搜索结果：Head & face medicine

Chronological age predicts cancer survival but does not capture differences in biological aging rates. We apply FaceAge, an artificial intelligence algorithm that predicts biological age from a facial photograph, to serial clinical facial photographs to calculate the Face Aging Rate (FAR; change in FaceAge divided by the time between photographs). We analyze data from 2276 cancer patients receiving radiation therapy, using photographs captured during routine care. Higher FAR is associated with worse overall survival in stratified analyses of cohorts with the following intervals between photographs: short 10-365 days (adjusted hazard ratio [aHR] and 95% confidence interval: 1.25 [1.03-1.51]), mid 366-730 days (aHR: 1.37 [1.00-1.86]), and long 731-1,460 days (aHR: 1.65 [1.22-2.22]) after adjustment for time between photographs, sex, race, and diagnosis. FAR provides additional prognostic information beyond single time-point measures of FaceAge. FAR is a non-invasive prognostic biomarker that captures dynamic changes in biological aging.

Modern facial rejuvenation can no longer be limited to the "facelift": Perceived age is strongly influenced by the smile, incisor display, lip support, and the proportions of the lower third of the face. These parameters are shaped by orthodontics (especially clear aligners) as much as by aesthetic surgery. What are the orthodontic determinants of facial rejuvenation (smile/perioral region/lower third), and how can they be integrated into a surgical or medical-aesthetic rejuvenation strategy? The objective of this article is to propose a practical decision-making algorithm capable of determining in which cases orthodontics alone is sufficient and in which cases a combined orthodontic-facial rejuvenation strategy is more appropriate. A structured narrative review was conducted based on searches of the PubMed, Scopus, and Embase databases (1990-2025). Articles addressing smile aging, aligner predictability (torque, extrusion, rotations), facial aging anatomy (fat compartments/skeletal framework), and rejuvenation techniques (midface/lower third, perioral complex) were selected. (1) Aging is associated with reduced maxillary incisor display and relatively increased mandibular incisor exposure, along with lip lengthening. (2) Clear aligners align and level effectively, but their accuracy varies depending on the type of movement, with extrusion and some torque/rotations remaining less clinically predictable. (3) Surgical and non-surgical rejuvenation strategies target both the "container" (skeletal structure) and the "content" (fat compartments/superficial muscular aponeurotic system [SMAS]), as well as the perioral complex, in order to restore proportions perceived as more youthful. A simple algorithm for co-planning orthodontic treatment and facial rejuvenation can identify clinical warning signs that justify a combined strategy (orthodontics combined with injectables, lipofilling, lip lift, or cervico-facial rejuvenation). An orthodontist-friendly framework for facial rejuvenation relies on four levers: (1) incisor display (at rest/during speech/when smiling), (2) incisor torque and smile arc, (3) lip support (avoiding retraction with an "aging-like" effect), (4) vertical dimension of occlusion and lower-third height. Orthodontists are key partners in facial rejuvenation because they control major perioral aesthetic determinants. Shared planning (standardized photographs, dynamic smile analysis, and precise torque and lip-support objectives) improves the naturalness of outcomes and reduces aesthetic discrepancies. Le rajeunissement facial moderne ne peut plus se limiter au « lifting du visage » : la perception d’âge dépend fortement du sourire, de l’exposition incisive, du support labial et de la proportion du tiers inférieur du visage. Or, ces paramètres sont modulés par l’orthodontie autant que par la chirurgie esthétique. Quels sont les déterminants orthodontiques du rajeunissement facial (sourire/région périorale/tiers inférieur) et comment les intégrer à une stratégie de rajeunissement chirurgical ou médico-esthétique ? L’objectif de cet article est de proposer un algorithme décisionnel, directement exploitable, afin de décider dans quel cas l’orthodontie seule suffit, et dans quels cas une stratégie combinée orthodontie-rajeunissement facial s’avère plus cohérente. Une revue narrative structurée a été réalisée à partir d’une recherche dans les bases PubMed, Scopus et Embase (1990-2025). Les articles relatifs au vieillissement du sourire, à la prévisibilité des aligneurs (torque, égression, rotations), à l’anatomie du vieillissement facial (compartiments graisseux/architecture osseuse) et aux techniques de rajeunissement (étage moyen/tiers inférieur, région périorale) ont été sélectionnés. (1) Le vieillissement s’accompagne d’une diminution de l’exposition des incisives maxillaires et d’une augmentation relative de l’exposition incisive mandibulaire, parallèlement à l’allongement de la lèvre supérieure. (2) Les aligneurs sont efficaces pour l’alignement et certains mouvements, mais leur précision varie selon le type de mouvement : l’égression incisive et certains contrôles de rotations ou de torques demeurent cliniquement moins prédictibles. (3) Les stratégies chirurgicales et médico-esthétiques ciblent à la fois le « contenant » (structure squelettique) et le « contenu » (compartiments graisseux/système musculo-aponévrotique superficiel ou SMAS), ainsi que le complexe labio-mentonnier, afin de restaurer des proportions perçues comme plus « jeunes ». Une approche intégrant l’orthodontie dans le rajeunissement facial repose sur quatre leviers principaux : (1) l’exposition incisive (au repos/parler/sourire), (2) le contrôle du segment incisif (torque) et l’arc du sourire, (3) le support labial en évitant les mouvements de rétraction sans contrôle à effet « vieillissant », (4) la dimension verticale d’occlusion et la hauteur du tiers inférieur du visage. L’orthodontiste est un acteur central du rajeunissement facial car il pilote des déterminants majeurs de l’esthétique périorale. La co-planification interdisciplinaire (photographies standardisées, analyse dynamique du sourire, objectifs précis de torque et de support labial) améliore la naturalité des résultats et diminue les discordances esthétiques.

To evaluate associations between parapapillary choriocapillaris microvascular dropout (MvD) and optical coherence tomography (OCT)-detected deep optic nerve head (ONH) structures in glaucomatous eyes with and without myopia. Cross-sectional study from clinical trial data. 394 eyes from 262 patients with primary open-angle glaucoma (POAG) and glaucoma suspects were stratified into three groups of no myopia (axial length (AL)<24 mm; n=144), mild myopia (24 mm&#x2264; AL <26 mm; n=174), and high myopia (AL &#x2265; 26 mm; n=76). Spectralis ONH OCT radial B-scans were acquired relative to the Foveal-Bruch's Membrane Opening (FoBMO) axis. Bruch's Membrane Opening (BMO) and anterior scleral canal opening (ASCO) were manually segmented, and their size and shape were calculated. BMO/ASCO offset magnitude, neural canal obliqueness, and neural canal minimum cross-sectional area (NCMCA) were measured. The presence, area, and angular circumference of juxtapapillary MvD were evaluated using OCT-angiography en face choroidal images and B-scans. The MvD area (95% CI) was significantly greater in highly myopic eyes (0.38 [0.30, 0.47] mm&#xb2;), compared with mild myopia (0.33 [0.27, 0.39] mm&#xb2;) and no myopia (0.21 [0.14, 0.27] mm&#xb2;) (P=0.002). The MvD angular circumference was also significantly larger in mild myopia (75.4 [64.0, 86.9]&#xb0;), followed by high myopia (74.5 [58.0, 90.9]&#xb0;) and no myopia (52.6[39.9, 65.3]&#xb0;) (P=0.017). The highly myopic group showed a significantly larger BMO area, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness, along with smaller NCMCA, compared to the other groups (all P<0.01). In multivariable analysis, NCMCA, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness were significantly associated with both MvD presence (all P<0.05) and MvD area (all P<0.05). Additionally, NCMCA ovality index and neural canal obliqueness were associated with MvD angular circumference (P=0.01 and P=0.004, respectively). In myopic POAG eyes, the presence and area of MvD were associated with NCMCA, NCMCA ovality index, BMO/ASCO offset magnitude, and neural canal obliqueness, whereas MvD angular circumference was associated only with NCMCA ovality index and neural canal obliqueness. Evaluating choriocapillaris MvD alongside deep ONH structural alterations may provide clinical insights into the pathogenesis of glaucoma in myopia.

Patients with head and neck cancer (HNC) face significant challenges in accessing coordinated care due to the complexity and multimodality of their treatment and the impact on vital functions. The COVID-19 pandemic has disrupted cancer care while accelerating the adoption of digital health solutions. Mobile health (mHealth) apps offer potential solutions for remote symptom monitoring, communication between patients and providers, and continuity of care. Nevertheless, their acceptance among patients with HNC remains limited due to age-related digital divides and concerns about accessibility. The aim of this study was to investigate the impact of the COVID-19 pandemic on patients with HNC and to explore their attitudes toward mHealth apps as a supplement to cancer treatment. A secondary analysis of a cross-sectional survey was conducted between January 2023 and May 2024 at Julius Maximilian University of W&#xfc;rzburg in Germany. A total of 355 patients with HNC were recruited and completed the structured "Cancer and COVID-19" survey via the Corona Health app or in paper form. The 25-question survey assessed sociodemographic information, the impact of the pandemic on diagnosis/treatment/aftercare, and interest in mHealth apps. Descriptive statistics and bivariate correlations were used for the analysis. The cohort comprised 261 (74%) men and 94 (26%) women with an average age of 67 (SD 11.5) years. Most participants (n=264, 74%) stated that the pandemic had no impact on their cancer treatment, although 20% (n=71) experienced disruptions, particularly in follow-up appointments and treatment monitoring. Only 10% (n=36) currently used health apps, but 57% (n=203) expressed a willingness to use mHealth technologies. Younger patients, patients with higher education, and participants who were more affected by the pandemic showed greater openness to digital health solutions. The most significant barriers included age, digital literacy, and perceived usefulness, while preferred app features included interaction with physicians (n=160, 45%) and data sharing with researchers (n=153, 43%). Although the COVID-19 pandemic had only a limited direct impact on HNC care at the institution at hand, it revealed significant patient interest in mHealth apps. However, significant barriers remain, particularly among older adults with lower digital literacy. Future mHealth initiatives should focus on improving digital literacy, addressing privacy concerns, demonstrating clinical benefits, and developing personalized, accessible solutions to optimize cancer care for this vulnerable population.

Nocardia species are obligate aerobic actinomycetes. Human nocardiosis typically occurs in immunocompromised hosts and most commonly manifests as primary suppurative pulmonary infection. Hematogenous dissemination can lead to extrapulmonary involvement, with the central nervous system being the most frequent secondary site, followed by skin and subcutaneous soft tissues; pericardium, lymph nodes, and joints are affected only rarely. A 50-year-old HIV-positive man was admitted with a 1-month history of oral blood blisters and ecchymoses of the extremities. A right forehead abscess that developed during hospitalization yielded pus that was identified as Nocardia concava by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and confirmed by 16S rRNA gene sequencing. Initial management included antiretroviral therapy, systemic glucocorticoids, and intravenous immunoglobulin; subsequent targeted antimicrobial therapy with linezolid plus trimethoprim-sulfamethoxazole, instituted upon microbiological confirmation, resulted in clinical improvement and discharge. To our knowledge, this is the first case report of forehead abscess infection caused by N. concava in an acquired immunodeficiency syndrome (AIDS) patient. Human infections due to this organism remain extremely rare. Moreover, the infection site in this case was not the commonly affected lung or central nervous system, typically involved in nocardiosis, which resulted in atypical clinical manifestations prone to missed diagnosis or misdiagnosis. In this case, precise etiological identification allowed for early definitive diagnosis and favorable clinical outcomes. This case underscores the importance of increased vigilance for rare Nocardia infections in severely immunocompromised patients. For unexplained skin and soft tissue abscesses, early etiological examination is critical, and targeted antimicrobial therapy based on drug susceptibility can significantly improve prognosis.

To review the current state of ultrasound energy-based devices and their role in facial and neck rejuvenation. High-frequency ultrasound (HIFU) paved the way for the micro-focused and parallel beam ultrasound technology in aesthetics. Facial and cervical aging reflect multilayered structural changes, as well as reduced collagen production and increased collagen breakdown at the histologic level, resulting in rhytids and skin laxity. Micro-focused ultrasound with visualization (MFU-V) is adapted from HIFU, using significantly less ultrasound energy and visualization to precisely target the deep dermis and superficial musculoaponeurotic system (SMAS) at depths ranging from 1.5 to 4.5&#x2009;mm; synchronous ultrasound parallel beam (SUPERB) technology uses parallel transducers to deliver energy at a precise depth of 1.5&#x2009;mm to target the mid-dermis. Ultrasonic facial rejuvenation is ideal for those with mild to moderate skin laxity who desire incremental tightening and textural improvement without surgery. MFU-V can be performed at different tissue depths based on the transducer tip, with various combination protocols described; SUPERB technology delivers energy at a fixed depth. Self-limited erythema and edema, sun protection. The intersection of ultrasonic devices and regenerative medicine is promising. MFU-V and SUPERB are ideal noninvasive options for patients with mild to moderate skin laxity.

Surgical correction of ear shape and size is a common procedure in reconstructive and aesthetic surgery. However, objective reference values for ideal auricular proportions remain limited. To systematically evaluate public perception of ideal ear size using digitally modified full-face images and provide gender-specific aesthetic reference values. 141 dental students assessed a set of 16 male and 16 female clone images with ear sizes ranging from 4.9 to 7.9&#xa0;cm. Participants identified the most and least attractive sizes, as well as thresholds for "too small" and "too large." The most attractive ear sizes were between 5.7 and 6.3&#xa0;cm for male faces and 5.5-6.1&#xa0;cm for female faces, corresponding to approximately one-fourth the height of the head in both sexes. Ears &#x2265;6.5&#xa0;cm were generally perceived as too large. Correlation analyses revealed consistent individual judgment patterns. This is the first systematic analysis to define perceived ideal ear size in full-face views of young Caucasian adults. The findings offer clinically relevant guidance for aesthetic and reconstructive surgery, emphasizing the importance of age- and gender-sensitive planning.

Compare injury demographics in ice hockey versus roller hockey to provide insights for safety recommendations. Retrospective analysis using data from the National Electronic Injury Surveillance System. National Electronic Injury Surveillance System collects data on recreational activity-related and consumer product-related injuries treated in US Emergency Departments. All patients presenting to emergency departments for ice and roller hockey-related injuries 2013 to 2022. Age, sex, race, body part injured, and injury diagnosis. Ice hockey included product codes 1279 ("ice hockey") and 3272 ("hockey"). Roller hockey included product codes 3245 ("street hockey") and 5032 ("roller hockey"). Injuries were most common in the 11 to 15 years age group in both ice hockey and roller hockey (38.1% and 34.2%, respectively). Men represented most patients in both ice hockey and roller hockey (88.6% and 80.1%, respectively). White race constituted approximately 56.6% and 65.3% of all cases in ice and roller hockey, respectively. The 3 most common locations for injury in ice hockey were head (20.9%), face (12.3%), and shoulder (12.1%), while for roller hockey, they were head (17.6%), face (16.6%), and ankle (8.9%). The 3 most common types of injury in ice hockey were fracture (18.7%), laceration (17.8%), and contusion (12.5%), while for roller hockey, they were fracture (18.1%), strain/sprain (16.4%), and laceration (16.3%). Analyzing these injury patterns informs targeted safety regulations to prevent common injuries in each sport. Adjusting face equipment benefits players in both sports. Special attention to prevent shoulder injuries in ice hockey and ankle sprains in roller hockey is warranted.

Powered micromobility devices (PMDs), including electric scooters (e-scooters) and electric bicycles (e-bikes), can operate at speeds approaching those of low-speed motorcycles. Yet PMDs are treated as low-energy mechanisms in trauma surveillance systems and are not classified as distinct mechanisms of injury. Although prior studies report higher head injury rates in PMD crashes than bicycle crashes, injury severity and health care utilization relative to motorcycle crashes are not known. We hypothesized that e-scooter and e-bike crashes demonstrate distinct injury and resource utilization patterns compared with motorcycles and bicycles. We performed a retrospective cohort study using the 2023 Florida Agency for Health Care Administration emergency department and inpatient databases. Encounters for motorcycle, bicycle, e-scooter, or e-bike crashes were identified. Patients meeting National Trauma Data Standard criteria were classified as trauma registry-eligible. Multivariable regression evaluated associations between mechanism and severe head and facial injury. Of 50,889 encounters, 10,522 (20.7%) were trauma registry-eligible. Median ISS was highest for motorcyclists [10 (interquartile range: 4-22)], followed by bicyclists [9 (1-14)], e-bike [8 (2-17)], and e-scooter riders [6 (1-15)] (p<0.001). On adjusted analyses, e-scooter and e-bike crashes had no significant differences in adjusted odds ratios (aORs) of severe head injury relative to motorcycle crashes, while e-bike crashes were associated with a higher aOR of severe facial injury (aOR: 1.78, 95% confidence interval: 1.15-2.74). E-bike injuries demonstrated the second-highest intensive care unit utilization and per-encounter hospital charges after motorcycles (both p<0.001). E-scooter and e-bike crashes demonstrated injury and resource utilization patterns distinct from both traditional bicycles and motorcycles. Head injury risk among PMD riders was similar to that of motorcyclists, while facial injury risk among e-bike riders exceeded that of motorcyclists. Findings highlight the need for improved injury surveillance and evidence-based helmet standards for PMD users, including evaluation of whether full-face protection may be warranted. Prognostic/Epidemiological; Level III.

Photodynamic therapy and cryotherapy are treatment options for actinic keratosis; however, their efficacy and safety remain debated. To perform a high-quality systematic review and meta-analysis exploring the efficacy and safety of photodynamic therapy and cryotherapy in actinic keratosis. A systematic search was performed applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Web of Science, Cochrane, Science Direct, Ovid, EBSCO, Wiley, and Google Scholar for randomized controlled trials. A total of seven studies with 1233 patients were identified. PDT and cryotherapy showed similar success in clearing lesions (RR, 1.02; 95% CI, 0.92-1.13; p&#x2009;=&#x2009;0.74). While both treatments performed comparably on the head and face (RR, 1.10; 95% CI, 0.94-1.28; p&#x2009;=&#x2009;0.24), data from one trial suggested cryotherapy might be more effective for lesions on the arms and legs (RR, 0.88; 95% CI, 0.82-0.94; p&#x2009;<&#x2009;0.05). However, more research is needed to confirm this finding. Cosmetic outcomes were significantly better for PDT (74.62% vs. 49.11%: RR, 1.52; 95% CI, 1.4-1.65; p&#x2009;<&#x2009;0.00001) than cryotherapy. Similarly, PDT was superior to cryotherapy in patient satisfaction though the overall difference was not statistically significant (RR, 1.43; 95% CI, 0.91-2.25; p&#x2009;=&#x2009;0.12). PDT was associated with a significantly higher risk of burning sensations and pain (RR, 1.95; 95% CI, 1.27-3.02; p&#x2009;=&#x2009;0.002), whereas cryotherapy more frequently led to vesicles and blisters. Lesion clearance may depend on location. It is comparable for head and face lesions, while data from one trial suggests cryotherapy may be better for extremity lesions. PDT is associated with a higher occurrence of pain/burning, while cryotherapy leads to more vesicles/blisters. Future research should focus on standardized protocols, including blinded post-treatment assessments to improve reliability and minimize bias.

Early detection of developmental dysplasia of the hip in newborns and infants is essential to ensure lifelong mobility. As several municipalities conduct nurse-led hip ultrasound screenings during newborn and infant home visits, nurses must acquire the accurate technique smoothly and effectively. Clarifying the challenges nurses face when performing ultrasound procedures helps support effective education. This study aimed to identify challenges inexperienced nurses face when performing basic ultrasound using the Graf-method in home settings. Descriptive case study. Ultrasound training was provided to 22 nurses in Japan to enable use during newborn and infant home visits. We analyzed 25 video cases from three nurses who required >&#x2009;180&#x2009;s to obtain a standard plane image. Videos were transcribed and inductively analyzed to identify challenges with reference to Yin's case study methodology. Conditions of the challenges were categorized into knowledge, skills, and attitudes with reference to Bloom's taxonomy. The knowledge gap led to the failure to correctly judge whether the femoral head/standard plane was captured. Skill deficiencies led to failure to move the probe vertically and difficulty maintaining the infant's straight lateral position. The combination of inadequate knowledge and skills resulted in failures to (1) place the probe directly over the femoral head, (2) display the image in the correct position and orientation, and (3) move the probe correctly regarding direction and range while maintaining the image in the correct position and orientation. Regarding attitude gaps, nurses failed to improve the procedure. Improving ultrasound proficiency for developmental hip dysplasia detection requires training in anatomy integration, sensory experience, and probe-screen coordination while addressing posture, equipment handling, and motor skills. University Hospital Medical Information Network Clinical Trial Registry: UMIN000051929.

Analyze demographic and clinical factors for patients presenting with dog bites to the face, head, or neck. Retrospective cohort. Single tertiary care, level 1 trauma center. A retrospective chart review identified patients presenting for facial dog bite injuries from 2012 to 2023. There were 906 patients with facial dog bites and 2061 injuries. Patients ranged from 0 to 91 years old with a median of 7 years, and 50.6% were female. The 2 most common causes for injury were playing with the dog (32.0%) or an unprovoked attack (17.3%). Family dogs were responsible for 61.3% of injuries. Pitbulls (22.4%), Labradors (10.5%), and German Shepherds (7.0%) were the most identified breeds. The cheeks (25.9%), lips (20.8%), and nose (9.0%) were most injured. Hospital admission was required in 17.0% of patients. Regarding management, 16.9% required operative repair, 65.9% were repaired at bedside, and 17.9% were managed conservatively. There were 878 patients prescribed intravenous or oral antibiotics (96.9%) with amoxicillin-clavulanate most frequently prescribed (62.7%). Of the 138 patients bit by dogs with outdated or unknown rabies vaccination status, 35.5% (n&#x2009;=&#x2009;49) received a rabies vaccination, and 34.8% (n&#x2009;=&#x2009;48) received rabies immunoglobulins. Of the 254 patients not current on tetanus vaccination, 78.7% (n&#x2009;=&#x2009;200) received a booster. Dog bites to the head and neck are common injuries, with many patients requiring hospital admission and/or repair. Understanding the demographics of these injuries is important to identify physical and socioeconomic burdens of disease, gaps in adherence to protocols/guidelines, and areas of targeted education/preventative interventions.

Modern medicine, especially oncology in low- and middle-income countries (LMICs), requires clinicians to remain updated in a rapidly evolving field of medicine in the face of a high clinical load. Clinicians need to be able to critically evaluate published evidence and make informed decisions about the individual patients they treat. A clinical culture that encourages clinicians to question and think critically would produce high-quality research from parts of the world that have highest disease burden but lowest contribution to published research. A two-day research methods course was conducted jointly by the Tata Medical Center, Kolkata and the West Bengal Chapter of the Indian Psychiatric Society on 22nd-23rd August 2025. We report on our experience of organising this course and the lessons learned from interacting with the audience in an LMIC setting. Live anonymous participant responses were captured using Mentimeter software during the training, and written anonymous feedback were provided by majority of attendees. The three main barriers to conducting research that our participants reported were: 'lack of training in research', 'difficulties in writing a research paper' and the 'researcher's personal circumstances'. The participants in our course comprised both men and women clinicians, mostly in their early careers and this group of learners appreciated hands-on training on literature search, reference management and working with the SPSS statistical software to conduct standard statistical tests. To achieve this, institutions and individuals need to foster a conducive environment for research, inspiring those who will be responsible for the future health care delivery.

Patients with pre-existing severe mental disorders (SMD) face barriers to optimal cancer treatment. Structured interventions may improve care, but knowledge about their feasibility in daily clinical practice is needed. To assess the feasibility of the CASEMED Model. This mixed-methods feasibility study was conducted at Aarhus University Hospital and included patients with pre-existing SMD and breast, lung, or head and neck cancer. The intervention components included early detection of psychiatric comorbidity, screening for physical and psychiatric symptoms, involvement of caregivers, continuity, education, and enhanced cross-sector collaboration through an onco-psychiatric multidisciplinary team conference (opMDT). Data were collected from patient records and interviews focusing on intervention delivery, acceptability, burden, unintended consequences, and mechanisms of change. Of 27 eligible patients, 23 (85%) participated. Patients had breast (48%), lung (26%), or head and neck cancer (26%) and were diagnosed with moderate to severe depression (65%), bipolar affective disorders (26%), or schizophrenia and other psychotic disorders (9%). Overall, the intervention was feasible and well-accepted, with minimal burden reported. It facilitated a multidisciplinary approach, patient-centered care and cross-sector collaboration. The main implementation barriers included difficulties identifying the appropriate target population, lengthy questionnaires, lack of continuity among oncological professionals, and low general practitioner participation in opMDTs. This feasibility study demonstrates that the CASEMED Model is acceptable and feasible, with a low level of burden and few implementation barriers. The intervention facilitated a multidisciplinary approach with potential to enhance cancer care. Further research is needed to confirm its effectiveness and generalizability in other healthcare settings.

Patients in the prone position in the intensive care unit are at risk of facial skin failure, a concern that has traditionally been managed through frequent repositioning, often necessitating considerable effort from healthcare practitioners. This study aims to evaluate the effectiveness of an original improved U-shaped pillows in preventing pressure injuries to the head and face of patients undergoing prone ventilation. A retrospective analysis was conducted on data from 61 patients who underwent prone positioning ventilation. The study group consisted of 31 patients who used the improved U-shaped pillow, which features 7 independent air chambers designed for dynamic segmental pressure regulation. The control group was composed of 30 patients who underwent decompression using traditional integrated U-shaped sponge pillows, which lack pressure-adjustment capabilities. There were no significant differences between the 2 groups at baseline. While the intergroup difference in facial pressure injury incidence was not statistically significant (6.5% vs 23.3%, P&#x2005;=&#x2005;.081) and no significant benefit was detected in the univariate analysis (P&#x2005;=&#x2005;.080), a significant advantage of the new pillow emerged after adjusting for potential confounders. In the multivariate regression analysis, the study group demonstrated a significantly reduced incidence of facial pressure injuries compared to the control group (P&#x2005;=&#x2005;.048). A comparison of the average number of head position changes per hour between the 2 patient groups during prone positioning indicated that the study group demonstrated significantly better performance than the control group. This difference was statistically significant (0.55&#x2005;&#xb1;&#x2005;0.10 vs 0.68&#x2005;&#xb1;&#x2005;0.15, P&#x2005;<.001). The satisfaction level among nurses in the study group was significantly higher than that in the control group (3.61&#x2005;&#xb1;&#x2005;0.69 vs 3.04&#x2005;&#xb1;&#x2005;0.69, P&#x2005;=&#x2005;.003). A statistically significant positive correlation was identified between body mass index and pressure injury incidence (P&#x2005;=&#x2005;.004). The application of the original improved U-shaped pillow was associated with a reduced incidence of craniofacial pressure injuries in prone-ventilated patients after adjustment for confounders, while also mitigating the clinical nursing burden and improving job satisfaction among healthcare staff.

Very low birth weight (VLBW) preterm infants face significant nutritional challenges, and the selection of an appropriate enteral nutrition protocol is critical for promoting growth and development while minimizing the risk of complications. This study aimed to analyze the impact of early administration of total enteral feeding with various nutritional preparations on the growth status of VLBW preterm infants. A retrospective study was conducted on 79 cases of VLBW preterm infants. The subjects were categorized into 3 groups based on the differences in nutritional intervention: the breastfeeding group (BF group, n = 28), the standard preterm formula group (SPF group, n = 25), and the extensively hydrolyzed protein formula group (EHF group, n = 26). The discharge weight, weight gain, and growth rate of infants in the EHF group were significantly higher than those in the SPF and BF groups, and the growth rate in the SPF group was higher than that in the BF group. Upon discharge, the SPF group exhibited greater length and head circumference compared to the BF and EHF groups. The incidence of diarrhea in the SPF group was higher than that in the BF and EHF groups. Upon discharge, the uric acid level in the EHF group was higher than that in the SPF group. The hospital stay for infants in the SPF and EHF groups was shorter than that in the BF group. The EHF group had a significantly higher mean daily protein intake compared to the SPF and BF groups, while the SPF group exhibited a higher carbohydrate intake than the other 2 groups. While SPF feeding is effective in improving the head circumference and body length of VLBW preterm infants, it is associated with a higher incidence of diarrhea. In contrast, EHF feeding yields better weight gain outcomes and demonstrates superior safety.

Dermoscopic image segmentation plays a crucial role in computer-aided diagnostic (CAD) systems as an important tool for diagnosing skin lesions. The precise segmentation of lesion regions in dermatological images facilitates more objective and accurate diagnostic decision-making in clinical practice. However, many existing deep learning models face challenges in accurately segmenting lesion edges and are computationally complex, which limits their deployment on resource-constrained edge devices. Therefore, this study aimed to design a dermoscopic image segmentation model that simultaneously addresses the challenges of edge segmentation and maintains low computational complexity. We developed a wide edge-assisted lightweight dermoscopic image segmentation network (WENet) consisting of a lightweight encoder and a wide-edge-assisted decoder. The encoder is constructed using a squeeze dual-path convolution (SDPC), which adopts a bottleneck design and employs asymmetric convolutions with large and small dilation rates to significantly reduce model complexity while ensuring efficient feature extraction. It also integrates the statistical multi-feature adaptive channel recalibration attention (SACA) module for precise channel feature recalibration. The decoder consists of the wide-boundary generator (WBG), prediction information fusion decoding layer (PFDL), and progressive multi-scale feature fusion segmentation head (PMSSH). The WBG generates wide-edge labels by combining ground-truth annotations with morphological erosion and applies deep supervision to guide the model to learn boundary features, enhancing the model's edge segmentation performance without increasing the parameter count. The PFDL fuses region and boundary predictions with decoding features and employs a grouped design using the SDPC for feature extraction. It then enhances spatial feature information using group multi-axis Hadamard product attention (GHPA). The PMSSH progressively integrates multi-scale features to bridge the semantic gap across scales, ultimately producing the final segmentation map. WENet was evaluated on the International Skin Imaging Collaboration (ISIC)2017, ISIC2018, and Pedro Hispano 2 (PH2) datasets, and achieved mean intersection over union (mIoU) scores of 80.37%, 81.34%, and 85.98%, and specificity (Spe) values of 98.37%, 97.39%, and 96.23%, respectively, while maintaining a model size under 15KB. The model has significantly fewer parameters compared to recent state-of-the-art models, while maintaining excellent segmentation performance. The proposed WENet presents an accurate yet computationally efficient solution for dermoscopic image segmentation, outperforming state-of-the-art methods in both model compactness and boundary segmentation precision.

To characterize the injury profile and return-to-play (RTP) timelines of elite pickleball players on the Professional Pickleball Association (PPA) Tour. Retrospective observational study. Professional pickleball tournaments held on the PPA Tour or professional circuits between 2018 and 2025. One hundred thirteen elite pickleball players (48 male, 65 female), ranging in age from late teens to mid-40s (mean age &#x223c;31 years). Descriptive analysis of publicly documented injury reports and RTP data. Injury type, location, mechanism, competition withdrawal, and RTP duration. Seventy-five injuries were recorded in 52 players (46%) during the 7-year period. Lower extremity injuries were most common (49%), particularly ankle sprains (13) and knee injuries (8), along with Achilles ruptures and Anterior Cruciate Ligament (ACL) tears. Head and face injuries (13%) were often from paddle or ball impacts and included concussions. Upper extremity injuries (12%), such as wrist ligament tears and elbow tendinopathies, were less frequent. Approximately 68% of injuries led to at least 1 tournament withdrawal. Return to play varied: 35% returned within days, 15% in weeks, and &#x223c;19% required multiple months. Several severe injuries, including ACL tears and Achilles ruptures, were season ending. Elite pickleball players sustain a diverse array of injuries, with lower extremity sprains being the most prevalent. Although many athletes return quickly, others experience prolonged recovery. These results highlight the need for enhanced injury prevention efforts, centralized injury surveillance, and targeted conditioning programs to support player health as the sport continues to grow. These findings can inform injury prevention strategies and medical monitoring for professional pickleball players.

Trigeminal neuralgia (TN) is a chronic neuropathic pain condition characterized by brief, intense, and electrical shock-like facial pain. The most common causes of this are due to neurovascular compression of the superior cerebellar artery (SCA). However, as seen in this case report, duplication of the SCA resulting in TN is extremely uncommon. A 63-year-old woman presented with a 1-day history of paroxysmal, shock-like pain on the right side of her face affecting both the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve. Each episode of pain would last 1-2 min, occur multiple times each day, and be precipitated by chewing, with resultant ipsilateral tearing. Her past medical history included no trauma, dental disease, or systemic illnesses. Examination of the neurological system revealed all cranial nerves were normal, and there were no facial motor deficits. Magnetic resonance imaging (MRI) of the head-and-neck region with gadolinium enhancement, demonstrated an anomalous duplication of the right SCA where its lower branch compressed and deformed the cisternal portion of the right trigeminal nerve, representing a Grade II neurovascular conflict, with no cerebrospinal fluid visible between the vessel and nerve. Computed tomography scan of the brain demonstrated evidence of chronic ischemic changes and age-related cortical atrophy. Based on the findings from the above diagnostic testing, she was diagnosed with typical TN secondary to neurovascular compression from an anomalous duplicated SCA. She was started on carbamazepine with good symptomatic relief. Duplication of the SCA is a rare anatomical anomaly which may result in symptomatic neurovascular compression of the trigeminal nerve. In cases of suspected neurovascular compression of the trigeminal nerve, high-resolution MRI is necessary to identify these vascular abnormalities and guide the appropriate treatment options. R&#xe9;sum&#xe9;La n&#xe9;vralgie du trijumeau (NT) est une affection douloureuse neuropathique chronique caract&#xe9;ris&#xe9;e par des douleurs faciales br&#xe8;ves, intenses et de type d&#xe9;charge &#xe9;lectrique. La cause la plus fr&#xe9;quente est une compression neurovasculaire, le plus souvent due &#xe0; l&#x2019;art&#xe8;re c&#xe9;r&#xe9;belleuse sup&#xe9;rieure (ACS). Cependant, comme illustr&#xe9; dans ce cas, la duplication de l&#x2019;ACS responsable de NT est extr&#xea;mement rare. Une femme de 63 ans s&#x2019;est pr&#xe9;sent&#xe9;e avec une histoire d&#x2019;un jour de douleurs paroxystiques, de type d&#xe9;charge &#xe9;lectrique, localis&#xe9;es au c&#xf4;t&#xe9; droit du visage, int&#xe9;ressant les branches ophtalmique (V1) et maxillaire (V2) du nerf trijumeau. Chaque &#xe9;pisode durait 1 &#xe0; 2 minutes, survenait plusieurs fois par jour et &#xe9;tait d&#xe9;clench&#xe9; par la mastication, avec une lacrymation ipsilat&#xe9;rale associ&#xe9;e. Les ant&#xe9;c&#xe9;dents m&#xe9;dicaux ne r&#xe9;v&#xe9;laient ni traumatisme, ni pathologie dentaire, ni maladie syst&#xe9;mique. L&#x2019;examen neurologique montrait des nerfs cr&#xe2;niens intacts, sans d&#xe9;ficit moteur facial. L&#x2019;imagerie par r&#xe9;sonance magn&#xe9;tique (IRM) de la t&#xea;te et du cou avec injection de gadolinium a mis en &#xe9;vidence une duplication anormale de l&#x2019;ACS droite, dont la branche inf&#xe9;rieure comprimait et d&#xe9;formait la portion cisternale du nerf trijumeau droit, correspondant &#xe0; un conflit neurovasculaire de grade II, sans interposition de liquide c&#xe9;phalo-rachidien entre le vaisseau et le nerf. La tomodensitom&#xe9;trie (TDM) c&#xe9;r&#xe9;brale montrait des signes de l&#xe9;sions isch&#xe9;miques chroniques ainsi qu&#x2019;une atrophie corticale li&#xe9;e &#xe0; l&#x2019;&#xe2;ge. Sur la base des donn&#xe9;es cliniques et radiologiques, un diagnostic de n&#xe9;vralgie du trijumeau typique secondaire &#xe0; une compression neurovasculaire due &#xe0; une duplication de l&#x2019;ACS a &#xe9;t&#xe9; pos&#xe9;. Un traitement par carbamaz&#xe9;pine a &#xe9;t&#xe9; instaur&#xe9;, avec une am&#xe9;lioration symptomatique notable. La duplication de l&#x2019;ACS constitue une anomalie anatomique rare pouvant entra&#xee;ner une compression neurovasculaire symptomatique du nerf trijumeau. En cas de suspicion de conflit neurovasculaire, une IRM &#xe0; haute r&#xe9;solution est indispensable pour identifier ces anomalies vasculaires et orienter la prise en charge th&#xe9;rapeutique appropri&#xe9;e.