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Congenital musculoskeletal disorders in calves, including those of genetic, infectious, or nutritional origin, can result in significant economic losses because of lameness, increased treatment costs, and reduced productivity. However, an accurate diagnosis is often difficult under field conditions. This report presents a case of bilateral hip dysplasia in a 1-month-old Hanwoo calf born prematurely that exhibited progressive lameness and joint deformities. Radiographic and computed tomography examinations revealed shallow acetabular sockets and underdeveloped femoral heads, consistent with congenital hip dysplasia. Additional abnormalities were observed in the left talus and calcaneus. Hematological and biochemical analyses results were unremarkable. Polymerase chain reaction assays for commonly implicated congenital viral pathogens yielded negative results; therefore, the underlying etiology was suspected to arise from genetic defects. The calf's clinical condition deteriorated over time, and cessation of treatment was decided. Necropsy confirmed severe bilateral joint dysplasia, luxation, and femoral head erosion. This is the first documented case of bilateral hip dysplasia in a Hanwoo calf confirmed by advanced imaging and necropsy. This report emphasizes the diagnostic value and clinical significance of advanced diagnostic modalities in assessing comparable defects in Hanwoo cattle.

Overscanning is a common issue in CT planning, leading to unnecessary radiation exposure. To develop a deep learning model to segment anatomical structures in scout views to optimize scan ranges and reduce radiation. In this single-center retrospective study, 1146 patients undergoing CT between 2022 and 2025 were included. The model was trained on segmentations of 26 target structures in five regions (head, neck, chest, chest-to-pelvis, abdomen-to-pelvis), transferred to scout views and manually corrected. Performance was evaluated using the Dice-S&#xf8;rensen coefficient and normalized surface distance on an internal test set of 100 patients and 36 external chest CTs. Automated versus manual scan planning was compared in 61 internal (chest, upper abdomen, head) and 14 external (chest) CTs, with z-axis coverage and dose-length product. 1146 patients (mean age, 63&#x2009;&#xb1;&#x2009;17 years; 577 men) were included. For target structures in five regions, mean DSC and NSD were 0.93 and 0.88. External mean DSC across chest targets was 0.851&#x2009;&#xb1;&#x2009;0.051. Automated planning captured relevant anatomy in 98% of internal and 92.9% of external CTs. Scan length significantly decreased for automated planning in the internal test cohort (chest 50&#x2009;mm (15%), p&#x2009;<&#x2009;0.001; upper abdomen 60&#x2009;mm (25%), p&#x2009;<&#x2009;0.001; cranial 19&#x2009;mm (11%), p&#x2009;<&#x2009;0.001), yielding corresponding DLP reductions of 19%, 25% and 11%, respectively. In the external cohort, scan length decreased by 115&#x2009;mm (28.7%, p&#x2009;<&#x2009;0.0001) with a corresponding 28.5% DLP reduction. The proposed model enables reliable automated CT scan planning and reduces overscanning and radiation exposure without compromising diagnostic quality. Question Can segmentation of anatomical structures on CT scout views enable automated scan planning to reduce overscanning and unnecessary radiation exposure? Findings A deep learning model segmented planning-relevant anatomy on CT scout views and reduced scan length and dose while preserving anatomical coverage. Clinical relevance Unnecessary radiation from overscanning is a patient safety concern. Automated CT planning with the proposed deep learning model reduces radiation exposure while ensuring full anatomical coverage for the evaluated scan regions.

This study evaluated the effectiveness of combining a digital real-time evaluation system and virtual simulation system in enhancing tooth preparation skills for preclinical training. A total of 32 students from the Class of 2020 were trained using the traditional phantom head simulator. In contrast, 28 students from the Class of 2021 and 32 students from the Class of 2022 completed the training and the first ceramic crown preparation test and were assigned to Groups A or B, receiving training either with the digital real-time evaluation system or with the virtual simulation system, respectively. After completing the second incisor crown preparation test, training tasks were exchanged for a month, concluding with a final incisor crown preparation test and questionnaire. Students from the Class of 2022 completed a multidomain well-being survey to evaluate their perceived stress levels and overall well-being. The 2021 and 2022 cohorts scored significantly higher than the 2020 cohort in the final test. Groups A and B (the 2021 and 2022 cohorts) showed statistically significant sequential improvement across the three tests. However, no significant difference was observed between the performance of Group A and Group B in any individual test (p&#xa0;>&#xa0;0.05). Students expressed stronger support for the implementation of the digital real-time evaluation system relative to the virtual simulation system. The combination of the digital real-time evaluation system with virtual simulation system enhances the manual dexterity of dental students in ceramic crown preparation. The sequence in which these two digital methods are implemented does not influence the effectiveness of preclinical tooth preparation training, suggesting that this combined approach may serve as a flexible and effective strategy for preclinical education. A positive association was observed between students' final test scores in tooth preparation and their emotional well-being.

A high sodium intake is a major risk factor for raised blood pressure. Consumption of fish fillet is associated with lower blood pressure in humans and other animals, whereas the effects of consuming fish residuals are less explored. To obtain high-quality fishmeal with acceptable sensory properties, the fish residuals may be washed with seawater onboard factory trawlers. This will increase the sodium content in the residuals, and whether this affects blood pressure has not yet been investigated. The primary objective of the present study was to investigate if the increased sodium content in Atlantic cod (Gadus morhua) residuals after washing with saltwater affected the development of high blood pressure in male obese Zucker fa/fa rats which spontaneously develop hypertension. Rats were fed diets containing cod protein powders&#xa0;prepared from unwashed or saltwater-washed backbone or head fractions (n 6/group) as 25% of total protein with the remaining 75% as casein, or casein as the sole protein source (Control group, n 6) for six weeks. Blood pressure was measured on day 0 and 40. The diets containing backbone protein powder, independent of whether this fraction was washed with saltwater or not, attenuated the blood pressure increase compared to the Control group, whereas diets containing washed or unwashed head protein powder did not affect the blood pressure development. To conclude, a diet containing cod backbone protein powder attenuated the blood pressure increase in obese Zucker fa/fa rats, and this effect was not compromised by the higher sodium content in backbones washed with saltwater.

Chronic oral inflammatory diseases, particularly periodontitis, are increasingly recognized as important contributors to the onset and progression of systemic disorders. Accumulating epidemiological, clinical, and mechanistic evidence indicates that the oral cavity is not an isolated organ, but rather a critical hub and early window for systemic disease development. Through microbial translocation, chronic low-grade inflammation, immune dysregulation, oxidative stress, and epigenetic reprogramming, oral diseases engage in bidirectional communication with distant organs.We conceptualize this integrated network as the "oral-X axis, " encompassing the oral-cardiovascular, oral-metabolic, oral-respiratory, oral-gastrointestinal, oral-oncologic, oral-immune, oral-brain, and other systemic axes. At the core of these interactions lies periodontitis-associated microbial dysbiosis dominated by key pathogens such as Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans. The ensuing inflammatory response compromises periodontal barrier integrity, facilitating the dissemination of bacteria, virulence factors, and inflammatory mediators into the systemic circulation. These processes promote endothelial dysfunction, insulin resistance, breakdown of immune tolerance, neuroinflammation, and the formation of pro-tumorigenic microenvironments, thereby mechanistically linking oral inflammation to a broad spectrum of systemic diseases. This review systematically summarizes the current evidence supporting the oral-X axis, with a particular focus on epidemiological associations and underlying molecular and cellular mechanisms. In addition, we discuss periodontal interventions and oral microbiome modulation as potential strategies for the prevention and treatment of systemic diseases. A deeper understanding of the oral-X axis may provide novel insights into integrated oral-systemic healthcare and precision medicine.

The perioperative management of spontaneous cerebrospinal fluid leaks (sCSFL) of lateral skull base remains under debate. We systematically synthesized and evaluated the current literature, to investigate the perioperative cranial-pressure assessment protocols and relief methods. The assessment corresponded to fulfillment of criteria for idiopathic intracranial hypertension (IIH) or otherwise defined in the study. Relief methods included either medical, that is, acetazolamide, or invasive, that is, lumbar puncture (LP) or drain (LD) or ventriculoperitoneal shunt (VPS). Selected studies concerned surgical treatment of lateral sCSFL. Data extracted included the following: study characteristics, patient characteristics, primary outcomes, and secondary outcomes. Data sources: MEDLINE, EMBASE, and Cochrane Library. Baseline data were calculated from 2039 operations, out of which 423 had perioperative LP or LD. When only studies which mentioned recurrence or persistence rates were considered, 262 of them were used routinely or in selected patients and 117 occasionally. In those two cohorts, recurrence or persistence rates were similar (10.1% vs. 8.9%). Intracranial pressure was assessed in 335 patients from 10 studies and 48 among them were diagnosed with IIH (14.3%). Acetazolamide was inconsistently used in 17.7% of cases. From 18 studies that reported the use of VPS, this was used in 11.2% of the cases. Systematic perioperative LP or LD use does not affect the recurrence or persistence rates. However, decision making with respect to the use of LP or LD is inconsistently reported in the literature. The same issue holds for the use of acetazolamide or VPS. Assessment of intracranial hypertension is usually neglected, and when used, not standardized. 2.

Multiple small diameter fan-shaped and parallel core decompression are the surgical procedure used to treat the early osteonecrosis of the femoral head. However, It is not known which method is more appropriate from biomechanical perspective. Therefore, we aimed to analyze the mechanical stability of different distribution parameters of the two drilling methods using finite element analysis. Ten finite element models were established, including different drilling number (three-hole, four-hole, five-hole, seven-hole and nine-hole) based on fan-shaped and parallel core decompression. The stress and strain of the proximal femur was calculated to evaluate the biomechanical stability. Results showed that maximum equivalent stress in the entire structure, greater trochanter's lateral wall, and bone tunnels increased with more drill holes in both groups, following the order: three-hole < four-hole < five-hole < seven-hole < nine-hole. At the same hole count, fan-shaped core decompression had higher maximum equivalent stress in the greater trochanter's lateral wall, cortical bone tunnel, cancellous bone tunnel, and bone tunnel in the osteonecrosis area compared to parallel core decompression, with notable percentage increases in the cancellous bone tunnel (21.18%-585.71%). Additionally, fan-shaped drilling exhibited higher average stress and local strain, especially in the cancellous bone tunnel, whereas parallel drilling maintained lower stress and strain levels across most regions. From a biomechanical perspective, multiple small-diameter parallel core decompression is superior to fan-shaped decompression, offering better stability and reduced stress concentration in the proximal femur for early femoral head osteonecrosis.

The Smc5/6 complex is a vital protector of eukaryotic genome stability, coordinating DNA repair, replication fork maintenance, recombination intermediate processing, and chromosome organization. Within this complex, the Nse5/6 heterodimer has recently emerged as a key factor influencing Smc5/6 dynamics, acting at the interface of structural control, enzymatic regulation, and chromatin recruitment. Structural studies from yeast to mammals show that Nse5/6 associate with the Smc5/6 head-neck region, restricting ATPase head engagement and stabilizing an inactive, chromatin-loading-ready state. Upon ATP binding and DNA interaction, conformational changes displace or reposition Nse5/6, facilitating Nse4-mediated head closure, DNA entrapment, and loop-modulating activity. Functional analyses across Saccharomyces cerevisiae, Schizosaccharomyces pombe, mammals, and plants indicate that Nse5/6 is essential for recruiting Smc5/6 to damaged or stalled replication forks, stabilizing chromatin association, and coordinating SUMO-dependent repair pathways. Loss of Nse5/6 leads to defects in replication stress tolerance, accumulation of recombination intermediates, impaired chromatin loading, and widespread genome instability. This review synthesizes emerging structural and functional insights into Nse5/6, emphasizing its conserved yet species-adapted mechanisms that regulate ATPase gating, DNA substrate selection, and chromatin recruitment. Collectively, these findings redefine Nse5/6 not as a peripheral structural factor but as a dynamic regulatory hub that orchestrates Smc5/6 activity in genome maintenance, development, and antiviral defense.

This study aims to evaluate the presence of cervical vertebral fusion in individuals with an open bite compared to those without, matched by skeletal relationship, age, and sex. This matched-comparative study analyzed 234 lateral head radiographs, dividing the subjects into two groups. The open-bite group consisted of 117 patients (69 women and 48 men; average age 24.05 &#xb1; 12.5 years), while the control group included an equal number of individuals with a similar gender ratio (average age 23.79 &#xb1; 11.95 years). Both groups were matched based on their skeletal relationship, specifically the ANB angle. A trained and calibrated radiologist conducted a visual assessment of the cervical spine using lateral cephalometric radiographs for each subject. The study evaluated the presence of simple fusion and block fusion. Statistical analyses were performed using the Chi-square test and binary logistic regression (p < 0.05). The incidence of simple fusion was higher in the control group (35%) compared to the open-bite group (26.5%). A small number of cases (2.6%) of block fusion were found only in the anterior open-bite group. However, these differences did not reach statistical significance (p = 0.096). Additionally, no significant influences were identified regarding sex, age, group, or ANB angle (p > 0.05). There were no differences in the overall prevalence of cervical fusions between individuals with anterior open bite and those without. However, the finding that block fusions occurred exclusively in the open-bite group underscores the importance of evaluating the cervical spine, as it may affect the individual's head position.

Transoral robotic thyroidectomy has emerged as a scarless alternative to conventional and remote-access approaches; however, technical standardization and outcome data for truly scarless three-port configurations remain limited. The aim of this study was to describe the surgical technique and early clinical outcomes of three-port transoral robotic thyroidectomy (TORT) as a truly scarless remote-access approach to the thyroid gland. This technical note reports a consecutive series of 25 patients who underwent three-port transoral robotic thyroidectomy between June 2017 and May 2019 at Korea University Hospital. Surgical steps, including vestibular port placement, working-space creation, robotic docking, and lobectomy procedures, are detailed. Perioperative data, postoperative outcomes, and complications were retrospectively analyzed. The median age was 41.0 years, and 76.0% of patients were female. Unilateral thyroidectomy was performed in 80.0% of cases, and central neck dissection in 52.0%. The median operative time was 308.0 minutes, with minimal blood loss (3.0 mL). No intraoperative complications occurred. Transient hypoparathyroidism and recurrent laryngeal nerve palsy were observed in 4.0% of patients each, while one permanent recurrent laryngeal nerve injury (4.0%) was recorded. No cases of mental nerve injury or surgical site infection were observed. Postoperative pain was low, and the median hospital stay was 3 days. Three-port transoral robotic thyroidectomy is a feasible and safe technique in carefully selected patients when performed in experienced centers. Despite a prolonged operative time during the initial learning phase, complication rates were acceptable and cosmetic outcomes were excellent. This approach should currently be reserved for high-volume endocrine robotic units under strict indication criteria and structured training pathways.

ImportanceSudden sensorineural hearing loss (SSNHL) significantly impacts quality of life. Identifying genetic and serological markers could improve early diagnosis and prognosis.ObjectivesThis study aimed to investigate the potential correlation between the miR-204-5p rs718447 polymorphism and the occurrence of SSNHL in the Chinese Han population.DesignA hospital-based, case-control study.SettingThe Third People's Hospital of Hubei Province in China.ParticipantsOne hundred forty patients with idiopathic SSNHL and 140 age-frequency-matched and sex-frequency-matched healthy controls of Chinese Han ethnicity.ExposuresGenotyping was performed using the LightCycler 480 Real-Time PCR system. miR-204-5p expression was measured by RT-qPCR, while enzyme-linked immunosorbent assay was utilized to determine the interleukin-1&#x3b2; (IL-1&#x3b2;) concentration.Main Outcome Measures:Primary: Association between rs718447 genotypes and SSNHL risk. Secondary: Diagnostic/prognostic performance of miR-204-5p; correlations with IL-1&#x3b2; and fibrinogen (FIB) levels.ResultsIn the SSNHL group, miR-204-5p was significantly elevated (P&#x2009;<&#x2009;.01). The A allele [odds ratio (OR)&#x2009;=&#x2009;0.470, 95% confidence interval (CI): 0.297-0.744] and AG/AA genotypes (OR&#x2009;=&#x2009;0.486, 95% CI: 0.297-0.793) were identified as potential protective factors against SSNHL, whereas the GG genotype was associated with an increased risk of SSNHL. miR-204-5p expression progressively increased as hearing loss worsened from mild to severe, and GG genotype patients demonstrated higher miR-204-5p expression (P&#x2009;<&#x2009;.01). The SSNHL group exhibited significantly higher IL-1&#x3b2; and FIB concentrations, especially GG carriers (P&#x2009;<&#x2009;.01). Additionally, high miR-204-5p expression (OR&#x2009;=&#x2009;3.039, 95% CI: 1.435-6.439, P&#x2009;=&#x2009;.004) and the GG genotype at rs718447 (OR&#x2009;=&#x2009;2.853, 95% CI: 1.095-7.433, P&#x2009;=&#x2009;.032) were associated with poorer hearing recovery outcomes, with the GG genotype showing a correlation with poorer outcomes, consistent with a potential link involving miR-204-5p-associated inflammation and coagulation abnormalities.ConclusionThe miR-204-5p rs718447 polymorphism was associated with susceptibility to SSNHL.RelevanceThese findings identify rs718447 and miR-204-5p as potential biomarkers for SSNHL. Future studies should validate these results in larger, multicenter cohorts and explore the underlying mechanisms to assess their utility in personalized treatment strategies.

Obstructive sleep apnea (OSA) involves recurrent upper airway collapse. While anatomical factors are key, the correlation between three-dimensional (3D) upper airway parameters and OSA severity remains inconsistent, limiting personalized treatment. 69 OSA patients underwent polysomnography and computed tomography. The upper airway was segmented into nasopharynx, retropalatal oropharynx, and retroglossal oropharynx. Parameters, including soft palate length, hyoid-to-mandibular plane distance, subregion volumes, minimum cross-sectional area (MIN-CSA), and the ratio of total volume to MIN-CSA (TV-NP-OP/MIN-CSA), were measured. Spearman's correlation, receiver operating characteristic (ROC) analysis, and logistic regression assessed associations with the apnea-hypopnea index (AHI). Bonferroni correction was applied (p&#x2009;<&#x2009;0.005). AHI significantly correlated with MIN-CSA (r&#x2009;=&#x2009;-0.478), anteroposterior diameter at MIN-CSA (AP-MIN) (r&#x2009;=&#x2009;-0.399), lateral diameter at MIN-CSA (Lat-MIN) (r&#x2009;=&#x2009;-0.323), and TV-NP-OP/MIN-CSA (r&#x2009;=&#x2009;0.473) (all p&#x2009;<&#x2009;0.001). TV-NP-OP/MIN-CSA ("Anatomical Risk Index") showed good diagnostic performance for moderate-to-severe (area under the curve (AUC) = 0.779) and severe OSA (AUC&#x2009;=&#x2009;0.789), and was an independent predictor across body mass index (BMI) subgroups. No volumetric parameters correlated with AHI. Reliability was excellent (intraclass correlation coefficients (ICCs) > 0.90). TV-NP-OP/MIN-CSA is a robust 3D anatomical parameter associated with OSA severity, offering a potential imaging biomarker for risk stratification. Question What is the most relevant 3D anatomical parameter derived from CT imaging that correlates with OSA severity, and can it serve as a reliable imaging biomarker? Findings The ratio of TV-NP-OP/MIN-CSA was strongly correlated with OSA severity (r&#x2009;=&#x2009;0.473, p&#x2009;<&#x2009;0.001) and served as an independent predictor across all BMI subgroups, with excellent measurement reliability. Clinical relevance This CT-based "Anatomical Risk Index" can help identify high-risk OSA phenotypes, guide personalized treatment planning, and improve risk stratification without requiring additional imaging, thereby optimizing therapeutic outcomes.

To evaluate functional oral intake and patient-reported dysphagia, neck disability, and symptom-specific health-related quality of life (HRQOL) amongst patients who underwent pectoralis major myocutaneous flap (PMMF) versus microvascular free flap reconstruction after salvage laryngectomy. Retrospective analysis of prospectively collected data. Multidisciplinary head and neck cancer (HNC) Survivorship clinic. Patients with at least 6&#x2009;months of postoperative follow-up from salvage total laryngectomy/total laryngectomy with partial pharyngectomy and subsequent PMMF or free flap reconstruction were included. Patients who underwent total laryngo-pharyngectomy, with recurrence, with metastatic disease, and/or with missing data were excluded. Functional Oral Intake Scale (FOIS) and validated patient-reported outcome measures, including Eating Assessment Tool-10 (EAT-10), Neck Disability Index (NDI), and measures of pain-, swallowing-, and shoulder-specific University of Washington Quality of Life (UW-QOL) subscale scores. Twenty-four patients underwent PMMF, and 30 patients underwent microvascular free flaps. Mean EAT-10, NDI, and pain-, swallowing-, and shoulder-specific UW-QOL subscale scores were not significantly different between these two groups. Mean FOIS was slightly higher in patients reconstructed with PMMF (5.67&#x2009;&#xb1;&#x2009;1.52 vs. 4.57&#x2009;&#xb1;&#x2009;2.12), p&#x2009;=&#x2009;0.047, but the clinical relevance of this finding is unclear. Patient-reported outcomes pertaining to dysphagia, neck disability, and pain-, swallowing- and shoulder-specific HRQOL did not vary significantly between patients reconstructed with PMMF versus microvascular free flap. Future studies with larger cohorts are required to further establish differences in functional outcomes between reconstructive approaches following salvage laryngectomy.

Cataracts and presbyopia affect millions worldwide, driving demand for advanced intraocular lenses (IOLs) to restore vision and reduce spectacle dependence. Extended depth of focus (EDoF) IOLs, such as Clareon Vivity and TECNIS PureSee, provide continuous vision with minimal disturbances. Given limited direct clinical comparisons, this research offers a head-to-head analysis of their visual performance and optical stability in cataract patients. This retrospective cohort study analyzed 106 eyes from 72 patients who underwent phacoemulsification with Clareon Vivity or TECNIS PureSee IOL implantation. Primary outcome measures were monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate VA (UIVA) at 66/80 cm, uncorrected near VA (UNVA) at 40 cm, and longitudinal internal higher-order aberrations (HOAs), specifically total coma. Refractive error (spherical/cylindrical powers [SPH/CYL], spherical equivalent [SE]) and defocus curve (+1.5 D to -3.5 D under mesopic/photopic conditions) were measured at 1 and 3 months postoperatively; HOAs (spherical aberration [SA], coma) and pupil size were assessed at 1&#xa0;week, 1 month, and 3 months, and contrast sensitivity (CS; 1.5-18 cpd) at 1 month using standardized equipment. Both IOLs significantly improved UDVA (p < 0.05). Clareon Vivity showed superior monocular UIVA at 80 cm at 1 and 3 months (p = 0.0042 and p = 0.0711, respectively), comparable UIVA at 66 cm and UNVA at 40 cm, a broader defocus range (+0.5 D to -2.0 D), and lower total coma at 1 and 3 months (p = 0.001 and p = 0.0097) with reduced variability, emphasizing mid-range vision and optical stability advantages. TECNIS PureSee exhibited comparable refractive outcomes and CS, with initial superiority in monocular UNVA at 40 cm at 1 month (p < 0.05), providing robust early near vision. Clareon Vivity excels in intermediate vision, defocus tolerance, and coma stability, while TECNIS PureSee offers strong initial near focus. These differences suggest Clareon Vivity may be particularly suitable for patients prioritizing mid-range stability, while both IOLs provide excellent overall visual performance.

Intubation is a critical skill in pediatric emergency medicine, yet many residents report limited procedural exposure. Simulation-based training provides a safe and structured environment to address this gap. Authors of this ongoing quality improvement (QI) initiative aimed to enhance pediatric residents' intubation skills through simulation-based assessment in partnership with the Department of Anesthesiology. A total of 24 residents participated (Pediatrics = 17; Med-Peds = 5). Stage 1 of the QI initiative consisted of a didactic seminar led by anesthesiology residents, followed by a skills workshop with four stations: bag-mask ventilation (BMV), oropharyngeal/nasopharyngeal airway placement, laryngeal mask airway insertion, and endotracheal intubation. Outcomes included pre- and post-intervention multiple-choice examinations (MCQs), self-reported confidence surveys, and objective skills assessments evaluated by anesthesiology faculty. Primary outcomes were changes in knowledge, confidence, and intubation competency scores. Mean pre-MCQ scores were 11.75 (&#xb1;3.2) out of 20, increasing to 16.4 (&#xb1;2.8) post-intervention (p < 0.001). Skills assessment identified lower performance in LEMON assessment, head positioning, and BMV technique. Self-reported confidence in airway management increased from 3.6 (&#xb1;2.1) to 7.2 (&#xb1;1.5) (p < 0.001). Confidence in BMV improved from 5.7 (&#xb1;2.3) to 8.5 (&#xb1;1.7) (p < 0.01), and confidence in intubation increased from 3.5 (&#xb1;1.9) to 7.0 (&#xb1;1.4) (p < 0.001). Stage 1 of this QI initiative improved both knowledge and self-reported confidence in pediatric airway management among residents. These findings suggest that simulation-based training may enhance short-term competency in pediatric intubation skills. Long-term skill retention will be evaluated in Stage 2 using a delayed post-intervention MCQ following a high-fidelity simulation session.

Facial sagging is associated with changes in underlying facial structures, including the dermis, subcutaneous fat, and muscle layers. However, previous studies have focused primarily on surface appearance, and quantitative evaluations linking sagging to individual internal structures remain limited, making it difficult to identify key determinants of sagging and to optimize intervention targets. This study aimed to clarify, using statistical analyses and predictive models, the contributions of quantitative structural parameters of the dermis, subcutaneous fat, and muscle to facial sagging, and to obtain fundamental insights for individualized evaluation and intervention optimization. A total of 220 women aged 20-79&#x2009;years were enrolled. Facial sagging was assessed using the Merz Scale. Dermal properties were quantitatively measured. The thickness and echogenicity of subcutaneous fat and muscle layers were evaluated using high-resolution ultrasound. Skin displacement and volume increase associated with postural changes were calculated as dynamic sagging indices. Associations between structural characteristics and sagging indices were analyzed using correlation and multiple regression analyses. Sagging appearance was significantly correlated with dermal viscoelasticity, subcutaneous fat thickness, and zygomaticus major muscle thickness. Regression analysis indicated that sagging was jointly influenced by dermal, fat, and muscle characteristics, with relative structural contributions varying by facial site and age. Dynamic sagging indices were significantly correlated with age and Merz scores. This study demonstrated that facial sagging is not attributable to aging of a single layer but results from overlapping changes in the dermis, subcutaneous fat, and muscle layers, highlighting the necessity of integrated structural evaluation. UMIN Clinical Trials Registry: UMIN000060199.

Rotator cuff tears and long head of the biceps tendon (LHBT) injuries are primary causes of shoulder pain. During rotator cuff repair, concurrent LHBT injuries are frequently identified. Surgical management of LHBT injuries can effectively relieve pain and improve shoulder function. Two commonly used surgical approaches for LHBT repair are interference screw compression fixation and suture anchor ligation fixation. However, no definitive conclusion has been reached regarding which technique yields superior clinical outcomes. This study compared the efficacy of arthroscopic rotator cuff repair combined with different LHBT fixation techniques in treating repairable rotator cuff tears with LHBT injuries and evaluated their impact on shoulder joint function. This retrospective study analyzed clinical data from 112 patients with rotator cuff tears and LHBT injuries who underwent arthroscopic rotator cuff repair at the Department of Orthopedics of Xiaoshan Affiliated Hospital of Wenzhou Medical University. Patients were allocated into two groups based on the LHBT fixation method: interference screw tenodesis group (n = 54) and suture anchor tenodesis group (n = 58). Functional outcomes were evaluated using the Constant-Murley shoulder function score, University of California at Los Angeles (UCLA) shoulder score, and visual analogue scale (VAS) at preoperative baseline and at 3, 6, and 12 months postoperatively. The incidence of postoperative complications was also compared between the two groups. In both the interference screw tenodesis group and the suture anchor tenodesis group, VAS scores at all postoperative time points were significantly lower than preoperative values, while Constant-Murley and UCLA scores were significantly higher than baseline (all p < 0.008). Both groups showed a progressive improvement over time (scores at 6 and 12 months were significantly better than at 3 months, and scores at 12 months were better than at 6 months; all p < 0.008). Between-group comparisons showed that VAS scores in the suture anchor tenodesis group at 3, 6, and 12 months post-operatively were significantly lower than those in the interference screw tenodesis group (p < 0.05). Additionally, the Constant-Murley scores and UCLA scores in the suture anchor tenodesis group at 3 and 6 months were significantly higher than those in the interference screw tenodesis group (p < 0.05). No statistically significant differences in Constant-Murley or UCLA scores were observed between the two groups at baseline or at 12 months postoperatively. The incidence of postoperative complications was slightly lower in the suture anchor tenodesis group compared with the interference screw tenodesis group; however, the difference did not reach statistical significance (p > 0.05). For proximal LHBT injuries, both interference screw compression fixation and suture anchor ligation under shoulder arthroscopy can effectively restore LHBT continuity, relieve shoulder pain, and improve functional outcomes. Suture anchor ligation demonstrates superior efficacy in pain relief, particularly during early postoperative recovery. However, in terms of long-term functional improvement at 12 months, both techniques yield comparable results. Moreover, suture anchor fixation is associated with a relatively lower, although not statistically significant, rate of postoperative complications.

Four new species of the flabby whalefish genus Gyrinomimus Parr, 1934 are described based on female specimens: G. alepis sp. nov. from the southern Atlantic, G. amaokai sp. nov. from the Northern Hemisphere, G. johnpaxtoni Su & Ho, sp. nov. from the Pacific and Atlantic, and G. johnsoni sp. nov. from the northern Pacific. Each of the new species differs from congeners in the length of gill filaments on fourth gill arch, numbers of dorsal- and anal-fin rays, gill rakers, head and lateral-line pores, anal lappets and vertebrae, distribution of cavernous tissue, and the shape and length/width ratio of copular tooth plate. Moreover, three species groups are defined: G. bruuni species group, G. grahami species group, and G. myersi species group. Each group differs in the length of gill filaments, numbers of anal lappet and gill rakers, and distribution of cavernous tissue. Diagnostic characters and detailed descriptions of the new species are provided and compared to congeners, with variations discussed. Finally, an identification key to species groups and all known species is provided.

Mechanistic target of rapamycin complex 1 (mTORC1) is a nutrient sensor that integrates diverse inputs to regulate protein translation and cell growth. While mTORC1 is activated on the lysosome in the classical model, it has become increasingly clear that this multifaceted signaling complex is active at various subcellular locations, such as the nucleus. However, what specific functions mTORC1 serves at these locations and how its signaling is compartmentalized are unclear. To interrogate subcellular pools of mTORC1, we developed TerminaTOR, a genetically encodable inhibitor of mTORC1 that can be targeted to specific subcellular locations. When TerminaTOR is directed to the lysosome, it inhibits canonical lysosomal mTORC1 and induces autophagy. Furthermore, TerminaTOR targeted to the nucleus specifically inhibits nuclear mTORC1, uncovering noncanonical roles of nuclear mTORC1 in regulating the transcription of CCAAT motif-containing genes. Thus, mTORC1 exhibits functional spatial compartmentalization and TerminaTOR serves as a powerful tool for unraveling spatially regulated functions of mTORC1 across different scales.