The increasing frequency and severity of wildfires has necessitated assessing fire effects on soil systems. Variation in fuel loads and fire effects create landscape mosaics with distinct abiotic properties, a heterogeneity that has been dubbed pyrodiversity. Expanding on the pyrodiversity framework, the pyrodiversity-biodiversity hypothesis posits that pyrodiversity increases niche diversity, thereby promoting biodiversity. This hypothesis, however, has remained untested for soil microbes and microeukaryotes. We explored this hypothesis for soil fungal communities using pre- and post-fire data from three empirical fuel load manipulations and across a total of five different vegetation contexts. We first compared pre- and post-fire abiotic heterogeneity to test whether fuel load manipulations would lead to greater environmental heterogeneity, particularly in soil properties. We then tested whether such manipulations led to greater fungal biodiversity as measured by fungal richness, β-diversity, and community dispersion. Labile abiotic soil resource (e.g. plant available phosphorus and inorganic nitrogen) heterogeneity increased post-fire, but this effect depended on the experimental context. In contrast, we observed little evidence for pyrodiversity-associated increases in post-fire fungal richness or diversity; community dispersion increased only in the study with the most extreme fuel load manipulations. Although our analyses did not clearly answer whether pyrodiversity begets biodiversity, our results highlight the nuances of soil responses to fire. Pyrodiversity-biodiversity linkages appear to depend on the system and on the diversity metric: the hypothesis had no support based on fungal richness, but community dispersion provided some support, even if only in one experiment. Understanding system-specific responses may be particularly important as fires increase in systems where they have been suppressed or have been historically rare.
Canines exhibit various behavioral abnormalities, such as excessive barking, destructive behaviors, and indoor defecation when left at home alone. Identifying these abnormal behaviors and implementing scientific and reasonable interventions can help improve canine welfare and promote harmonious coexistence between humans and companion animals. However, existing canine behavior recognition methods struggle to adapt to the characteristics of strong temporal continuity and uneven motion amplitude of abnormal behaviors exhibited by lonely dogs, resulting in inadequate temporal feature representation and low recognition accuracy. Therefore, this study developed a TP-CanineNet model based on a Weakly Supervised Video Anomaly Detection (WS-VAD) framework to address this issue. The model integrated a Temporal Context Aggregation (TCA) module to efficiently capture local-global temporal dependencies and suppress temporal noise, and further enhances the representation of temporal features in dog behaviors. Meanwhile, a Pseudo-Instance Discriminative Enhancement (PIDE) module is adopted to strengthen the feature distinction between abnormal and normal behaviors. We constructed an Alone-Dog dataset comprising 430 video samples and 60 ground-truth labeled samples to validate the model's effectiveness. Experimental results showed that the proposed model achieved a frame-level AUC of 85.19% and an AP of 72.55%, representing improvements of 2.20% and 8.33%, respectively, over the baseline model. The method can provide intelligent detection of domestic dog behaviors when left alone at home.
Hazardous acoustic event detection is critically important for intelligent surveillance, emergency response systems, and public safety monitoring applications. Accurate and real-time identification of dangerous sound events such as explosions, alarms, screaming, and weapon-related sounds can significantly improve situational awareness and accelerate emergency response in safety-critical environments. This study proposes a lightweight deep learning architecture for hazardous sound classification based on convolutional feature extraction and channel attention mechanisms. The proposed framework utilizes log-mel spectrogram representations as input and incorporates a TinyCNN backbone enhanced with squeeze-and-excitation channel attention modules to improve discriminative spectral feature learning while preserving computational efficiency. A custom balanced dataset consisting of eight hazardous acoustic classes, including crying, dog barking, emergency alarm, explosion, fire, glass breaking, screaming, and weapon-related sounds, was constructed with one thousand audio samples per class. The model was evaluated using accuracy, precision, recall, and F1-score metrics. Experimental results demonstrate that the proposed architecture achieves strong multi-class classification performance while maintaining real-time inference capability suitable for edge deployment scenarios. Quantitative evaluations confirm the effectiveness of the lightweight framework for hazardous acoustic event detection. Additional ablation studies indicate that the integration of channel attention mechanisms and spectrogram-based augmentation strategies substantially improves model robustness, feature discrimination, and generalization performance. The obtained findings demonstrate that the proposed lightweight channel-attention-enhanced architecture provides an efficient and reliable solution for real-time hazardous sound detection in intelligent monitoring and public safety systems. The combination of computational efficiency and robust classification performance highlights the suitability of the proposed framework for deployment in resource-constrained and edge-based environments.
Multimodal perception can often evoke performance that is greater than the sum of its unimodal parts in cognitive tasks. For example, choice reaction time research has found responses to multimodal stimuli that are faster than could be explained by responses to its individual unimodal components. This has led to a growth in multimodal perceptual research to explain behavioural observations, but less is known about multimodal influences on more cognitively demanding tasks such as semantic activation and memory. Across 3 well-powered pre-registered memory experiments (total n = 792), this study tested if multimodal encoding could reduce perceptual demands, evoke semantic processing, and encourage episodic recollection. In Experiment 1 the presence of congruent visual information aided later unimodal auditory retrieval (e.g., a dog picture and a barking sound), but multimodal manipulations had similar effects across young and older adults. Experiment 2 equated auditory only and visual only memory for picture-sound items by utilising blurring of the visual pictures, generating a novel shared stimulus set. Here there was no benefit to multimodal encoding, and identifiability of a given stimulus was more strongly related to memory following multimodal encoding than memory following unimodal encoding. Experiment 3 utilised the remember-know paradigm and found no specific multimodal encoding effects on episodic remembering, but did find that item identifiability was more strongly linked to recollection than to familiarity. Our data highlight how multimodal processing is nuanced and supports a general need for multimodal research to explain wholistic sensory processing.
To demonstrate the effectiveness of surgical treatment for complicated expiratory tracheal stenosis. The authors present anamnestic data, symptoms, diagnostic approaches, surgical features and outcomes in a patient with expiratory tracheal stenosis and syncopal episodes. Expiratory tracheal stenosis remains an underdiagnosed and underestimated condition. Primary etiopathogenetic factor is excessive intrathoracic pressure during exhalation. The gold standard for diagnosis is tracheobronchoscopy. Imaging techniques are useful only in dynamic formats. Conservative therapy (anti-inflammatory, mucolytic and bronchodilators), including positive end-expiratory pressure (PEEP) ventilation, is effective for most patients, but should be considered as a palliative measure. Surgical treatment aimed at posterior tracheal wall reinforcement is indicated for complications such as syncopal episodes, severe barking cough, and impaired social functioning. Minimally invasive techniques are available and appropriate for expiratory tracheal stenosis. Long-term outcomes depend on consistent lifelong pulmonological care. Иллюстрация эффективности хирургического лечения при осложненном экспираторном стенозе трахеи (ЭСТ). Представлены описание анамнеза, клинических проявлений и методов диагностики, а также особенности хирургического лечения и его результаты у пациента с ЭСТ, приводящим к синкопальным состояниям. ЭСТ остается недооцененным заболеванием. Основным патофизиологическим механизмом ЭСТ является чрезмерное давление в грудной клетке на выдохе. Основным вариантом диагностики остается фибротрахеобронхоскопия. Лучевые способы визуализации имеют смысл только при их динамических вариантах. Консервативная терапия (противовоспалительная, муколитическая, бронходилататационная), включая дыхание с положительным давлением в конце выдоха, у большинства пациентов с ЭСТ эффективна, но ее следует относить к паллиативному варианту. Хирургическое лечение, направленное на укрепление задней стенки трахеи, показано в тяжелых случаях, при развитии таких осложнений, как синкопальные состояния, сильный лающий кашель, ограничивающий социальную адаптацию. При лечении больных с ЭСТ доступны и приемлемы миниинвазивные технологии. Отдаленный результат лечения зависит от адекватной пожизненной терапии под наблюдением пульмонолога.
Chronic nonspecific cough in children is a common and challenging clinical problem. Flexible bronchoscopy plays a crucial role in identifying underlying etiologies when non-invasive investigations are inconclusive. This study aimed to assess bronchoscopy and related diagnostic findings in children presenting with chronic cough. This prospective cross-sectional study included 64 children aged 3 months to 18 years who presented with chronic nonspecific cough lasting more than four weeks. All patients underwent a standardized evaluation that included clinical assessment, laboratory tests, chest X-ray, and high-resolution CT. Pulmonary function testing was performed in children older than five years. Flexible bronchoscopy was conducted, and bronchoalveolar lavage samples were examined for cytological and microbiological analysis. This prospective study included 64 children (32 males) with a median age of 8 months (IQR 36-84) with chronic cough, classified as dry (n = 38), wet (n = 21), or barking (n = 5) cough. Bronchoscopy revealed abnormalities in 87.5% of cases, most commonly purulent secretions and congenital airway anomalies. BAL showed neutrophilia in 95.3%, and cultures were positive in 20.3%, mainly for Haemophilus influenzae and Streptococcus pneumoniae. For predicting PBB, the combined multivariable model demonstrated good discriminative ability (AUC = 0.809, P = 0.004). Increasing age (OR = 1.038, P = 0.024) and tobacco smoke exposure (OR = 4.15, P = 0.04) were significant independent predictors. For congenital airway anomalies, the combined model demonstrated excellent predictive performance (AUC = 0.912, P < 0.001), outperforming individual clinical variables. Flexible bronchoscopy demonstrated a high diagnostic yield in children with chronic cough that remained unexplained following comprehensive noninvasive evaluation. However, a definitive assessment of its clinical utility requires direct comparison with other diagnostic modalities, which is addressed in the subsequent analysis.
Minimally invasive repair of inguinal hernias offers several advantages over the conventional open approach in the context of reduced postoperative pain and faster return to daily activities with a non-inferior recurrence rate. With the increasing adoption of robotic platforms in surgical units worldwide, robotic transabdominal pre-peritoneal (rTAPP) repair has become an increasingly popular option offered to the patients. Successful surgical outcomes for any minimally invasive inguinal hernia depend on thorough understanding of the internal landmarks of myopectineal orifice (MPO). A conceptual framework such as inverted Y or 5 triangles described by Furtado et al. is essential to be understood prior to embarking on any minimally invasive inguinal hernia repair. While complex inguinal hernia repairs have traditionally been relative contraindication for laparoscopic repair due to technical difficulties, the robotic approach may help overcome these challenges. What sets this technique apart is the integration of a structured teaching framework designed to standardise the dissection process. We present the case of an 82-year-old female who underwent rTAPP for bilateral inguinal hernias, classified per the European Hernia Society (EHS) as right (P L2M0F1) and left (P L1M0F1). Following Veress needle insufflation, a 12-mm visiport was inserted in the right pararectal space, with two 8-mm robotic ports placed in linear alignment. Instrumentation included a bipolar grasper, camera, and monopolar scissors. A self-adhesive mesh and barbed sutures were introduced intra-abdominally at the outset. Total operative time was 80 minutes. The urinary catheter was removed post-procedure, and the patient was discharged the same day following an uneventful recovery. In this surgical technique we visually overlay Furtado's concept onto the robotic intraoperative view to create a reproducible anatomical roadmap. By mapping these defined safety and danger zones during the robotic dissection, we translate theoretical anatomy into a practical, stepwise intraoperative guide. This educational overlay aims to enhance reproducibility, anatomical orientation during the surgical learning curve, and potentially reduce complications or recurrence by promoting consistent identification of key landmarks. Whilst further randomised studies comparing robotic and laparoscopic approaches are needed to fully assess the role of robotic approach in surgical treatment of inguinal hernias, this visual framework serves as a training tool for surgeons adapting rTAPP.
Human activities increasingly reshape wildlife diel activity patterns, yet species-specific adjustments across land-use gradients with varying levels of human pressure and protection remain poorly understood. Nepal's 2020 COVID-19 lockdown created a quasi-experimental reduction in human mobility, allowing clearer attribution of temporal responses to human pressure. Using camera trap data from matched 30-day windows (March 24-April 24) in 2019 (pre-lockdown) and 2020 (lockdown) across the Bardia complex, representing a mosaic of human pressure and protection gradients, including Bardia National Park (NP), its buffer zone (BZ), and adjacent human-dominated areas outside of buffer zone (OBZ). NP-2020 treated as the baseline and quantified species-specific activity patterns with kernel densities, coefficients of overlap (Δ, 95% CIs), circular mean peak-time shifts (hours, 95% CIs), and a nocturnality index (% detections between 19:00-05:00 h, 95% bootstrap CIs). We analyzed four contrasts and reported overlap and peak-time shifts within species, contrasting NP-2020 with the same species in BZ and OBZ during survey periods 2019 and 2020. Relative to the NP-2020, herbivores -especially chital, barking deer, hog deer, and wild boar shifted activity peaks by ~ 6-11 h toward night and showed reduced overlap within-species in BZ and OBZ, with several near anti-phase schedules in OBZ. Sambar remained comparatively stable and crepuscular, while tigers exhibited low NP-BZ overlap and near 12 h offsets in their activity peaks. Lockdown conditions increased overlap and attenuated nocturnal displacement for several species (notably chital and sambar), evidencing rapid behavioral relaxation. The dominant pattern is a gradient of increasing nocturnality and declining overlap in activity patterns as human pressure increases from NP to BZ to OBZ, with persistent nocturnality in hog deer and wild boar indicating chronic constraints. We emphasize integrating temporal refugia into management by limiting high-intensity human activities during crepuscular periods and reducing nighttime noise and lighting at forest-agriculture interfaces, so wildlife need not rely on extreme nocturnality to coexist with humans. Long-term monitoring that couples activity metrics (overlap, peak-time shifts) with environmental factors and physiological indicators is needed to evaluate demographic and fitness consequences and to inform temporal ecology in multi-use landscapes.
Thyroid eye disease (TED) is a serious medical condition observed in patients with thyroid disorders, and patients often present in emergencies, threatening their vision. This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients. This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes. Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.
Premature rupture of fetal membranes (PROM) is a significant obstetric complication associated with preterm birth and increased maternal and neonatal morbidity and mortality, particularly in resource-limited settings. It is a multifactorial condition resulting from complex interactions between infectious, inflammatory, mechanical, and biochemical processes that weaken the chorioamniotic membranes. This narrative review synthesises current evidence and international clinical guidelines on the diagnosis and management of PROM. It examines the epidemiology, risk factors, and underlying pathophysiology, with emphasis on the roles of infection, inflammatory mediators, and matrix metalloproteinases. Diagnostic strategies are reviewed, including clinical assessment, conventional bedside tests, and emerging biomarker-based approaches such as placental alpha-microglobulin-1 and insulin-like growth factor binding protein-1. Evidence-based management approaches are discussed, including prophylactic antibiotics, antenatal corticosteroids, magnesium sulphate for fetal neuroprotection, selective use of tocolysis, and gestational age-specific timing of delivery. Emerging areas, including outpatient management, prevention strategies, amnioinfusion in preterm PROM, and considerations for cerclage retention and breech presentation, are also addressed. In conclusion, this review provides a comprehensive and up-to-date synthesis of current knowledge on PROM to inform clinical practice. Improved risk stratification, timely diagnosis, and adherence to evidence-based management remain essential to optimise maternal and neonatal outcomes.
Online adaptive radiotherapy (oART) has recently gained traction due to its potential clinical benefits. However, it presents significant challenges in developing effective quality assurance (QA) programs, particularly within multi-centre, multi-platform clinical trials settings. In this study, a Failure Mode and Effects Analysis (FMEA) was conducted to identify high-risk components of oART across different centres using different platforms and workflows to inform the development of risk-based QA processes for multi-centre clinical trials. The National Radiotherapy Trials Quality Assurance (RTTQA) Group and domain experts from five UK radiotherapy centres using oART conducted an FMEA following AAPM Task Group 100 (TG-100) guidelines. Through collaborative discussions, participants identified a comprehensive list of oART-specific failure modes (FMs) and agreed on scoring guidance for rating their occurrence (O), severity (S), and detectability (D). Finally, this standardised scoring system and guidance were used by multidisciplinary teams from different centres to independently score the FMs and the risk priority numbers were calculated as RPN = O*S*D. Median RPN scores were used to rank the FMs from high to low risk. The two FMs representing the greatest risk in the oART workflow were linked to the daily outlining step; incorrect contouring due to missing or inaccurate clinical information RPN (Median [Range]) = 96 [16 - 120], followed by target or OAR delineation errors RPN = 56 [16 - 140]. These failures were mostly associated with insufficient manual review. Overall, contouring, imaging, dose calculation, and plan appraising FMs were rated as highest risk. These FMs were predominantly operator/workflow dependent. FMEA identified critical oART-specific FMs requiring targeted QA within clinical trials. Mitigating variability is fundamental to ensuring the validity of clinical trial endpoints. Workflow variability matters: scoring differences across centres highlight the need for harmonisation or cross-validation via end-to-end testing.
Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Among 1,220 patients, 342 (28.0%) presented with ruptured aneurysms. Propensity-score-matched analyses revealed no significant difference in thromboembolic complications (11.8% vs. 5.9%, p = 0.056), similar periprocedural adequate occlusion (53.3% vs. 53.8%, p > 0.9), and similar retreatment rates (11.8% (95% CI 7.8-17.6%) vs. 7.1% (95% CI 4.1-12.0%), p = 0.14); however, adequate occlusion at follow-up was lower (82.2% vs. 93.3%, p = 0.002) and functional outcomes were worse (mRS ≥ 2 in 34.1% vs. 21.9%, p = 0.012) among patients with ruptured aneurysms. Ruptured aneurysms demonstrated expected inferior follow-up functional and angiographic outcomes when compared with unruptured aneurysms, but no difference in retreatment rate and procedural safety. These findings support WEB as a safe and effective treatment option for appropriately selected ruptured intracranial aneurysms in routine clinical practice.
Postoperative atrial fibrillation (POAF) is the most frequent post-cardiac surgical arrhythmia and is associated with haemodynamic instability, longer hospital stays, higher healthcare utilisation, stroke and adverse long-term outcomes. Conventional models of POAF focus on advancing age, pre-existing atrial substrate, increasing operative complexity, inflammatory responses related to cardiopulmonary bypass, disturbances in autonomic balance, and acute metabolic insults during the perioperative period. Although these explanations are important, they may be incomplete. Malignancy and the cancer-associated systemic environment involve biological processes potentially relevant to postoperative atrial vulnerability, such as chronic inflammation, oxidative stress, impaired vascular function, hypercoagulability, altered immune response, frailty, and treatment-related myocardial, pericardial, or conduction-system injury. This review assesses whether malignancy should be regarded as an underrecognised modifier of susceptibility rather than as a coincidental comorbidity. Most available data are extrapolated from cardio-oncology and thoracic oncology studies or general studies related to atrial fibrillation (AF) rather than studies focused on cardiac surgery. While malignancy cannot be dismissed as irrelevant to the generation of POAF, it also does not permit causal inference. Future studies should move beyond binary cancer status and incorporate cancer activity, treatment exposures, biomarker profiles, and atrial substrate measures to determine whether malignancy improves perioperative POAF risk stratification.
In the current system of radiological protection, radiation effects are classified as either tissue reactions (also known as deterministic effects) or stochastic effects. The objectives of the system are to manage and control exposures to ionising radiation so that harmful tissue reactions are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable. Thus, the classification of health effects is a very important pillar of the system of radiological protection. In recent years, there has been debate regarding the adequacy of the current scheme for classifying health effects. Recent publications, including those from ICRP, have highlighted the need for a review of the ICRP scheme for health effects classification. This article outlines the basis for the establishment of ICRP Task Group (TG) 123 and the outlined tasks, the key sources of uncertainties for consideration, the agreed approach and timeline to tackle the above tasks, as well as the links with and dependencies on the other ongoing developments to the system being considered by the other ICRP task groups.
Magnetic Resonance Imaging can be a challenging experience for many, despite improvements in scanner design and acquisition speed. A key area of importance to patients is communication about what is happening throughout their scan experience, which can be overlooked in increasingly busy departments. With the new scanner technology available in this community diagnostic centre, there is an updated autovoice function that automatically provides the patient with an update on the expected scan duration. A post-scan survey was administered to patients attending for MRI scanning. Open and closed questions were used to explore patients' views on the usefulness of this autovoice functionality and to better understand how it was received and how it influenced their experience. A total of 313 questionnaires were collected during the two-month period. Most participants perceived the autovoice prompt as useful, with one in five patients preferring the auto prompt over that of a radiographer, and the majority having no preference either way (68%). Entry into the scanner and preference for the delivery of information during the scan were not significant (p = 0.054), with no strong preference one way or the other, although a greater number of headfirst opted for autovoice. Age was not significant (p = 0.063), but those aged 50 years or less showed a greater preference for autovoice than those over 50. Those reporting heightened perceived anxiety on the day suggested greater benefit from the autovoice during the examination. Content analysis of the survey responses indicates a generally positive experience and response towards the autovoice, with some criticisms and suggestions for improvement highlighted. The feedback underscores the importance of clear communication, time awareness, and supportive staff in improving the patient experience during scans. For many, automated systems seem to be perceived as beneficial, offering consistent information, helping them anticipate what to expect, and reducing the likelihood of miscommunication or omission. Findings from this evaluation indicate that patients generally report a positive MRI experience, with the integration of autovoice prompts contributing meaningfully to their sense of communication and reassurance. MRI scans can be stressful, and clear communication during the scan is important for patient comfort. This study asked people to complete a survey after their MRI scan to understand their views on an automated voice system that gives updates about scan timing. This study found that most people felt the automated messages were helpful, especially those who felt more anxious, and many had no strong preference between automated messages and staff communication. This matters because improving how information is shared during scans can help people feel more reassured and improve their overall experience.
This systematic review and diagnostic test accuracy meta-analysis aimed to evaluate the diagnostic performance of flat-panel computed tomography (FPCT) for acute stroke-related findings, particularly intracranial hemorrhage and ischemic events, in comparison with standard CT or MRI. A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines. PubMed, Scopus, and Embase were searched through September 2024 for diagnostic accuracy studies comparing FPCT with CT or MRI in acute stroke settings. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using random-effects and bivariate models. Subgroup analyses and sensitivity analyses addressed heterogeneity. Thirteen studies were included in the meta-analysis. Pooled univariate estimates showed a sensitivity of 82.2% (95% CI: 75.1-87.7), specificity of 93.1% (95% CI: 88.5-96.0), and DOR of 78.6 (95% CI: 40.3-153.4). Bivariate analysis demonstrated improved diagnostic performance with a sensitivity of 86.5%, specificity of 96.7%, and DOR of 187.3. Subgroup analysis revealed higher sensitivity for intracerebral hemorrhage (92.6%) than ischemic stroke (62.3%, p=0.003). Specificity was highest for intraventricular hemorrhage (98.8%). While significant heterogeneity and publication bias were detected, results remained robust after exclusion of outliers. FPCT demonstrates high specificity and moderate-to-high sensitivity for stroke-related findings, with strongest performance for intracranial hemorrhage. These findings support consideration of FPCT as a complementary in-suite imaging tool in selected direct-to-angiosuite workflows, particularly for rapid hemorrhage exclusion. However, its lower sensitivity for ischemic changes and susceptibility to contrast-related artifacts indicate that FPCT should complement, rather than replace, standard CT/MRI-based evaluation.
Periprosthetic fracture following hip resurfacing arthroplasty is an uncommon but important complication and represents a distinct failure mode compared with fractures around conventional stemmed total hip arthroplasty. Existing periprosthetic fracture classifications are useful descriptively, but they do not fully address the biomechanical and biological considerations unique to hip resurfacing. Herein, the epidemiology, risk factors, mechanisms of failure, diagnostic workup, classification, and management of periprosthetic fractures following hip resurfacing arthroplasty is presented. Particular emphasis is placed on early femoral neck failure, avascular necrosis, femoral neck notching, varus component positioning, implant stability, adverse local tissue reaction, metal ion assessment, and the role of cross-sectional imaging. The article also proposes the SAVE classification, a treatment-oriented framework incorporating four key domains: Stability of the implant, Anatomical fracture location, Viability of the femoral head-neck segment, and local Environment. The SAVE classification provides a practical framework for determining whether the resurfacing construct can realistically be preserved or whether revision arthroplasty is more appropriate. By linking classification directly to treatment strategy, it may improve consistency in assessment and guide decision-making in these complex injuries.
Cerebral arteriovenous malformations (cAVMs) are congenital cerebrovascular anomalies that are associated with a high risk of intracerebral bleeding, which may be exacerbated by cerebral vasospasm (CVS). Despite advances in treatment modalities such as microsurgical resection, stereotactic radiosurgery, and endovascular embolization, CVS remains a significant concern, often precipitating significant neurological morbidity and mortality. Nimodipine, a calcium channel blocker, is widely used in aneurysmal subarachnoid haemorrhage (aSAH) to reduce neurological deficits. However, its role in cAVM-related CVS remains unclear. We performed a comprehensive review, collecting all cases reporting nimodipine use in adult cAVM patients in the literature. We aimed to identify the role of nimodipine in preventing cerebral ischaemia and deterioration in these patients. We executed a qualitative synthesis and calculated risk ratios for aneurysmal presence and odds ratios between the use and absence of nimodipine. Fisher's exact test was also used to calculate p-values when n < 5. A total of 12 articles were included, reporting 27 patients with a mean age of 41.3 years and equal gender distribution. Postoperative neurological deficits were reported in 40.7% of patients receiving nimodipine. Patients who received nimodipine had lower mortality (10.7%) compared with those who did not (33.3%). Current evidence is confined to small, heterogeneous case series; prospective, controlled studies with standardised nimodipine regimens are required to define its role in cAVM-related vasospasm and neurological outcome.
Wear assessment of prosthetic feet is critical for monitoring device performance and replacement, especially in rural or resource constrained areas where clinical follow-ups can be infrequent. Standardised, reliable methods for wear evaluation are limited. This study investigates the inter-observer reliability of a method for quantifying patterns and relative magnitudes of plantar surface wear of prosthetic feet and presents preliminary results for intra-observer error. Sixty-two plantar images of used SACH feet from Sri Lanka were scored by four independent groups a published method for quantifying prosthetic foot wear. A 20x10 grid was applied to each image, and wear was scored from 0-9 per cell based on visual indicators. Interobserver agreement was assessed on full (48 feet, 4 raters) and reduced (62 feet, 3 raters) datasets. Intraobserver reliability was tested by 2 raters re-scoring five images after 5 + days. Kendall's W evaluated agreement, and a modified scoring method was developed and evaluated. Interobserver agreement ranged from fair to excellent and was higher in the reduced dataset. Intraobserver agreement appears high, especially in central, less-worn areas of the foot. The modified method showed reduced intraobserver variability but lower interobserver agreement, largely due to increased ties affecting Kendall's W, not increased disagreement. The original and modified methods for wear qualification demonstrate high reliability, supporting their use as a low-cost, field-appropriate tool for monitoring prosthetic foot wear to enhance the evaluation and design of prosthetic feet, particularly in resource-limited settings. While the full method provides higher resolution data, the reduced method is more broadly applicable to different foot types. Clinically, this method offers a reliable, scalable approach to assessing prosthetic foot wear, potentially supporting community-based monitoring. Further testing and methodological alterations to encompass additional foot designs are required for clinical use.
Cypress knees are woody root structures of cypress trees (Taxodium spp.) that curiously protrude upwards out of the ground. To better understand knee growth characteristics, 30 knees in a southwestern Florida depressional cypress swamp were measured monthly for 14 years (2012-2025) for tip growth. Substantial knee growth, when it occurred, was during the months of June through September, but only when the month coincided with water levels above ground. Regardless of water levels or the canopy's leafiness, knee growth rates consistently declined in October, and knee growth was rarely detectable from November through March. In other words, seasonal growth of cypress knees was triggered by above-surface water levels occurring during the tree's typical growing season. These conclusions are further supported by extreme weather years when knees failed to grow during flood-less summers (2012, 2023), and knees remained dormant during unusual January/February wet conditions (2016, 2024). Growing seasons with higher water levels and longer hydroperiods were positively correlated with greater cypress knee tip growth, as well as a higher percentage of knees growing that season. Considering that 90% of knee tips were above mean high water at the onset of the study, the advantage of expanding a knee's thin-barked growing tip during high water conditions may be, in addition to gaining height, to augment gas exchange with the inner tissues of the knee where aerobic respiration aids in starch storage processes and phloem's distribution of oxygenated resources. For this sample of knees, the mean seasonal growth rate was 0.39 cm/year, and a single-season individual maximum was 3.6 cm/year.