Idiopathic scoliosis is a common 3D spinal deformity with a global prevalence of 2% to 3% in adolescents. Early detection is crucial for timely intervention and preventing curve progression. Although standing full-spine radiography with Cobb angle measurement remains the diagnostic gold standard, its time-consuming nature limits its utility for large-scale screening. Safe, rapid, and noninvasive screening methods are urgently needed to identify high-risk individuals while reserving x-rays for definitive diagnosis. This study aimed to evaluate the diagnostic accuracy of a custom-developed millimeter-wave imaging system in patients with suspected scoliosis, with radiographic Cobb angle measurement serving as the reference standard, and explore its potential as a first-line screening tool. This prospective diagnostic accuracy study enrolled consecutive outpatients with suspected scoliosis. All participants underwent rapid millimeter-wave imaging scanning (Ka band, 29-40 GHz with no undressing required) followed by standard standing full-spine radiography. Scoliosis was defined as a Cobb angle of 10° or higher. Millimeter-wave images were evaluated using four morphological indicators: (1) shoulder height asymmetry (≥2 cm), (2) trunk lateral shift (≥2 cm), (3) waistline contour asymmetry (≥5°), and (4) lower-limb height difference (≥1 cm). A multiparameter integration strategy classified screening as positive if more than 2 indicators exceeded threshold values. Cobb angle measurements were performed independently by 2 experienced orthopedic surgeons blinded to millimeter-wave image results and each other's assessments. Diagnostic performance metrics (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy) were calculated according to the STARD (Standards for Reporting of Diagnostic Accuracy Studies) guidelines. A multivariate logistic regression model incorporating the 4 morphological parameters was constructed for receiver operating characteristic curve analysis. Ultimately, 132 participants were included. Radiographic evaluation confirmed 98 (74.2%) cases with scoliosis (Cobb angle≥10°) and 34 (25.8%) negative cases. Millimeter-wave imaging achieved an overall accuracy of 86.4% (114/132; 95% CI 76.5%-94.7%), sensitivity of 85.7% (84/98; 95% CI 75.1%-96.5%), specificity of 88.2% (30/34; 95% CI 70.7%-97.6%), positive predictive value of 95.5%, and negative predictive value of 68.2%. Receiver operating characteristic curve analysis of the multivariate logistic regression model exhibited an area under the curve of 0.862 (95% CI 0.802-0.922), with a sensitivity of 92.9% (91/98) and specificity of 38.2% (13/34). Notably, sensitivity was lower for mild curves (Cobb angle=10°-20°) than for moderate or severe curves (≥20°). Millimeter-wave imaging represents a feasible, rapid, and non-ionizing radiation screening method for scoliosis with good diagnostic accuracy (accuracy=114/132, 86.4%; sensitivity=84/98, 85.7%; specificity=30/34, 88.2%). Its capability to penetrate clothing and rapid scanning time (approximately 2 seconds) make it suitable for large-scale screening applications. As a first-line screening tool, this method identifies high-risk individuals for targeted referral and definitive radiography. It follows the "as low as reasonably achievable" principle, optimizing scoliosis screening and reducing unnecessary radiation exposure.
Stomach contents with seeds in avian fossils from the latest early/earliest middle Eocene Messel oil shale (Germany) are surveyed. 20 bird specimens belonging to 10 species with seeds produced by at least 13 different plant species are reported. The fossils provide the earliest direct evidence for avian frugivory and suggest that seed dispersal by neornithine (crown group) birds occurred earlier and was more extensive than currently thought. For the first time, we report seeds in the stomach content of stem group Trogoniformes, which today are important seed dispersers in the New World tropics. Other birds belong to the Galliformes, Gruiformes (Messelornithidae), Coliiformes, Coraciiformes, and the extinct taxa Halcyornithidae and Zygodactylidae. Extant Coraciiformes are predominantly carnivorous, whereas some Galliformes and Gruiformes as well as the Coliiformes today also consume fruits. All reasonably well-preserved seeds appear to be from angiosperms, including specimens identified as Rutaceae, Mastixiaceae, and Vitaceae. Unidentified seeds represent various other plant groups. Several of the arboreal birds ingested seeds of the Vitaceae. This plant family already evolved in the Late Cretaceous, whereas arboreal Neornithes did not radiate before the early Cenozoic. As such, and at least concerning arboreal birds, these fossils provide evidence for the "recruitment hypothesis", which suggests that early Cenozoic seed dispersers exploited an existing diversity of edible fruits.
Obesity-related type 2 diabetes (DM) is increasing rapidly and at present reaching epidemic proportions in some Worldwide populations. The aim of this study was to provide new knowledge on the interplay between genetic and lifestyle obesity-related risk factors in populations with the highest incidence of obesity-related diabetes could provide an important tool to help prevent or delay diabetes onset in high-risk groups. Community free-living individuals visiting primary health centers were recruited to the study following informed written consent. Demographic and clinical characteristics, physical activity, dietary intake and biological markers of DM were measured at baseline and follow up. Validated questionnaires were used to assess physical activity and dietary intakes. A Cox proportional hazards analysis was used to examine the risk of developing diabetes diagnosed using the WHO cut-of-points criterion of HbA1c ≥ 6.5% at follow after adjusting for known clinical risk indicators. A total of 375 Community free-living locals UAE citizens subjects, 348 (93%) of them females and 253 non-locals' expatriates [187 (73%)] females were recruited and followed up for a period of 427 ± 223 days. Using WHO cut-of-points for diagnosing DM (HbA1c ≥ 6.5%), 31 (6%) subjects out of 545 followed up developed DM. Overall local United Arab Emirates (UAE) citizens reported significantly lower levels of physical activity in comparison to non-local expatriates. The Cox proportional hazard model analysis revealed that being obese, UAE national and physically inactive is associated with a significantly increased risk of DM after adjusting for other prognostic indicators [non-UAE national: Odd ratio (95% CI): 0.13 (0.04, 0.47); p=0.002; physically active: 0.31 (0.11, 0.90); p=0.002]. The Kaplan Meier figures show the significantly increased risk of developing DM in physically inactive local UAE citizens compared with expatriates' residents (p<0.05). In contrast risk of developing DM was no different between physically very active UAE nationals compared to non-nationals at follow up (P>0.5). Our finding suggests that physical inactivity in high-risk groups is the most important risk factor for developing DM. Urgent actions are needed to increase physical activity in this high-risk group coupled with further research to understand the reasons for this striking indigenous population variability.
Hormonal contraceptive (HC) use is common among servicewomen and has been discussed in relation to health, performance, and operational readiness. No systematic data exist on HC prevalence among German servicewomen. This study analyzes contraceptive practices and motivations for contraceptive choice in German servicewomen. A nationwide, cross-sectional online survey was conducted among female members of the German Armed Forces. Recruitment occurred via military institutions and a digital flyer. The anonymous questionnaire (40 items, 10-15 min) assessed demographic characteristics and contraceptive use. Data were cleaned and analyzed using R. Inferential analyses comprised pairwise adjacent comparisons using Fisher's exact test with Holm correction. A total of 2818 servicewomen completed the survey (response rate 11.2%; mean age 33.9 years). Overall, 38.1% reported current HC use. Combined oral contraceptive pills (COCP) were the most common method (18.5%), followed by hormonal intrauterine devices (8.9%) and progestin-only pills (8.4%). HC use declined with increasing age, primarily due to decreasing pill use, although 8% of women ≥40 years still reported COCP use. Systemic long-acting reversible contraceptives (LARC) (implants and injections) were virtually absent. Contraceptive use differed significantly across age- and length-of-service categories, but not BMI categories. Pregnancy prevention was the primary reason for HC use (82%), followed by management of menstrual pain and bleeding. A small proportion reported HC use for performance-related cycle control (13%) or masking of amenorrhea (2%). Deployment-related switching to HC was uncommon. HC use among German servicewomen appears low compared with reports from British and U.S. militaries. Given evidence linking certain systemic LARC formulations to potential effects on bone metabolism, the low prevalence warrants further investigation in the context on musculoskeletal health and injury risk in a population exposed to high mechanical loading. Preventive efforts in the German military should consider a broader range of modifiable risk factors, including nutrition and training load. The findings may indicate potential gaps in military-specific education and counseling regarding informed contraceptive choice, occupational implications of different methods, and age-related hormonal management. The response rate and the limited scope of certain questionnaire items should be considered when interpreting the results.
Cannabis use is increasing, even during pregnancy. The purpose of this study was to investigate how women of childbearing age perceive the safety of cannabis use during pregnancy compared to alcohol and tobacco use. Cloud Research recruited a national U.S. cohort of women of childbearing age (N = 622) to complete an anonymous online survey assessing cannabis, alcohol, and tobacco use during pregnancy. Validated tools measured perceptions of safety and risks to fetal, birth, and infant development. Data analyses included descriptive statistics, McNemar's tests, and repeated-measures ANOVA with post-hoc comparisons. The average age was 29.47 years (SD = 6.83, range: 18-42). Participants self-identified as White (65.9%, n = 410), Black or African American 28.1% (n = 175), Asian 5.9% (n = 37), American Indian or Alaska Native 3.9% (n = 24), or Other 4.7% (n = 29); 17.7% (n = 110) identified as Hispanic or Latino. Most participants identified as heterosexual (82.0%, n = 510). Among participants who had been pregnant (N = 351), 25.9% reported cannabis use during pregnancy, compared with 23.6% for tobacco and 8.2% for alcohol. The median frequency of prenatal cannabis use was twice weekly, with joints and blunts being the most common methods. Reported reasons for use included relief of nausea, anxiety, sleep disturbance, and pain. We used a five-point Likert scale to determine whether they thought cannabis, alcohol, and tobacco were safe to use during pregnancy, where 1 = not at all safe, and 5 = completely safe. Prenatal cannabis use was rated as safer (M = 3.85, SD = 1.46) than alcohol. (M = 4.86, SD = 0.54, p < .001) or tobacco (M = 4.79, SD = 0.63, p < .001). Findings indicate that women of childbearing age perceive cannabis as relatively safe during pregnancy, particularly for symptom management. These perceptions underscore the need for targeted education, accurate messaging, and consideration of the social, cultural, and emotional factors that influence substance use during pregnancy to safeguard maternal and fetal health.
Worldwide, new technologies appeared to be inevitable for human being. Man is the creator of all these technologies but the core question is whether these innovations are dangerous and threatening for creativity, especially in arts. Technology significantly influences art creativity by providing new tools and mediums, such as digital painting and virtual reality, which expand the artistic possibilities. It also enhances the accessibility, allowing artists to reach wider audiences and fostering inclusivity within the art community. This relationship between art and technology isn't new, but the digital revolution has accelerated changes at an unprecedented pace, creating exciting new possibilities while challenging the traditional notions of creativity, ownership, and what we even consider "art" in the first place. While AI can enhance efficiency, it lacks the instinct, emotion, and nuance that human-driven storytelling provides. Emerging technologies such as Artificial Intelligence (AI), Virtual Reality (VR), and blockchain are re-shaping the creative industries by enabling new forms of expression, expanding access to global audiences, and redefining how art is produced, distributed, and experienced. However, if an AI creates a piece, should the credit go to the machine, the programmer, or the artist who directed it? There is a completely understandable and reasonable concern that AI-generated art may lead to homogenization, where artworks start to look similar due to reliance on the same algorithms and datasets. While the nature of the creative process is under debate, many believe that creativity relies on real-time combinations of known neural and cognitive processes. Every original work, whether it is a music or a painting, contains within it that invisible sign of inimitableness, which Benjamin called 'the aura'. A convinced suspicion of the original work, whether it be a music, novel or a painting, saves within itself that invisible sign of irreversibility dictated to the aura.
Hospitalists often consult physical therapy (PT) and occupational therapy (OT) for hospitalized patients. PT and OT improve patient functional status, the likelihood of home discharge, and reduce the risk of hospital-acquired conditions. Despite this, hospitalized patients with normal functional status are unlikely to benefit from PT and OT. Consulting PT and OT for patients with normal functional status may divert services from those more likely to benefit. Hospitalists should employ screening tools to identify patients with normal functional status who are unlikely to benefit from PT and OT and avoid consulting PT and OT for these patients.
To assess the risk of stroke/TIA and progression to atrial fibrillation (AF) in Indian patients with device-detected atrial high-rate episodes (AHRE) lasting less than 24 h. In this single-centre prospective matched cohort study, 109 patients with AHRE < 24 h matched to 109 controls without AHRE on age (+/-5 years), sex, device type, device indication, and CHA2DS2-VASc score. Followed for a minimum of 12 months (mean 18.4 months). The CHA2DS2-VASc score was near-perfectly matched between groups (mean 3.26 vs. 3.29, score distribution chi-square p = 1.00). A stroke or TIA occurred in 7 patients with AHRE versus 1 control (annual rate 4.28% vs. 0.61%; OR 7.41, 95% CI 0.90-61.3; p = 0.020; HR 7.19, 95% CI 0.89-58.48; log-rank p = 0.031). Progression to clinical AF, AHRE ≥ 24 h, atrial flutter, or atrial tachycardia happened in 32 AHRE patients versus 2 controls (annual rate 19.7% vs. 1.2%; OR 22.2, 95% CI 5.17-95.6; HR 19.55, 95% CI 4.6-81.71; log rank p < 0.001). Stroke risk increased with CHA2DS2-VASc score: 2.15% (score 3), 4.16% (score 4), 6.66% (score 5), and 9.5% (score ≥ 6). In this hypothesis-generating study, device-detected AF lasting less than 24 h is associated with a significantly higher risk of stroke/TIA and progression to clinical AF in Indian patients. It requires confirmation in larger studies. Region-specific absolute risks must be considered when applying international anticoagulation guidelines.
Ebeye Hospital is a 60-bed acute care and district hospital in the Republic of the Marshall Islands (RMI). In October 2022, the hospital's Infection Prevention and Control (IPC) Program initiated health care-associated infection and antimicrobial resistance surveillance, along with efforts to promote appropriate antimicrobial use. New National IPC Guidelines call for the institution of appropriate infection control measures (based on the organism identified and site of infection) and adjustment, when needed, of patients' antibiotic regimen within 24 hours of release of multidrug-resistant organism culture results. A descriptive cohort study was conducted on hospital inpatients who tested positive for multidrug-resistant organisms, using program data from October 25, 2022, to December 31, 2023. Each case (n=58) was reviewed to assess: a) the timeliness of initiating infection control measures, and b) the timeliness and appropriateness of antibiotic selection, as guided by the RMI National Antimicrobial Guidelines. Multidrug-resistant organism cases involved a variety of organisms and occurred across all clinical wards. Of these, 35 cases (60%) met IPC standards. The primary reasons for not meeting IPC standards were lack of isolation rooms (n=10, 44%) and failure to meet the IPC initiation criterion per the working definition (n=13, 56%). Only 8 cases (14%) adhered to antibiotic usage guidelines. The most common reasons for non-adherence were prolonged antibiotic duration (n=19, 38%) and shorter-than-recommended duration (n=16, 32%). Management of a substantial proportion of multidrug-resistant cases at Ebeye Hospital failed to meet IPC standards. These findings highlight several areas for improvement.
Osteoarthritis (OA) is a prevalent degenerative joint disease with limited effective treatment options. Joint inflammatory pain is a primary reason patients seek care, but systemic drug administration often causes severe side effects, while intra-articular injection suffers from rapid clearance and poor tissue penetration. Herein, we develop nanozyme-based Janus nanomotors loaded with metformin (MET) for reactive oxygen species (ROS)-targeted therapy in OA. Leveraging intrinsic superoxide dismutase (SOD) and catalase (CAT) enzymatic activity, these nanomotors harness pathologically elevated ROS within the articular microenvironment as chemical fuel, achieving self-propelled deep penetration into both cartilage and synovial tissue. This mechanism facilitates simultaneous on-the-move ROS scavenging and sustained deep-tissue MET release, which further restores redox homeostasis and protects chondrocytes by regulating the NRF2/KEAP1 signaling pathway. Furthermore, the nanomotors can suppress nociceptive signaling in the dorsal root ganglia (DRG), thereby alleviating joint pain and improving mobility. This research offers a novel and efficient approach for cartilage protection and arthritis pain management.
The article discusses the socio-legal aspects of the development mutual cooperation between Russia and China in the public health. This direction of the current Russian-Chinese political agenda is caused by some factors. One of them is the common nature of public health problems and challenges faced by the healthcare systems. Also the reason is the growth of cross-border mobility of the population of both countries, which necessitates coordination of efforts in the field of regulation, ensuring the quality of services, protecting patients rights and epidemiological control. In this regard, the objective of the study is to analyze the key areas, legal mechanisms and social challenges that influence the development of interaction between Russia and China in the field of public health. Based on the results of the study, the main vectors in the Russian-Chinese cooperation in the field of public health are defined. They include: 1) prevention and control of infectious diseases; 2) digital transformation of healthcare; 3) oncology and nuclear medicine; 4) medical education and science; 5) ethical problems. The main mechanisms of interaction between Russia and China in public healthcare are legal regulatory (bilateral agreements, interdepartmental protocols, harmonization of regulatory requirements) and projects in scientific and educational sphere. Overall, cooperation between Russia and China in healthcare is dynamically developing, multifaceted, and promising. However, there are a number of limitations and problems, including cultural barriers, legal restrictions and ethical challenges. To sum up, the Russian-Chinese cooperation in the field of public health has significant potential, but requires the development of a legal framework and a systematic approach. Одним из актуальных направлений в развитии отношений между Россией и Китаем на современном этапе является сотрудничество обоих государств в сфере общественного здравоохранения. Данный вектор российско-китайской политической повестки обусловлен рядом фактором, а именно: общим характером проблем здоровья населения и вызовами, с которыми сталкиваются системы здравоохранения, ростом трансграничной мобильности населения обеих стран, что вызывает необходимость координации усилий в области регулирования, обеспечения качества услуг, защиты прав пациентов и эпидемиологического контроля, которые обусловливают исследовательский интерес к изучению социально-правовых аспектов в развитии российско-китайского сотрудничества в сфере общественного здоровья. В этой связи цель данного исследования заключается в проведении анализа ключевых направлений, правовых механизмов и социальных вызовов, которые влияют на развитие взаимодействия между Россией и Китаем в сфере общественного здоровья. По результатам проведённого исследования на основе принципа методологической триангуляции были выявлены основные векторы в российско-китайском сотрудничестве в сфере общественного здоровья: 1) профилактика и борьба с инфекционными заболеваниями (в 2025 г. Россия и Китай подписали меморандум о сотрудничестве в области борьбы с инфекционными болезнями); 2) цифровая трансформация здравоохранения (в 2025 г. Минздрав России и Государственный комитет КНР по здравоохранению подписали Меморандум о взаимопонимании в области цифровой трансформации здравоохранения); 3) онкология и ядерная медицина; 4) медицинское образование и наука (образована Российско-Китайская ассоциация медицинских университетов, которая способствует обмену специалистами, разработке совместных образовательных программ и взаимному признанию дипломов о медицинском образовании). Основными механизмами взаимодействия России и Китая в сфере общественного здравоохранения выступают: нормативно-правовые (двусторонние соглашения, межведомственные протоколы, гармонизация регуляторных требований) и научно-образовательные (совместные исследования, обмен кадрами, образовательные программы). В целом, сотрудничество России и Китая в сфере здравоохранения можно охарактеризовать как динамично развивающееся, многогранное и перспективное. Однако есть ряд ограничений и проблем, включая культурные барьеры, правовые ограничения и этические вызовы. Сделан вывод о том, что российско-китайское сотрудничество в сфере общественного здоровья имеет значительный потенциал, но требует разработки правовой базы и системного подхода.
Time to treatment failure (TTF), defined as the time from random assignment to treatment cessation for any reason, is an end point readily obtainable from routine clinical and real-world data sources. Despite its growing use, evidence describing its relationship with progression-free survival (PFS) remains limited. We evaluated the association between TTF and PFS across tumor types and treatment modalities to assess the validity of TTF as an end point for pragmatic oncology trials. A systematic search identified randomized trials of advanced solid tumors reporting TTF and PFS. Correlations between hazard ratios (HRs) for TTF and PFS were assessed using inverse variance-weighted linear regression, stratified by prognosis (median overall survival <12 v ≥12 months). Subgroup analyses were performed according to therapy type and line of treatment. Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves to enable arm-level comparisons. Fifty-eight analysis units encompassing 19,099 patients across 13 tumor types were included. TTF and PFS were strongly correlated in both poor- (r = 0.81; 95% CI, 0.59 to 0.94) and good-prognosis (r = 0.79; 95% CI, 0.60 to 0.91) groups. In the intervention arm, median TTF and PFS were comparable in poor-prognosis trials (9.6 v 11.0 months, P = .12) but diverged in good-prognosis settings (16.8 v 23.0 months, P < .001). Correlation was the highest in chemotherapy-based (r = 0.93-0.96) and first-line (r = 0.88-0.90) trials and weaker in targeted-therapy (r = 0.35-0.55) and later-line settings (r = 0.35-0.82). TTF offers a practical, patient-centered end point, reflecting both treatment efficacy and tolerability. Its strong correlation with PFS supports its role as a clinically meaningful end point for pragmatic oncology trials in advanced cancers.
Kratom use is growing for both therapeutic and non-therapeutic effects. This survey assessed the temporal relationship between kratom initiation and prior, subsequent, or concurrent substance use or medical treatment. This cross-sectional, anonymous electronic survey was disseminated to American Kratom Association and Global Kratom Coalition members from 3/2025-9/2025. Adults aged ≥18 years who reported past or current kratom use were eligible. A novel questionnaire was generated assessing: kratom and other substance use characteristics; pursuit of medical treatment for selected diagnoses; and temporal relationships between kratom use and substance use or medical treatment. Of 161 respondents included, most (95.7%) currently versus previously used kratom. Whole-leaf product use was reported most often (90.3%), with 38.3% reporting concentrated kratom extracts and 16.9% single alkaloid isolates. Reasons for kratom use were therapeutic (50.3%), non-therapeutic (16.1%), or both (33.5%). Therapeutic (self-treatment) use was most commonly cited for pain (86.2%), mental focus (52.3%), mental health (46.9%), sleep (43.1%), and substance use disorder (27.7%). Most respondents had used ≥1 other psychoactive substance in their lifetime, including cannabis (74.3%), alcohol (68.2%), stimulants (43.2%), sedatives (33.1%), non-prescribed opioids (26.4%), or tobacco (6.1%); 10.1% reported no prior substance use besides kratom. Whether used for non-therapeutic or therapeutic purposes, kratom was rarely initiated first. Among those with a substance use history, only 3-10% reported trying kratom prior to other substances reported. Among those with pertinent medical conditions, 0-20% initiated kratom before receiving medical care for their reported conditions. This study builds on previous research assessing kratom use motivations, providing insight into the temporal relationship between kratom initiation and substance use or medical treatment. Kratom was rarely the first substance or therapeutic treatment tried, but rather most individuals initiated it concurrently with or after discontinuing other substances or medical care. Larger follow-up studies are warranted to confirm these results.
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To develop and validate a nomogram using routine admission indicators to predict total bilirubin on day 7 (TBil-Day7) in hepatitis B virus-related liver cirrhosis (HBV-LC) patients, enabling early identification of inadequate short-term TBil response and providing a reference for intensive treatment. We retrospectively enrolled 284 HBV-LC patients, randomly assigned 7:3 to training (n=198) and internal validation (n=86) cohorts. Candidate variables were clinical and laboratory parameters available within 24 hours of admission, with TBil-Day7 as the outcome. Predictors were selected via least absolute shrinkage and selection operator (LASSO) regression, and a multiple linear regression model was built and visualized as a nomogram. Model performance was evaluated using the coefficient of determination (R2), root mean square error (RMSE), mean absolute error (MAE), and the proportion of predicted values falling within ±20 μmol/L of the observed TBil-Day7 values. LASSO regression identified four predictors: admission TBil, direct bilirubin (DBil), aspartate aminotransferase (AST), and international normalized ratio (INR). The prediction equation was: TBil-Day7 (μmol/L) = -23.0159 + 0.5721×TBil + 0.5847×DBil + 0.0601×AST + 14.0707×INR. The training cohort had an R2 of 0.932. In the internal validation cohort, R2=0.75, RMSE=38.06 μmol/L, MAE=21.27 μmol/L, and 74.4% of predictions were within ±20 μmol/L of actual values. The calibration curve showed good agreement between predicted and observed TBil-Day7. This nomogram, incorporating four routine admission indicators (TBil, DBil, AST, INR), can predict TBil-Day7 in HBV-LC patients with reasonable accuracy. It facilitates early identification of high-risk patients with insufficient TBil decline and allows estimation of short-term treatment response at admission.
Cavernous venous malformation, previously termed orbital cavernous hemangioma, and recently classified as a venous malformation in the International Society for the Study of Vascular Anomalies (ISSVA) classification, represents one of the most common benign tumors of the orbit. It's a slow-growing lesion with mainly venous flow. Clinically, this lesion typically presents with a gradual onset of symptoms such as proptosis, vision loss, or diplopia, or it may be clinically silent and discovered incidentally on imaging performed for another reason. The reported cases of this lesion are typically located in the intraconal space. We present here an unusual case of a 40-year-old male with an extraconal cavernous venous malformation.
Does direct warming preserve embryonic developmental competence and molecular integrity as well as conventional multi-step warming in vitrified human and mouse cleavage-stage embryos? Direct warming yielded comparable developmental and molecular outcomes to conventional warming in both mouse and human cleavage-stage embryos. Conventional embryo warming uses stepwise cryoprotectant dilution to minimize toxicity and osmotic shock. Direct warming methods have been proposed, but their impact on post-warming development and the molecular comparison remains unclear. This is a controlled experimental study conducted over 18 months. A total of 490 vitrified mouse embryos and 15 donated human embryos were tested either in direct or conventional warming group. A subset underwent embryo transfer and follow-up. Parallel transcriptomic and DNA methylation profiling was performed on mouse and donated human embryos. Mouse cleavage-stage embryos (C57BL/6J) were vitrified and randomly assigned to direct (n = 265) or conventional (n = 225) warming. Post-warming survival and blastocyst formation were assessed in vitro. A subset (n = 211) underwent embryo transfer to evaluate implantation, live birth, and postnatal development to Day 21. For molecular analysis, pooled mouse embryos from fresh, conventional, and direct groups were analyzed by bulk RNA-seq and bisulfite sequencing. Ten vitrified human embryos (n = 5 per group) were analyzed individually by scRNA-seq and scBS-seq. All procedures were conducted under standard IVF lab conditions with ethical approval. Direct warming in mouse achieved comparable survival (95.8% vs 93.8%), blastocyst formation (88.6% vs 88.2%), implantation (82.5% vs 83.0%), and live birth rates (69.6% vs 71.1%) to conventional warming (all P > 0.05). Offspring showed similar growth, developmental milestones, and organ histology. Mouse transcriptome and methylome profiles revealed minimal differences and no significant pathway enrichment. In human embryos, ion channel-related gene variability was observed but without coordinated pathway disruption. Global methylation levels remained within expected developmental ranges. N/A. While the mouse model enables in vivo validation, species-specific differences in embryo size, membrane properties, and development may limit generalizability. As all embryos were cultured under optimized conditions, caution is advised when extrapolating to diverse clinical settings. To our knowledge, this is the first study to provide multi-level evidence supporting the safety and efficacy of direct warming as an alternative to conventional multi-step embryo warming protocols. By incorporating in vivo reproductive outcomes, postnatal development, and molecular profiling, it strengthens current evidence on the feasibility of this approach. The absence of pathway-level disruptions in transcriptome and methylome datasets suggests that direct warming does not impair essential developmental programs. These findings may support the clinical use of simplified warming procedures, especially for cleavage-stage embryo transfer or in resource-limited settings. However, further clinical studies are warranted to confirm long-term safety in humans. This work was supported by Collaborative Research Fund (CRF-C4007-24E), and Early Career Scheme (ECS-26103623) from the University Grants Committee (UGC), and Health and Medical Research Fund (HMRF 12230736) from the Hong Kong Government. The authors report no competing interests. N/A.
Primary malignant tumors of the mobile spine are rare but aggressive, and treatment decisions must balance oncologic control against neurologic risk, perioperative morbidity, and reconstruction durability. Because en bloc resection is technically demanding and associated with substantial morbidity, clinically important unanswered questions include which factors are associated with death and local recurrence after surgery, how prior procedure or local recurrence affects outcomes, and how often complications and revision for mechanical instrumentation problems occur. (1) What were the overall survival outcomes after en bloc resection, and which factors were associated with death? (2) What were the local recurrence-free survival outcomes after en bloc resection, and which factors-particularly margin status and prior procedure or local recurrence-were associated with local recurrence? (3) What were the proportions and patterns of perioperative complications, postoperative neurologic deterioration, and revision for mechanical instrumentation problems? We performed a retrospective comparative study using a longitudinally maintained institutional registry at a tertiary referral musculoskeletal tumor center. The study end date was set at December 2023; two patients who underwent surgery after that date were excluded because they no longer met the temporal inclusion criteria. Between August 2007 and December 2023, we included 70 patients with primary malignant tumors of the mobile spine who underwent planned en bloc resection when an oncologically appropriate margin was judged technically feasible and durable local control was expected to provide clinical benefit. Among these 70 patients, 84% (59 of 70) achieved at least 2 years of surveillance, 13% (9 of 70) died within 2 years, and 3% (2 of 70) were lost to follow-up before 2 years for reasons other than death. In addition, 14% (10 of 70) had not been seen within the last 5 years, although 9 of those 10 had already died. The mean ± SD age was 36 ± 17 years, 66% (46 of 70) were male, and chondrosarcoma was the most common histologic subtype, accounting for 33% (23 of 70) of patients. Tumors were staged using the Enneking and Weinstein-Boriani-Biagini systems. Overall survival and local recurrence-free survival were estimated using Kaplan-Meier methods, and factors associated with these outcomes were evaluated using Cox regression. Factors associated with perioperative complications were evaluated using multivariable logistic regression. Overall survival after en bloc resection was 67.0% at 5 years (95% confidence interval [CI] 54.3% to 79.7%). In the multivariable Cox model, high-grade tumor (HR 8.9 [95% CI 1.1 to 70.3]; p = 0.04), marginal margin (HR 4.4 [95% CI 1.1 to 17.5]; p = 0.04), and intralesional margin (HR 11.3 [95% CI 2.8 to 46.1]; p = 0.001) were associated with a higher hazard of death. Local recurrence-free survival was 67.5% at 5 years (95% CI 55.0% to 80.0%), and local recurrence developed in 31% (22 of 70) of patients. In the multivariable Cox model, prior intralesional procedure, open biopsy, or local recurrence (HR 2.9 [95% CI 1.2 to 7.1]; p = 0.02), marginal margin (HR 4.6 [95% CI 1.2 to 17.8]; p = 0.03), and intralesional margin (HR 9.7 [95% CI 2.6 to 36.5]; p = 0.001) were associated with a higher hazard of local recurrence. Perioperative complications occurred in 50% (35 of 70) of patients, including 18 major complication events. Postoperative neurologic deterioration occurred in 17% (12 of 70) of patients and was more frequent in patients with prior procedure or local recurrence than in those with no prior procedure other than core needle biopsy (31% [8 of 26] versus 9% [4 of 44], OR 4.4 [95% CI 1.2 to 16.7]; p = 0.02). Revision for mechanical instrumentation problems occurred in 6% (4 of 70) of patients; all four revisions were performed for posterior rod fracture. Although revision was more frequent in patients reconstructed with titanium mesh cages than in those reconstructed with three-dimensionally-printed vertebral body prostheses (30% [3 of 10] versus 2% [1 of 52], OR 21.9 [95% CI 2.0 to 240.2]; p = 0.01), no anterior column construct failed or required revision. For selected patients with primary malignant tumors of the mobile spine, en bloc resection can provide durable local control, but the likelihood of benefit depends on achieving an oncologically appropriate margin and avoiding unplanned intralesional procedures or open biopsy before referral. These findings support early referral to specialized centers, image-guided biopsy rather than unplanned open procedures, and multidisciplinary planning before definitive surgery. Future multicenter studies should incorporate tumor-specific analyses and longitudinal functional outcomes to better guide patient selection and counseling. Level III, therapeutic study.
Contact lens (CL) wear may induce changes to the tear film, leading to sensations of ocular dryness and CL discomfort, key reasons for CL discontinuation. CL care solutions can help address underlying mechanisms of CL discomfort, improving wear experience. We report outcomes of an in-home use test of Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA), which is formulated to maintain ocular surface homeostasis and improve CL comfort. In this IRB-approved, real-world survey study, adult soft CL users used BHP MPS for 7 days before completing a survey rating their experience (agreement/disagreement for attributes including CL cleanliness, comfort [including during extended screen use], prevention of CL dryness, perception of CL hydration, gentleness on eyes, and likelihood to recommend to others). A power analysis estimated sample size for 80% statistical power. Responses were analyzed with 2-sided exact binomial tests for agreement in >50% of responses (significance level α=0.05). Participants (N=435) were demographically balanced (mean age 42.5 years; 52.9% female). Over 60% of participants reported baseline CL dryness and tired eyes; 8.0% were likely to discontinue CL wear. At the end of the trial period, 98.9% were satisfied with how their CLs felt. Individual responses were significantly >50% for all attributes (p<0.05), including 91.7% agreeing that BHP MPS positively impacted CL comfort (and helped to keep CLs feeling clean [96.8%], keep CLs comfortable so that eyes do not feel tired [93.1%], maintain CL comfort [94.7%], prevent CL dryness [93.6%], maintain comfort with extended screen use [92.0%], and maintain hydration [94.7%] while being gentle on eyes [96.6%]); 94.0% would recommend BHP MPS to other CL wearers. No adverse events were reported. BHP MPS demonstrated strong performance across all key criteria evaluated in this real-world cohort of soft CL wearers for improved CL wear experience. Comfort is important to keep people wearing their contact lenses, but some people stop wearing them because their eyes feel uncomfortable and dry over time. For reusable contact lenses especially, the choice of lens cleaning and care solution is important to help keep lenses feeling comfortable. Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA) is a unique contact lens solution with ingredients that help clean and remove spots off the lenses, which may help keep the eye healthy and help the contact lenses feel more comfortable. The BHP MPS ingredients were chosen based on scientific research and advice from experts. This study looked at how using BHP MPS in daily life made people feel. The study included 435 people who regularly wore reusable contact lenses. Overall, these people agreed that BHP MPS helped keep their contact lenses clean and comfortable, was gentle on their eyes, and stopped their lenses from feeling dry, even if they were using a screen, like a computer, for a long time. Nearly everyone in the study agreed they would recommend BHP MPS to others who wear contact lenses. This study showed that BHP MPS can help reusable contact lens wearers, improving the way people’s eyes feel. This real-life study is important because it builds on what we already know about BHP MPS from other studies and helps people who wear contact lenses and their eye care doctors choose the right contact lens solution to use.
Craniopharyngiomas are rare parasellar tumors, and papillary craniopharyngiomas (PCPs) represent 8 to 20% of cases. Interim analysis of retrospective data collected from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). Fourteen U.S.-based academic skull base centers between 2011 and 2023. Patients with PCPs. Demographic, imaging, surgical, and outcome variables. Ninety-nine patients with PCPs were included. The mean age was 51.8 ± 14.7, and 57.6% were male. Most tumors showed mixed cystic/solid components (67.5%), were transinfundibular (50.0%), and were treated with an endoscopic endonasal approach (74.5%), with 51.1% demonstrating gross total resection (GTR). Pituitary stalk was preserved in 51.9%. Permanent arginine vasopressin deficiency was seen in 67.1% and was associated with pituitary stalk sacrifice ( p  = 0.003). Cerebrospinal fluid leak was the most common nonendocrine postsurgical, 30-day complication (9.1%), reason for return to the operating room (3.1%), and reason for 90-day readmission (8.1%). Most patients (63.9%) received no adjuvant therapy; GTR was associated with decreased radiotherapy use ( p  = 0.0001). BRAF V600E mutation was detected in 64/69 tumors tested, although only one patient was treated with a BRAF inhibitor. A mean follow-up of 12.3 ± 14.6 months was seen for the group. RAPID consortium enabled the largest real-world clinical information dataset for PCPs. Early findings support that GTR and stalk preservation are important to outcomes. Iterative analysis and discussion of data led to the generation of a framework for future studies to fully leverage the capabilities of multicenter registries.