Facemask ventilation is a key airway management skill but predicting difficulty can be challenging. Pre-operative three-dimensional face scanning may have diagnostic value. We aimed to identify interpretable facial shape features and to quantify their value for predicting difficult facemask ventilation. In this prospective observational single-centre study, pre-operative three-dimensional face scans were obtained, and a structured airway assessment was performed on patients undergoing ear, nose and throat or maxillofacial surgery. The primary outcome was difficult facemask ventilation documented as an alert in the patient health record. After postprocessing, three-dimensional face scans were fitted to an established, non-clinical facial model to identify interpretable shape coefficients. The area under the receiver operating characteristic (AUROC) curve for the DIFFMASK score was calculated before and after enrichment with three facial shape features and the added diagnostic value was assessed using likelihood ratios. Data from 398 patients were analysed. The optimism-corrected AUROC was 0.73 (95%CI 0.65-0.80) for the DIFFMASK score and 0.74 (95%CI 0.66-0.82) for selected facial shape features. Enrichment of the DIFFMASK score with three facial shape features improved goodness of model fit (p = 0.002) and achieved an optimism-corrected AUROC of 0.76 (95%CI 0.68-0.82). Generated face meshes with superimposed colour mapping revealed that morphological features of the nose, lower mandible, neck region and facial convexity were most predictive of difficult facemask ventilation. Pre-operative three-dimensional face scans predicted difficult facemask ventilation at least as well as the DIFFMASK score. Integrating the features of three selected facial shapes enriched the DIFFMASK score and improved its diagnostic value. Digital phenotyping can complement traditional clinical assessment. Researchers studied 398 patients having head and neck surgery. Before surgery, they used a special 3D scanner to record and study each patient's face and carried out normal airway checks. After the patients were given anaesthesia, doctors used a facemask to ventilate them. Doctors recorded when facemask ventilation was difficult. The researchers then looked for facial features in the 3D scans that might help predict when facemask ventilation would be difficult. Ventilation with a facemask is an important part of anaesthesia, but it can sometimes be difficult. Doctors wanted to know if 3D face scans could help spot patients in advance before anaesthesia who may develop difficulties. This could help doctors prepare and improve patient safety. The 3D face scans worked at least as well as the usual clinical scoring system at predicting difficult facemask ventilation. When the researchers combined the face scan information with the usual clinical scoring system, the prediction became even better. Certain facial features, such as the shape of the nose, jaw, neck and face, were linked with more difficult facemask ventilation. The study showed that 3D face scanning could be a useful extra tool for doctors when planning anaesthetic care.
Professional motorsport drivers face a high risk of concussions and repeated subconcussive head impacts due to their exposure to significant g-forces. Concussion symptoms may persist in some individuals, and repeated head impacts are thought to contribute to a gradual accumulation of axonal damage over time. However, little is known about the long-term neurological consequences of practicing professional motorsports. This case series aimed to present the neurological health status of former professional motorsports drivers and to explore potential relationships between cumulative head impacts exposure, resulting from professional motorsport practice over time, and long-term brain health. Recruitment began following a concussion awareness campaign led by the Automobile Club de Monaco targeting former professional motorsport drivers. Neurological health status was examined through clinical assessments (SCAT5 symptom inventory, neuropsychological assessment, video-oculography) and through neuroimaging (MRI with SWIp sequences and diffusion tensor imaging (DTI); 18 FDG-PET). We correlated data with cumulative head impact exposure, encompassing total motorsport exposure duration, professional practice duration, and self-reported concussion numbers. 12 former professional motorsport drivers (all male, age 55.8 ± 12.1) were recruited, including 58% with cognitive complaints and 50% with motorsport-related concerns. They had a mean motorsport practice duration of 31.3 ± 5.8 years, with a mean professional career of 26.3 ± 6.5 years, and a mean retirement age of 40.4 ± 5.6 years. While all participants had engaged in multiple motorsport disciplines, 83% had competed in Open-wheel single-seater racing and/or Sport car racing. 75% had at least one symptom on SCAT5 (2.5 ± 2.8), 33% at least one cognitive impairment (0.4 ± 0.7), 75% at least one impaired eye movement (1.5 ± 1.1), 58% at least one MRI abnormality (0.9 ± 1), 92% at least one DTI abnormality (1.8 ± 1.4) and 33% at least one 18 FDG-PET abnormality (0.7 ± 1.2). Attention (25%), processing speed (58%), visual episodic (58%), and working (50%) memory skills were above average. Only eye movement abnormalities were correlated to total exposure duration and to professional practice duration. This case series revealed that former professional motorsport drivers presenting with brain health concerns frequently exhibited mild, nonspecific neurological abnormalities. Two findings were particularly noteworthy: first, eye movement abnormalities correlated with cumulative motorsport exposure duration, and second, participants showed an atypical cognitive profile with above-average visuospatial and processing speed performances. This unique profile may make standard clinical assessments less sensitive for detecting subtle pathological processes-whether during their active career or later in life. While no causal links can be established, the observed findings may stem from cumulative head impact exposure and a high cognitive reserve, both of which might be inherent to professional motorsport practice. These observations highlight the need for large-scale longitudinal studies that integrate pre-season baselines with video-oculography and DTI, along with prolonged post-career follow-up, to specifically investigate the effects of repeated head impacts on this population during their career and throughout aging.
This study aimed to assess aspects of validity of four FACE-Q Aesthetics scales in a sample of patients undergoing and planning facial minimally invasive cosmetic procedures (MICPs), such as botulinum toxin, lip augmentation and soft tissue augmentation treatments. In 2023, a cross-sectional survey included 210 Hungarian women who had undergone and 147 planning facial MICPs, with similar mean ages Respondents completed four FACE-Q scales (Aging Appraisal, Appearance Distress, Early Life Impact and Age VAS), EQ-5D-5L, Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). Comprehensibility, ceiling/floor effects, structural validity (principal component analysis, confirmatory factor analysis), internal consistency, and construct validity (convergent, divergent, known-group validity) of the four FACE-Q scales were assessed. All FACE-Q scales, except the Age VAS, showed a ceiling effect (20-28%). Appearance Distress showed strong convergent validity with RSES (r = 0.742), BFNE-S (r = - 0.702), and EQ-5D-5L anxiety/depression (r = - 0.519). Aging Appraisal and Appearance Distress scales were unidimensional, whereas Early Life Impact Scale had a three-factor structure. All four FACE-Q scales were able to differentiate between known groups of patients based on self-esteem, fear of negative evaluation and acceptance of bodily appearance. Women who had undergone procedures reported higher Aging Appraisal (72.9 vs. 63.3) and Appearance Distress (77.1 vs. 68.4) scores and felt younger (- 5.0 vs. - 2.8 years) than those planning them (p < 0.001 for all). Our findings provide initial support for the validity of the four FACE-Q scales in MICP populations, but further validation (e.g. assessment of responsiveness and test-retest reliability) is needed.
To compare efficacy, recovery, pigmentary safety, and patient-reported outcomes of radiofrequency microneedling (RFMN) and fractional carbon dioxide laser (FCO2) for facial atrophic acne scars. In this prospective, randomized, split-face, evaluator-blinded exploratory trial, 33 patients were enrolled, and 30 completed the study. Each facial side was assigned to RFMN or FCO2. Three treatment sessions were performed at 8-week intervals. The primary endpoint was the change in Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) score. Secondary outcomes included physician-rated improvement, satisfaction, Dermatology Life Quality Index, pain, recovery-related outcomes, and adverse events. Both modalities significantly improved acne scars over time. Mean ECCA scores decreased from 54.73 to 30.53 with RFMN and from 53.67 to 31.03 with FCO2, without a significant between-treatment difference. Physician-rated improvement was comparable. RFMN showed higher efficacy satisfaction after the first session and higher safety satisfaction at all follow-up assessments. RFMN was associated with shorter erythema, pain, swelling, and scab-detachment durations and fewer post-inflammatory hyperpigmentation events. Both treatments improved facial atrophic acne scars in this exploratory split-face sample. RFMN offered faster recovery, fewer pigmentary events, and higher safety satisfaction.
Head and neck cancer (HNC) is a common malignant tumor, and its treatment often leads to functional impairments in speech, swallowing, and appearance, severely affecting patients' quality of life. Older individuals with HNC, due to the combined stress of aging and disease, face heightened mental health challenges. This study aims to evaluate the effect of AI-driven personalized health education on mental health, social support and quality of life in older patients after HNC surgery. A single-center, two-group, randomized controlled trial will be conducted. One hundred of postoperative HNC patients aged ≥ 60 years will be randomly assigned to the intervention group (n = 50) or the control group (n = 50). The intervention group will receive 12 months of personalized and phased health education through the "Kangkang" AI assistant, including video/graphic and real-time AI Q&A. The control group received standardized SMS health education at the same frequency. The outcomes will include Perceived Stress Scale, Barthel Index, Patient Assessment of Constipation Quality of Life, Nutritional Risk Screening 2002, Numerical Rating Scale for Pain, Rosenberg Self-Esteem Scale, Pittsburgh Sleep Quality Index, UCLA Loneliness Scale (3rd edition), Fear of Cancer Progression Questionnaire-Short Form, World Health Organization Quality of Life Assessment for Older Adults, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Morse Fall Scale. All assessments will be performed 5 times at baseline (preoperative) and 1, 3, 6, and 12 months postoperatively. Statistical analysis will be conducted using intention-to-treat analysis. Linear mixed models with maximum likelihood estimation will be used to analyze the continues variables and manage missing data. This will provide evidence on whether AI-driven, personalized health education can improve mental health, social support and quality of life in older patients after HNC surgery. The single-center design and reliance on self-reported outcomes may limit generalizability, and future multicenter studies are warranted. The trial has been prospectively registered in the China Clinical Trials Registry on December 5, 2025, with registration number of ChiCTR2500114052.
The unique anatomy and physiological barriers of the human eye-particularly rapid tear turnover and limited corneal permeability-present significant obstacles to achieving effective topical drug delivery. In response to these constraints, biopolymer-based extended-release systems have emerged as a promising and transformative class of ocular therapeutics. This review provides a comprehensive overview of recent advances in natural biopolymers, including polysaccharides and protein-derived polymers, for application on the ocular surface. These materials exhibit advantageous characteristics such as mucoadhesion, biocompatibility, and stimuli-responsive behavior, which collectively enhance precorneal residence time and enable controlled, sustained drug release. We further discuss diverse delivery platforms-ranging from in situ forming hydrogels and mucoadhesive nanoparticles to drug-eluting contact lenses and microneedle-based systems. In addition, we highlight how the integration of nanotechnology and bioinspired scaffolds can augment the delivery efficiency of therapeutic agents to ocular tissues. Overall, this review underscores the ongoing transition from conventional topical eye drops to sophisticated, functionalized delivery systems capable of maintaining therapeutic drug levels while simultaneously supporting tissue repair and wound healing. Finally, we outline the remaining challenges in clinical translation and consider the future potential of smart, responsive biopolymer systems in advancing the treatment of both anterior and posterior segment diseases.
Psychosocial stress detection via cost-effective means could prove a useful tool in the diagnosis of long-term stress experience and subsequent prevention of stress-related health disorders. Facial expressions are both part of and a relay for complex affective states, such as acute stress. In the current post-hoc study we investigated differences in facial activity between participants under acute psychosocial stress and in a stress-free control task. N = 126 adults either completed the Trier Social Stress Test (TSST) or a stress-free placebo TSST while being video recorded. Stress group participants also provided multiple samples of salivary cortisol, heart rate, heart rate variability and subjective stress. Facial activity was indexed via action unit (AU) activity on a frame-by-frame basis. We found that stress group participants showed significantly less facial activity across AU04 (brow lowerer), AU06 (cheek raiser), AU07 (eyelid tightener) and AU12 (lip corner puller) during the talk but not during the math block of the TSST. These group differences were not further explained by participant sex. These findings were corroborated by dynamic structural equation modeling of facial activity. Physiological and psychological stress reactivity, however, was not revealed to covary with facial behavior during evaluative stress. In conclusion, this study is another step towards stress detection via easy-to-implement and cost-effective means.
Interpersonal coordination is a fundamental social behavior that has been shown to be reduced in autism, though less is known about other psychiatric conditions. An automated quantitative measure of interpersonal coordination would enhance assessment, diagnosis, and monitoring of treatment-related change in autism and other psychiatric conditions. We introduce and apply a novel AI-based measure ('concurrence') to quantify and compare nonverbal interpersonal coordination during naturalistic conversation in individuals with and without various psychiatric presentations. The primary analysis included 380 12-18-year-olds with neurotypical development (NT), autism (AUT), or other psychiatric conditions (PSY), recorded during videoconference get-to-know-you conversations with a research staff member ('partner'). Replication analyses included 72 12-18-year-olds with NT or AUT, recorded during face-to-face conversations. A self-supervised AI method (concurrence) was applied to time series data representing facial expressions and head movements of participants and their conversation partners. This yielded interpersonal coordination scores for all participant-partner dyads, which were then compared transdiagnostically. Convergent and discriminant validity were assessed using annotated subsamples from a combined sample of 609 5-52-year-olds. Convergent validity was assessed with measures of social gaze, motor imitation ability, and conversation quality; discriminant validity was assessed with IQ scores. In the videoconference sample, AUT demonstrated significantly lower interpersonal coordination than PSY (unadjusted Cohen's d = 0.46, p < 0.001) and NT (d = 1.03, p < 0.001), with PSY also lower than NT (d = 0.50, p < 0.001). The AUT < NT effect was replicated in the face-to-face sample (d = 0.73, p < 0.05). The group-by-context interaction was nonsignificant (p = 0.33), suggesting group differences are robust to recording context. Convergent and discriminant validity was demonstrated through positive associations between interpersonal coordination and mutual social gaze (r(108) = 0.46, p < 0.0001), gross motor imitation ability (r(35) = 0.41, p < 0.05), and conversation quality ratings (r(364) = 0.34, p < 0.0001), but not IQ (r(367) = 0.03, p = 0.55). Generalizability is limited by sample characteristics including cognitive and verbal ability, age, and sex. The study demonstrates reduced interpersonal coordination in adolescents with autism and other psychiatric conditions (AUT<PSY<NT) using a novel, transdiagnostic computational measure. This finding replicated across different conversational contexts and the concurrence measure demonstrated convergent and discriminant validity, highlighting its potential as an automated and scalable individual-level measure of social skills.
The approval of lecanemab and donanemab represents a watershed moment in Alzheimer Disease (AD) treatment, yet clinicians face a novel challenge: guiding patients through treatment selection when head-to-head comparative data are absent. When confronted with the question "What would you do if you were me?", clinical providers must balance evidence-based medicine with the therapeutic alliance. This perspective examines the ethical, practical, and relational dimensions of responding to personal preference queries in the context of anti-amyloid immunotherapy selection, offering a framework for authentic engagement that honors both professional boundaries and patient-centered care.
Animal-related injuries are a significant public health concern, particularly in urban settings with high population density and widespread pet ownership. This retrospective descriptive study was based on a clinic-based case series of animal-related injury presentations at a high-volume rabies vaccination clinic in Hangzhou, China, from 2015 to 2024. Demographic characteristics, injury site, exposure category, animal species, and time to presentation were extracted from outpatient records. Delayed presentation was defined as seeking care more than 3 days after injury. Descriptive analyses were performed to summarize clinic-based patterns. Multivariable logistic regression was used to identify factors associated with delayed presentation and to examine differences between dog- and cat-related injuries. A total of 193,849 cases were included. Injuries exhibited significant seasonality, with the highest incidence in summer (30.16%) and the lowest in winter (20.22%). Females accounted for 55.9% of cases, and the 16-30 age group was the most affected (36.2%). Upper extremities were the predominant injury site (61.1%), and most cases were WHO Category II exposures (83.8%). Domestic animals caused 82.5% of injuries, with dogs (65.85%) and cats (27.64%) being the main offending animals. The rate of delayed presentation (>3 days) increased from 10.48% in 2015 to a peak of 20.67% in 2019 and then stabilized at approximately 16%. Multivariable logistic regression analysis showed that both Category I and Category III exposures (compared with Category II), injuries caused by non-dog species, and injuries caused by non-domestic animals were associated with higher odds of delayed presentation, while younger individuals and those with head and face injuries were less likely to delay care-seeking. For cat-related injuries (vs. dog-related injuries), independent predictors included increasing age, female sex, head and face injuries, and Category III exposure. This study provides a comprehensive description of animal-related injury presentations at a major urban rabies vaccination clinic. The findings highlight variation in healthcare-seeking behavior and injury patterns across demographic and exposure characteristics. These results may inform future hypothesis-driven research and support the development of targeted public health education strategies.
IntroductionTelehealth use expanded rapidly in oncology during the COVID-19 pandemic, but determinants for ongoing use in metropolitan cancer care after the pandemic remain unclear.MethodsA multi-centre retrospective cohort study of 271,889 oncology outpatient consultations (face-to-face, telephone, video) from 1 January 2019 to 30 June 2024 across four cancer centres in Sydney, Australia was conducted. Consultations were divided into pre-COVID, during-COVID restrictions and post-COVID restriction time periods. Multivariable generalised estimating equations modelled the odds of telehealth use in the during and post-restriction periods, testing interactions between time periods and key covariates.ResultsAcross 271,889 consultations with 21,125 patients the proportion of telehealth consultations was negligible pre-pandemic (0.4%), peaked during restrictions (24.7%) then reduced but was sustained post-restrictions (11.4%). Post-restrictions, telehealth use was more likely for follow-up consultations (vs new, p < .001), medical oncology consultations (vs radiation, p < .001), patients enrolled on a clinical trial (p < .001) and primary tumours including brain and genitourinary (vs breast, p < .001). Patients from the most socioeconomically disadvantaged quintiles (vs highest, p < .001), those who required an interpreter (p < .001), those receiving active treatment in the cancer centre (vs not on treatment, p < .001) and with primary tumours including head and neck or skin (vs breast, p < .001) were less likely to undergo telehealth consultations.ConclusionsThere is modest but sustained use of telehealth in oncology post-pandemic restrictions particularly for follow-up consultations, with less utilisation in populations experiencing disadvantage. Strategic, equity-focused policies are needed to ensure that telehealth use enhances, rather than exacerbates, disparities in access to cancer care.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous chronic respiratory disorder characterized by persistent airflow obstruction. Its high morbidity and mortality have posed a substantial public health burden, with current symptomatic treatments exhibiting inadequate control and potential adverse effects. With advances in microecological research techniques, the critical role of microbial homeostasis in the oral cavity, lungs, and gut in respiratory health has become increasingly prominent, and microbial dysbiosis is closely associated with progression and therapeutic outcomes of COPD. This review summarizes the compositional alterations of oral, lung, and gut microbiota in COPD patients, analyzes the interactions of the oral-lung axis and gut-lung axis, and delineates three mechanisms through which microbial dysbiosis promotes COPD progression: pathogenic bacterial migration, abnormal metabolite production and immune dysregulation. Additionally, this review summarizes Western and traditional Chinese medicine interventions targeting microbiota homeostasis, including antibiotics, microecological preparations, and herbal medicines, which have shown potential in improving COPD clinical outcomes. This review aims to provide a theoretical reference for the clinical diagnosis and management of COPD. Millions of people worldwide live with chronic obstructive pulmonary disease (COPD), which brings persistent breathing struggles that disrupt their daily living. Current standard treatments mainly relieve symptoms, but have limited effects on controlling disease progression, and may cause unwanted side effects. Mounting research shows that microbes in the mouth, lungs and gut play a critical role in maintaining lung health, while their imbalance can drive COPD progression. This review focused on the link between microbial balance and COPD to find new intervention ideas. We summarized changes in oral, lung, and gut microbes in people with COPD, and clarified how microbial imbalance exacerbates COPD via pathogen spread, abnormal metabolites and immune disorders. We also sorted out Western and traditional Chinese medicine strategies that restore microbial balance to improve COPD treatment and quality of life. These findings show a promising strategy for COPD therapy from the perspective of regulating microbial balance.
Objective.Accurate prediction of postoperative facial appearance is essential for orthognathic surgical planning, yet remains challenging due to the nonlinear biomechanical coupling between bone and soft tissue. While deep learning methods offer a faster alternative to traditional biomechanical simulation, they typically map bony displacements directly to facial surface deformation, overlooking the intervening soft-tissue layers with distinct biomechanical properties through which displacement is progressively transmitted. Moreover, the many-to-one effect of regional bony movements on each soft-tissue point remains insufficiently captured.Approach.We propose a novel network that introduces an interlayer mixture-of-experts mechanism to decouple bone-to-surface deformation propagation into three biomechanically inspired proxy representations at different tissue depth levels. Since the contribution of each depth level varies across individuals and facial regions, a gated routing network adaptively weights each layer's contribution, providing a data-driven approximation of spatially heterogeneous, patient-specific deformation transmission. Additionally, a bio-geometric convolution module captures regional bony influences through elastic-weighted neighborhood aggregation.Main results.Evaluations on 88 orthognathic surgery patients demonstrate that the proposed method achieves a mean whole-face error of 1.39 mm, below the 2 mm clinical threshold, with statistically significant improvements over all baselines (p<0.05) and the highest clinician acceptance rate (94%).Significance.By incorporating bio-geometric priors into a deep learning framework, our approach enables a more physically grounded and interpretable prediction paradigm, supporting efficient and clinically reliable surgical planning.
Single-port laparoscopic hernia needle extraperitoneal high ligation of the hernia sac (LH) has been widely adopted for indirect inguinal hernia due to its concealed surgical incision and rapid postoperative recovery. Laparoscope-Assisted Trans-scrotal Hernia Sac ligation (LAT-HSL) is an alternative surgical approach for high ligation of the indirect inguinal hernia sac performed via a scrotal approach under laparoscopic assistance. However, head-to-head comparative data on the clinical outcomes of LAT-HSL versus LH for pediatric inguinal hernia remains limited. To Comparing the efficacy, safety and economic outcomes of the LAT-HSL and LH procedures in the treatment of unilateral indirect inguinal hernia in boys aged 1-3 years. This multicenter, single-blind, prospective randomized controlled trial was conducted at the pediatric surgery departments of two tertiary children's medical centers in China. Male pediatric patients aged 1-3 years with primary unilateral indirect inguinal hernia (confirmed by abdominal ultrasonography) admitted between April 2024 and June 2025 were enrolled, with a total of 104 patients included in the final analysis. Eligible patients were randomly allocated to either the LH group (n=53) or the LAT-HSL group (n=51), with a 6-month postoperative follow-up period. The primary outcomes were postoperative hernia recurrence rate and overall complication rate within 6 months of surgery. Secondary outcomes included intraoperative parameters (pneumoperitoneum duration, operative time, mean end-tidal carbon dioxide [ETCO2], and incidence of intraoperative hypocapnia [ETCO2 < 35 mmHg]), postoperative recovery indicators (length of hospital stay, Face, Legs, Activity, Cry, Consolability [FLACC] pain scores at 12 and 24 hours postoperatively, and Manchester Scar Scale (MSS) scores at 1 week, 2 weeks, and 1 month postoperatively), and medical costs. Normally distributed continuous data were expressed as mean ± standard deviation and compared using the t-test. Non-normally distributed continuous data were presented as median (interquartile range [IQR]) and compared using the Mann-Whitney U test. Categorical variables were analyzed using Pearson's chi-square test and Fisher's exact test. Univariate and multivariate regression models were employed to identify independent factors associated with intraoperative parameters. A total of 104 patients were included in the study, with 53 cases (20.0 [16.0,31.5] months])in the LH group and 51 cases (16.0 [12.0,23.0] months) in the LAT-HSL group. Compared to the LH group, the LAT-HSL group had significantly longer operative time (30.0[24.0,42.0] minutes vs 24.0 [18.0,30.0] minutes, P=0.001) and hospital stay (1.0 [1.0,2.0] days, 1.0 [1.0,1.0] days, P=0.003). While, LAT-HSL group had significantly shorter pneumoperitoneum time (1.5[1.0,2.5] minutes vs 24.0[18.0,30.0] minutes, P < 0.001) and smaller proportion of normal-low ETCO2 values ( 2 cases [3.9%] vs 12 cases [22.6%], P=0.005). At Jiaxing University Affiliated Jiaxing Women and Children Hospital where disposable hernia needles are utilized, the consumable cost in the LAT-HSL group was significantly lower than that in the LH group (1569.1[1569.1,1569.1]CNY vs 1168.5[1078.8,1569.3]CNY, P=0.001). LAT-HSL and LH have comparable short-term safety and efficacy for the treatment of unilateral indirect inguinal hernia in boys aged 1-3 years. LAT-HSL is associated with a significantly shorter pneumoperitoneum duration and lower risk of intraoperative hypocapnia, and may reduce medical consumable costs in centers using disposable laparoscopic hernia needles. Therefore, LAT-HSL represents a safe, effective, and economical surgical option for this patient population.
Orthognathic therapy aims to correct severe maxillofacial deformities and enhance facial appearance. Certain orthognathic osteotomies may achieve gender-affirming changes, shifting a face towards a more feminine or masculine appearance. The objective was to develop a convolutional neural network (CNN) to quantify orthognathic therapy's effect on gender-defining facial features, in relation to malocclusion and osteotomy. A computational algorithm combining a face detector and a CNN trained on >0.5 million gender-labelled facial images and further fine-tuned on dedicated 7591 face images to predict perceived gender was applied on 2164 annotated facial images of 146 orthognathic patients. Perceived gender was graded and post-treatment scores were compared with pre-treatment scores, differentiating between corrected malocclusion and performed surgery. Female orthognathic patients demonstrated a significant feminizing shift (P < .001) particularly evident in the Class III female subgroup. This feminization effect was also observed in female patients with vertical, transverse and retrognathic facial disbalances. Male patients experienced strengthened masculine facial features especially in the Class II subgroup (P = .029), while the correction of vertical and transverse discrepancies resulted in minimal change. The most pronounced gender-affirming changes were achieved when bimaxillary osteotomies were performed in conjunction with chin osteotomy (P ≤ .002). CNN-based models offer dependable possibilities to quantify orthognathic treatment's impact on gender-related facial features, underlining their value in treatment planning and patient education. The results suggest that orthognathic corrections can significantly alter gender-affirming facial traits, which must be considered when defining individual treatment goals.
Weight loss associated with glucagon-like peptide-1 (GLP-1) agonists is frequently accompanied by reduced facial fat, sagging skin, and stubborn pockets of body fat. To identify aesthetic concerns related to GLP-1 agonist-associated weight loss and current nonsurgical treatment trends. An electronic survey was sent to health care professionals (HCPs) who were part of 3 large, opt-in databases. HCPs must have had experience treating patients with aesthetic concerns after GLP-1 agonists. The 406 HCPs who completed the survey (n = 100 dermatologists, n = 100 plastic surgeons, n = 105 physicians in other specialties, n = 101 nurses/physician assistants) reported treating a mean of 1,249 cosmetic patients per year. HCPs reported a mean increase of 137% in the number of patients receiving GLP-1 agonists from 2023 to 2024. HCPs perceive midface volume loss, face/neck skin laxity, and loose or sagging body skin to be the aesthetic changes most impacted by GLP-1 agonists, with patients also reportedly concerned about stubborn pockets of fat. Hyaluronic acid was considered the best treatment for facial concerns for an average of 47% of patients. This large survey of HCPs representing various specialties provides insights into patient face- and body-related aesthetic concerns associated with GLP-1-mediated weight loss.
A 58-year-old woman presented with painless progressive bilateral blurred vision, worse in the right eye, over several days. Two months prior, she developed a diffuse pruritic rash that spared her face. On examination, she was found to have reduced visual acuity bilaterally, optic nerve edema, anterior uveitis, and scattered intraretinal and peripapillary nerve fiber layer hemorrhages. Diagnostic evaluation demonstrated optic nerve head enhancement on MRI. Her serum workup showed positive antibodies for Borrelia burgdorferi with a negative Lyme disease Western blot and positive Treponema pallidum antibodies with an rapid plasma reagin titer of 1:1,024. CSF showed normal protein, a slight elevation in nucleated cells with lymphocytic predominance, and a negative Venereal Disease Research Laboratory. We examine the differential diagnosis for bilateral optic nerve edema and uveitis and explore challenges around interpreting diagnostic testing for a neuro-ophthalmic pathology of ongoing public health interest.
The resting angle forms between the lateral crus of the lower lateral cartilage (LLC) and the upper lateral cartilage. While conventional nasal valve repair relies on cartilage grafting for reinforcement of these structures, the functional significance of resting angle adjustment remains underexplored. We describe a technique to reposition the LLC, adjusting the resting angle to support the lateral nasal wall and restore external nasal valve (ENV) function without grafts, with the hypothesis that this approach improves functional and aesthetic outcomes. Retrospective cohort study. We retrospectively identified patients with ENV collapse-related nasal obstruction who underwent the described surgery. Pre- and postoperative peak nasal inspiratory flow (PNIF) measurements and FACE-Q scores were compared to evaluate functional and aesthetic improvement, respectively. Thirty patients (22 female, 8 male) were included. Postoperatively, median PNIF increased from 74.0 L/minute (interquartile range [IQR]: 73.0-76.0; 95% confidence interval [CI]: 72.5-75.5) to 96.0 L/minute (IQR: 93.0-97.0; 95% CI: 94.0-97.5), and median FACE-Q Satisfaction with nose scores from 17 (IQR: 16.0-18.0; 95% CI: 16.0-17.5) to 37 (IQR: 35.0-38.0; 95% CI: 36.5-37.5); both improvements were statistically significant (p < 0.001). Resting angle correction may not only improve aesthetics, but also stabilize the lateral nasal wall to prevent or repair ENV collapse.
Since October 2021, it has been possible in Leipzig to rent e-scooters and to participate actively in road traffic. Since then, a large number of traffic offenses has been recorded. This study examines alcohol and drug use among e-scooter riders in Leipzig and the surrounding area - particularly in relation to the new legal regulations. The accidents are analyzed in detail. A total of 411 traffic offenses recorded by the police between October 2021 and June 2024 were retrospectively analyzed. The study cohort consisted of 91.2% men. Of all rides under the influence of intoxicating substances, 65.9% took place in Leipzig. Differentiation of the traffic offenses revealed that 67.2% were administrative traffic offenses (§ 24a German Road Traffic Act, StVG), while 32.8% were criminal traffic offenses (§ 315c and § 316 German Criminal Code, StGB). Cannabis use was predominantly detected in administrative offenses, whereas alcohol consumption played the major role in criminal traffic offenses. Among cannabis users, the majority were non-chronic consumers (79.2%). The main cause of accidents was self-inflicted loss of balance (59.5%; n = 22). Accident consequences were primarily minor injuries (67.6%; n = 25), with injuries occurring mainly to the face (n = 5), head (n = 6), and upper extremities (n = 5). These data show that alcohol and cannabis consumption dominate the rising traffic offenses in Leipzig and its surrounding area. The results contain temporal and regional differences which point to distinct target groups and underscore the necessity of providing education regarding the legal framework and the impact of substances on driving and fall competences. In light of these findings, together with data from other regions, a re-evaluation of the statutory THC limit should be considered, as the current threshold primarily results in reduced penalties for occasional users, who may be at higher risk due to a lack of tolerance development. The observed injury patterns suggest an introduction of a helmet requirement.
To determine the prevalence of keratinocyte cancer and melanoma among people conducting aquatic and non-aquatic outdoor activities, and their associated ultraviolet radiation (UVR) exposures. This was a cross-sectional study incorporating a survey and total body skin cancer screen. There were 1,403 participants attending a specialized skin cancer-focused general practice during the period of September 2021 to August 2024. The main outcomes measured were the point prevalence of pre-cancerous skin lesions, keratinocyte cancers (KC) (i.e., basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) and primary cutaneous melanoma (MM). Of 1,403 participants (739 women, 664 men), 512 were identified as aquatic and 891 were identified as non-aquatic. Among aquatic participants, 98 of 512 (19.1%) participants were diagnosed with BCC, compared with 142 of 891 (15.9%) non-aquatic participants. Regarding SCC in the population, 46 of 512 (9.0%) aquatic participants were diagnosed compared with 89 of 891 (10.0%) non-aquatic participants. For melanoma (MM), 48 out of 512 (9.4%) aquatic participants were diagnosed and 48 of 891 (5.4%) non-aquatic participants, resulting in an odds ratio nearly double (1.8 times) for aquatic participants compared with non-aquatic. Participants of increased age and male gender had an increased likelihood of being diagnosed with MM. Primary locations for KC were the head, face and neck (32% aquatic, 36% non-aquatic), which differed for MM, being primarily located on the back (40% aquatic, 37% non-aquatic). While the prevalence of BCC and SCC was similar across activity groups, aquatic participants demonstrated a significantly higher prevalence of MM, despite reporting lower cumulative lifetime UV exposure. A higher MM risk is likely attributable to greater participant engagement during peak ultraviolet radiation (UVR) hours. These findings underscore the need for skin cancer surveillance in aquatic enthusiasts, who should be recognised as a high-risk population within the national melanoma screening framework.