posterior traversal through the parotid-sternocleidomastoid region. The mandibular angle/antegonial notch region represents a critical transition zone in submental thread lifting. Anchoring within a dense subangular deep fascial layer beneath the platysma may improve procedural safety by reducing the need for deep posterior passage and by supporting a stable lifting vector. Further quantitative cadaveric mapping and prospective clinical studies are needed.

BackgroundBathing residents is among the most physically demanding tasks in long-term care facilities, involving frequent lifting, turning, washing, and dressing. In Taiwan, chronic staff shortages force caregivers to work under time pressure and adopt awkward, non-ergonomic postures, substantially increasing the risk of cumulative musculoskeletal disorders (MSDs).ObjectiveThis study examined the association between postural risk and MSDs among caregivers performing bathing tasks in long-term care facilities.MethodsFifteen caregivers from long-term care institutions in Yunlin and Chiayi, Taiwan, participated. The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess musculoskeletal discomfort, and the Rapid Entire Body Assessment (REBA) method was applied to evaluate postural risks.ResultsThe mean REBA score was 11.67 (SD&#x2009;=&#x2009;0.94), indicating a very high-risk task requiring immediate intervention. The trunk and upper arms showed greater risk than the lower arms and legs. The mean MSD score was 1.87 (SD&#x2009;=&#x2009;1.97), with a prevalence of 84.4%. Symptoms were most severe in the lower back, followed by the upper limbs. Pain locations corresponded with high-risk postures, suggesting an association between posture and discomfort. Risk levels were unrelated to age or work tenure but were linked to task exposure and environmental constraints.ConclusionsBathing assistance poses a risk for long-term care workers. Facilities should prioritize height-adjustable electric shower beds and armrest-supported chairs to reduce trunk flexion. Although body mechanics training and job rotation may help, they cannot fully address staffing shortages or workspace "constraints." Long-term adoption of automated bathing systems is needed to reduce hazardous exposure and improve safety.

Estimation of lumbar spinal loads is important for understanding low back pain, guiding ergonomic interventions, and informing surgical and rehabilitation planning. Historically, intradiscal pressure (IDP) provided one of the few internal in vivo measures of disc loading; more recently, telemetry, musculoskeletal (MS) modeling, finite element (FE) analysis, hybrid MS-FE approaches, displacement/control-based methods, and AI surrogates have expanded the toolbox for estimating spinal loads. We present a narrative perspective review based on a literature search in PubMed, Scopus, and Web of Science using terms related to spinal loads, IDP, telemeterized implants, MS modeling, FE analysis, hybrid MS-FE coupling, displacement/control-based methods, wearable/EMG-based approaches, and AI/machine learning surrogates. Human lumbar studies and methodological contributions relevant to load estimation or validation were included; animal models were excluded. Invasive approaches (needle-based IDP, discography, intra-abdominal pressure, and telemeterized implants) provide task-dependent internal pressures or forces in small, selected cohorts and now primarily serve as benchmarks for model validation. MS models estimate segmental compression, shear, and net moments from motion and EMG, with typical L4-L5 compressive forces of &#x223c;1-2 kN in relaxed standing and &#x223c;3-5 kN during common lifting tasks. FE and hybrid MS-FE simulations resolve how these loads are distributed across discs, facets, and ligaments and relate segmental forces to internal stresses. Displacement-driven/control-based models and emerging AI/wearable-based surrogates provide additional non-invasive pathways for task-specific lumbar load estimation. This methods-focused synthesis outlines how invasive data support MS, FE, hybrid, and AI-based approaches and highlights recurring challenges in muscle redundancy, constitutive and parameter uncertainty, limited in vivo benchmarks, and heterogeneous model reporting. Within this framework, IDP is best regarded as an internal benchmark rather than a stand-alone metric of "spinal load" which is more fully described by compression, shear, moments, and internal stresses.

Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It can affect young healthy adults during physical exertion or the Valsalva maneuver. There is little evidence behind a fibrocartilaginous embolism causing spinal cord infarctions. The efficacy of thrombolytic therapy in spinal cord infarction is not well established. A 56-year-old male with hypertension presented with acute onset left arm and leg weakness after a Valsalva maneuver. The exam was remarkable for dense flaccid paralysis of the left arm and leg. Patient received thrombolytic therapy for suspicion of stroke. MRI C-spine revealed a nonenhancing lesion from C2 to C5 with diffusion restriction on DWI, suggesting a spinal infarct. He received 5 days of high-dose steroids with mild improvement of left lower extremity weakness. Labs were unremarkable for underlying inflammatory or demyelinating causes of myelopathy. We ruled out aortic dissection and cardioembolic causes. Upon further evaluation, the patient endorsed lifting heavy weights and had cervical spondylosis on imaging, which led to the diagnosis of fibrocartilaginous embolism. On 1-year follow-up, he is walking without support with some motor improvement in the distal left upper extremity. It is important to have a wide differential diagnosis in acute cases of myelopathy. In our patient's case, his diagnosis was one of exclusion. This case highlights a rare cause of spinal cord infarction in a middle-aged man. The efficacy of thrombolytic therapy in such cases needs further investigation.