Due to our ageing population, the incidence of subacute head injuries such as chronic subdural hematoma is increasing. As current clinical decision rules regarding CT imaging are in context of acute head injuries, it remains unclear what presenting symptoms of subacute (>48 h after initial trauma) head injuries in older adults are relevant for clinical practice. To aim of this study is to describe the prevalence of traumatic intracranial hemorrhage in older adults presenting to the emergency department with subacute head injuries and identify symptoms associated with traumatic ICH. This retrospective cohort included patients > 65 years who underwent CT imaging for subacute head injuries in the emergency department of a single level-2 trauma center between 2020-2024. The primary outcome was traumatic ICH. Secondary outcomes included hospital length of stay, anticoagulation reversal, neurosurgical intervention, and 90-day mortality. 374 patients were included, with a mean age of 79.1 (SD 6.7) and 170 (54.5%) were male. 62 (16.6%) patients had ICH, of which 40 (68%) were large lesions with mass effect or epidural hematoma. In patients with ICH, median hospital length of stay was 7 (IQR 4- 11) days, 8/18 (44%) anticoagulated patients received pharmacological reversal, 25 (40%) received neurosurgical intervention, and five (8%) died within 90 days. Prior CT images were available from < 48 h post-injury for 20 (32%) patients with ICH, of which 14 (70%) already reported ICH. Symptoms associated with ICH were headache (aOR 2.90, 95%CI 1.60-5.24), vomiting (aOR 2.57, 95%CI 1.25-5.28), focal neurological deficits (aOR 5.82, 95%CI 2.98-11.37), and gait disorders (aOR 3.54, 95%CI 1.94-6.45). ICH was more common in patients presenting > 30 days (aOR 4.19, 95%CI 1.99-8.82). The prevalence of traumatic intracranial hemorrhage is relatively high in older adults with subacute head injuries, which despite a high rate of neurosurgical interventions has a generally favorable prognosis. Presenting symptoms such as headache, vomiting, neurologic deficits and gait disorders are often evident. These findings may also argue for a wait-and-see approach in older adults with acute head injuries.
Lipoblastoma is a rare benign tumour, with a higher recurrence rate in the head and neck region owing to complex anatomy. The study summarizes the clinical features, surgical risks, and complications of paediatric lipoblastoma in various anatomical domains of the head and neck, aiming to improve diagnosis and management. A retrospective review was conducted on children who were treated for lipoblastoma of the head and neck between 2016 and 2023. Data assessed included location, demographics, clinical presentation, imaging, treatment, complications, recurrence, and follow-up. A total of 32 patients with lipoblastoma were retrospectively analyzed. These lipoblastomas located in the face (n = 2, 6.3%), nuchal region (n = 3, 9.4%), anterior neck (n = 6, 18.8%), lateral neck (n = 1, 3.1%), parapharyngeal region (n = 6, 18.8%), cervicomediastinal region (n = 4, 12.5%), and cervicoscapular-axillary region (n = 10, 31.3%). Complete resection was achieved in twenty-four cases. Residual lesions were confirmed in eight patients (25.0%). During a mean follow-up of 64.2 months, residual lesions regressed in two patients, remained stable in four, and progressed in two parapharyngeal cases that required secondary surgery via a transcervical approach. No recurrence was observed after complete resection. A location-based approach aids in understanding surgical risk and prognosis in pediatric head and neck lipoblastoma. Given the benign nature and favorable outcomes, maximal safe resection with preservation of critical neurovascular structures is recommended. Complete excision may be technically challenging in deep head and neck spaces, and careful surgical planning is essential.
Achieving negative surgical margins remains a critical determinant of local recurrence and survival in head and neck cancer (HNC) surgery. Current intraoperative margin assessment techniques, including frozen section analysis, suffer from sampling errors and procedural delays. Tumor-targeted fluorescence imaging offers real-time tumor visualization but lacks standardized quantitative approaches for clinical decision-making. We developed a Tumor Probability Mapping (TPM) framework using panitumumab-IRDye800 fluorescence imaging in 16 HNC patients. Ex vivo specimens and gross tissue sections were imaged using near-infrared fluorescence systems. A total of 5,442 regions of interest (ROIs) were manually distributed across fluorescence images of gross specimen sections validated by histopathology. Signal-to-background ratios (SBR) were calculated and used to train the following predictive models: generalized linear model fit standard logistic regression (MATLAB, glmfit), standard logistic regression (R, LOG), mixed-effects logistic regression (GLMER), and Bayesian mixed-effects regression (BRMS). Model performance was evaluated using receiver operating characteristic and area under the curve (ROC-AUC) analysis, sensitivity, specificity, along with beta-calibration and model fit. All models demonstrated excellent (> 90%) discriminative ability between tumor and normal tissue. The glmfit model, selected for clinical implementation, achieved 95.8% accuracy, 90.8% sensitivity, 98.8% specificity, and an AUC of 0.989 on test data. The final TPM algorithm provides real-time probability assessment of tumor presence based on fluorescence intensity quantified by histopathology validated historical data. TPM represents a significant advancement in fluorescence-guided surgery by converting qualitative fluorescence signals into quantitative probability assessments validated against histopathology. This approach provides surgeons with standardized, real-time tumor probability information that extends beyond qualitative assessments and/or binary threshold determinations, potentially improving surgical outcomes by enhancing margin assessment and reducing local recurrence rates.
Per-oral pancreatoscopy-guided lithotripsy (POPL) is effective for main pancreatic duct (MPD) stones, but transpapillary access may be limited by downstream ductal narrowing. We evaluated primary endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PGS) followed by POPL via a mature transmural tract for pancreatic head MPD stones. This single-center retrospective pilot study included 20 consecutive patients who underwent first-line EUS-PGS followed by POPL between 2022 and 2026. The primary outcome was complete stone clearance. EUS-PGS was technically successful in 95% (19/20). POPL was technically successful in 95% (18/19). Complete stone clearance was achieved in 89% (16/18). Early adverse events occurred in two patients after EUS-PGS and two after POPL; all were mild. No late adverse events occurred. Symptomatic recurrence occurred in 6% (1/16). EUS-PGS followed by POPL as a first-line access strategy was feasible and achieved high stone clearance with acceptable safety for pancreatic head MPD stones requiring lithotripsy.
The robotic-assisted extended "Sistrunk" approach (RESA) is a minimally invasive technique providing access to hypopharyngeal and laryngeal structures via a submental incision and vallecular pharyngotomy, bypassing the base of tongue. We report 10 RESA procedures in previously irradiated head and neck cancer patients, including six organ-preservation surgeries and four total laryngectomies. RESA enabled completion of the planned surgery, achieving R0 margins in all cases. Postoperative bleeding occurred in four patients (three Clavien-Dindo IIIb; one II). One cervical abscess was managed endoscopically. After total laryngectomy, three patients developed a subclinical pharyngeal dehiscence visualized on barium swallow exam, without evidence of a pharyngo-cutaneous fistula. Disease-specific survival was 100% (median 15.5 months); two patients died of unrelated causes. Swallowing improved or remained stable in seven patients at 1 year (three developed recurrence, a second primary, or died). RESA is a feasible salvage option with acceptable oncologic and functional outcomes in selected patients.
Copyright: © 2026 Bivens et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The main goals were to assess safety and efficacy (i.e., recurrence reduction). Seventeen patients were enrolled. The most common adverse events were grades 1 and 2 injection site reactions, and they occurred more frequently in the PepCan group (p < 0.0001). Two patients had allergic reactions (grade 2 and grade 3), at the 6th vaccination, which were considered to be a dose-limiting toxicity. No serious adverse events were reported. In the intention-to-treat analyses, 45% (5/11) had non-recurrence in the PepCan group while 80% (4/5) had non-recurrence in the placebo group (p = not significant). Those who received PepCan and experienced non-recurrence showed a trend of having higher new peripheral T cell immune responses to human papillomavirus type 16 E6 (p = 0.05). Pre-vaccination T helper type 1 cells were higher in the PepCan non-recurrence group compared to the PepCan recurrence group (p = 0.01). PepCan consists of four human papillomavirus type16 E6 peptides and a Candida skin testing reagent. Patients with head and neck squamous cell carcinoma who had no evidence of disease after standard of care treatments were randomized at 3:1 to PepCan versus placebo (saline). Seven intradermal injections were given followed with two observational visits. Safety was assessed using CTCAE version 5, and efficacy was assessed based on not having recurrence within 2 years. In addition, immune responses and oral and gut microbiome were assessed. PepCan was well tolerated. PepCan does not seem to be effective in reducing recurrence; however, the results are inconclusive given the small patient numbers.
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[68Ga]Ga-FAPI-04 targets FAP overexpressed in pancreatic cancer microenvironment. This study compared diagnostic efficacy and clinical impact with [18F]FDG PET/CT in pancreatic cancer. Of 97 suspected pancreatic cancer patients (58 males; mean age 63.0 ± 10.1 years), 88 were confirmed as pancreatic cancer (57 by pathology, 31 by imaging follow‑up). [68Ga]Ga-FAPI-04 PET/CT showed significantly higher SUVmax than [18F]FDG PET/CT in primary lesions (10.2 ± 3.5, 95%CI: 9.320-11.126 vs. 6.1 ± 3.8, 95%CI: 5.092-7.152; p = 0.001) and lymph node metastases (4.1 ± 2.4, 95%CI: 3.718-4.559 vs. 3.3 ± 2.3, 95%CI: 2.845-3.714; p = 0.001), with superior AUCs for primary tumors and lymph nodes(0.851, 95% CI: 0.735-0.981 vs. 0.802, 95% CI: 0.354-0.803; p = 0.001) (0.867, 95% CI: 0.827-0.907 vs. 0.701, 95% CI: 0.641-0.761; p = 0.001). The T/B ratio of bone and visceral metastases was higher in [68Ga]Ga-FAPI-04 PET/CT than [18F]FDG PET/CT(4.7 ± 3.1, 95%CI: 4.108-5.245 vs. 2.5 ± 1.6, 95%CI: 2.231-2.835; p = 0.001) with superior AUC(0.938, 95% CI: 0.912-0.964 vs. 0.919, 95% CI: 0.886-0.951; p = 0.040), as were liver (5.0 ± 4.0, 95%CI: 3.706-6.284 vs. 2.7 ± 1.3, 95%CI: 2.211-3.131; p = 0.001), peritoneal (5.4 ± 3.3, 95%CI: 4.318-6.482 vs. 3.0 ± 2.1. 95%CI: 2.211-3.745; p = 0.001) and other organ metastases (4.4 ± 2.5, 95%CI: 3.756-5.035 vs. 2.7 ± 1.7, 95%CI: 1.379-2.254; p = 0.001). [68Ga]Ga‑FAPI‑04 SUVmax and TBR were positive predictors for primary tumors (SUVmax: OR = 1.951, 95%CI: 1.286-2.960, p = 0.004) and nodal metastases (SUVmax: OR = 4.199, 95%CI: 2.970-5.939, p = 0.001; TBR: OR = 14.502, 95%CI: 7.228-29.095, p = 0.001). For bone and visceral metastases, both tracers were positive predictors, but [68Ga]Ga‑FAPI‑04 SUVmax (OR = 2.925, 95%CI: 2.048-4.177, p = 0.003) and T/B ratio (OR = 3.520, 95%CI: 2.311-5.362, p = 0.001) outperformed [18F]FDG (SUVmax: OR = 1.901, 95%CI: 1.308-2.761, p = 0.003; T/B ratio: OR = 2.480, 95%CI: 1.488-4.136, p = 0.001). Furthermore, [68Ga]Ga-FAPI-04 achieved higher accuracy (93.2% vs. 72.7%, p = 0.007), revised the staging of 7 patients and altered the treatment (surgical resection to unresectable) in 6 patients. Limitations include single‑center, short follow‑up, small subgroups (e.g., recurrent lesions) and incomplete pathologically confirmation. [68Ga]Ga-FAPI-04 PET/CT suggested potentially better diagnostic performance to [18F]FDG PET/CT and improves staging and clinical decision-making in pancreatic cancer, suggesting potential clinical value.
To systematically review and meta-analyse the prognostic value of quantitative mid-treatment imaging biomarkers for predicting locoregional tumour control in patients undergoing definitive radiotherapy for mucosal head and neck squamous cell carcinoma. A systematic literature search (2005-2023) was conducted in PubMed, EMBASE, Scopus, and Cochrane databases according to a pre-registered PROSPERO protocol. Studies evaluating quantitative imaging features derived from CT, MRI, or PET during radiotherapy were included. Imaging features were grouped as baseline, absolute mid-treatment, or relative mid-treatment (delta) parameters. A random-effects meta-analysis was performed on studies reporting receiver operating characteristic (ROC)-based area under the curve (AUC) values. Forty-one studies encompassing 1654 patients were included. Seventeen studies (n = 612 patients) reported sufficient data for meta-analysis. The pooled AUC for relative mid-treatment parameters was 0.796 (95% CI: 0.762-0.831), demonstrating higher predictive performance than absolute mid-treatment parameters (AUC 0.686; 95% CI: 0.628-0.745). Baseline parameters showed moderate predictive ability (AUC 0.736; 95% CI: 0.688-0.785), and while numerically lower than relative mid-treatment parameters, this difference did not reach statistical significance. Diffusion-weighted MRI (ΔADCmean) and FDG-PET (ΔMTV, ΔTLG) emerged as the most consistently predictive modalities. Relative measures offer practical advantages, including internal self-normalisation and improved reproducibility across imaging platforms. Relative mid-treatment imaging biomarkers demonstrate superior predictive performance compared to baseline and absolute measures, supporting their potential role in adaptive radiotherapy strategies. Further prospective multi-centre studies with standardised imaging protocols and external validation are essential for clinical translation.
Plastic phenotypes are important biological adaptations, yet their evolution and genomic basis remains insufficiently unexplored. This study examines the origin of an inducible defensive structure, the helmet, that emerged during evolution of a novel morphotype in the freshwater microcrustacean Daphnia sinensis This specific morphotype exhibits consitutively expressed pointed head shape as a juvenile, and forms conspicuous retrocurved helmets in response to infochemicals of the predatory cladoceran Leptodora Our genomic analyses, focusing on single-nucleotide and genome structural variation, indicate monophyletic origin of this morphotype, which apparently emerged following a pond-to-lake habitat shift. The ancestral round-headed morphotype of D. sinensis lives in pond habitats without Leptodora and apparently lacks ability to form large inducible helmets. The divergence of the two morphotypes is characterized by signals of positive selection and extensive chromosome structural changes. A signal of hard selective sweep is particularly strong in the tightly linked ISM1 and TM2D2 genes, both involved in morphogenesis, but with contrasting level of divergence between morphotypes. ISM1 differs in coding regions and amino acid sequences, indicating protein-level changes; TM2D2 differences primarily involve regulatory regions, as confirmed by different level of expression of this gene between morphotypes despite shared protein sequences. Daphnia knockout mutants for TM2D2 or ISM1, generated from a helmet-forming clone using CRISPR-Cas9, exhibit much reduced plastic formation of the helmet, demonstrating the polygenic control of this adaptive trait and large effect sizes of the respective genes. Our study characterizes the evolutionary and genetic basis of a classic example of an adaptive plastic trait.
Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as less-invasive options for patients remaining symptomatic despite optimal medical therapy (OMT). We conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TEER and TTVR versus OMT. Three RCTs were included after systematic search of PubMed, Embase, and ScienceDirect (inception to December 2025). A frequentist network meta-analysis (random-effects) was performed in R. A Bayesian NMA with vague priors was conducted in parallel to obtain posterior rank probabilities and SUCRA values. Relative effects were translated into absolute risk differences and number-needed-to-treat (NNT) / number-needed-to-harm (NNH) using pooled OMT baseline event rates, with 95% CIs via parametric bootstrap. The network comprised 1,050 patients (star-shaped, OMT common comparator; no direct TEER-TTVR comparison). Neither TEER (RR 0.99, 95% CI 0.56-1.76) nor TTVR (RR 0.85, 95% CI 0.51-1.41) significantly reduced all-cause mortality. Both interventions improved NYHA class ≥ 1 class (TEER RR 1.46, 95% CI 1.30-1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41-4.47, NNT 2), KCCQ-OS (TEER MD + 11.00, 95% CI 7.46-14.54; TTVR MD + 17.80, 95% CI 12.78-22.82; both exceeding the 5-point MCID with ≥ 95% confidence), and 6MWD (TEER MD + 17.53 m; TTVR MD + 30.90 m; neither clearly exceeding the 30-m MCID). Both increased major bleeding (TEER NNH 29; TTVR NNH 21) and new pacemaker implantation (TEER NNH 91; TTVR NNH 10). Bayesian posterior probability that TTVR was best was 100% for NYHA improvement, 99% for KCCQ-OS, and 82% for 6MWD, but only 1% for avoidance of pacemaker implantation. In patients with symptomatic moderate-to-severe TR, both TEER and TTVR plus OMT provide consistent and clinically meaningful improvements in functional status and quality of life. Longer-term trials with direct head-to-head comparisons are warranted. Not applicable. This study is a systematic review and meta-analysis of previously published randomized controlled trials.
A systematic review recommended seven multimorbidity indices for predicting mortality. However, their performance has not been assessed in a head-to-head comparison. We externally validated these indices and determined their performance compared to counting co-occurring diseases. Within the prospective Rotterdam Study in the Netherlands, we constructed seven specific sub-cohorts, selected from 14 926 community-dwelling older adults to match the target population of the selected multimorbidity indices. We calculated prediction scores according to the indices' original methods and used these as predictors in logistic regression models with all-cause mortality as outcome. We assessed their performance and compared it to four benchmark models fitted on the same index-specific samples. These models were based on (i) age and sex; (ii) counts of co-occurring diseases, age and sex; (iii) counts of co-occurring diseases associated with mortality, age and sex; and (iv) individual diseases as separate predictors, age and sex. The total population sizes of the seven sub-cohorts ranged from 2409 to 9045 participants. The mean age of the populations ranged from 59.4 to 77.0 years; the proportion of women ranged from 56.0% to 61.8% (excluding single-sex indices). The absolute risk for mortality ranged from 0.9% to 13%. Discriminative performance of the indices and corresponding count models was nearly identical across all indices (maximum difference in C-statistic: 0.06), yet higher than age-and-sex models. Absolute accuracy of the prediction scores was similar across all models (maximum improvement in Brier score: 4%). Calibration was poor in four out of seven indices, all of which had a follow-up time of 2 years or less. Counting co-occurring diseases is as accurate in predicting all-cause mortality in the general population as using multimorbidity indices. These findings imply that counting diseases is the more practical and reliable way of providing prognosis to patients with multimorbidity in a population of community-dwelling adults.
Elucidating molecular structures from spectroscopic data remains one of chemistry's most fundamental challenges, typically requiring extensive expert knowledge and manual interpretation of multiple analytical techniques. This is because the structure elucidation problem often has degenerate solutions for a limited set of experimental data. Existing computational approaches are limited to single spectroscopic modalities, require extensive manual preprocessing, and lack the confidence estimates and context necessary for practical application. Here we present SECS, a framework that combines contrastive learning with evolutionary algorithms to automate structure elucidation directly from raw, multimodal spectroscopic data. By aligning embeddings across NMR, infrared, and mass spectrometry, SECS mimics how experts use multiple spectroscopic lenses while providing calibrated confidence scores and relevant database context. On challenging molecular identification tasks, SECS matches expert chemist performance in head-to-head comparisons in a pilot study. The system successfully identifies incorrect structure assignments in published literature and adapts to new chemical domains without retraining by updating its reference database. Our approach demonstrates how synergistic combination of machine learning paradigms can solve analytical bottlenecks that have constrained chemical discovery.
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.
Benign enlargement of the subarachnoid space (BESS) is a condition characterized by widened subarachnoid spaces, typically associated with macrocephaly or increasing head circumference during infancy or early childhood. Often described as idiopathic and self-limiting, BESS has also been associated with developmental delays and spontaneous subdural collections. Yet, complete interrogation of these associations is limited by lack of normative subarachnoid space characterization and standardized diagnostic criteria. This project aimed to review and synthesize literature on imaging criteria and subarachnoid space measurements for BESS in infants and young children. A systematic PubMed search was conducted using BESS-related terminology, informed by preliminary findings from a manual snowball review. We limited results to reports that provided subarachnoid space measurements from computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound (US) neuroimaging and investigated subjects with or without BESS and/or macrocephaly from birth to 5 years old. Reports with concomitant neurological conditions affecting brain size were excluded. The final collection included twenty-four reports (US n=10, CT n=6, MRI n=6, multiple n=2), consisting of 2,731 infants and children aged 0-36 months. Most reports evaluated non-BESS/macrocephaly subjects (n=15), followed by BESS and/or macrocephalic subjects (n=3) or both (n=6). Subarachnoid space measurements which were not expressly designated or were without detailed descriptions were the most commonly reported subarachnoid space index measure (n=14), followed by craniocortical width (CCW, n=9). Upper CCW measurements for non-BESS/macrocephaly subjects in US reports ranged from 5 mm to 10.86 mm. In general, for each study that included both non-BESS/macrocephaly and BESS and/or macrocephaly subjects, measurements reported were greater among BESS and/or macrocephaly subjects. There was some evidence of overlapping measurements between the subjects, such as those of CCW measurements in US studies. Overall, substantial variability was observed in imaging methodology and measurement thresholds. This review underscores the need for standardized diagnostic criteria to improve the consistency and reliability of BESS diagnosis.
The Q-factor dominated by thermoelasticity ( Q TED ) is a non-negligible component of the total quality factor in high-performance design of Micro Hemispherical Resonators (MHRs). However, finite-element analysis (FEA) of Q TED is prohibitively time-consuming. This paper presents a rapid and accurate prediction framework based on a hybrid CNN-Transformer model, enhanced by data augmentation via polynomial fitting of FEA simulation results. Ablation studies confirm the optimal architecture, where replacing the feed-forward network with a secondary multi-head self-attention mechanism yields the highest performance. Comparative experiments demonstrate that the proposed model surpasses mainstream prediction methods in both accuracy and robustness, with Monte Carlo Dropout verifying well-calibrated uncertainty. We systematically analyze the influence of geometric parameters (thickness T, height H, and anchor radius r) on Q TED through the digital model and physical mechanisms. Results show that an optimal design for maximizing Q TED is characterized by low H , low r , and high T . Practical trade-offs and manufacturability considerations are discussed, recommending a low r to reduce sensitivity to fabrication variations in T and H . The framework quickly improves computational efficiency compared to FEA, providing an efficient and reliable tool for the optimization and robust design of MHRs.
Prior research across various medical specialties has shown that a program's online presence can significantly influence an applicant's decision to pursue advanced training. As oral and maxillofacial surgery (OMS) fellowship opportunities expand, residents increasingly depend on the internet to compare programs and gather information about postgraduate options, making accessible and comprehensive website content essential. This study evaluates the online information available for OMS fellowship programs and identifies weaknesses relative to fellowship websites in other medical specialties. A cross-sectional review of OMS fellowship websites (OMSFWs) was performed, assessing predetermined criteria categorized as recruitment content or educational content. These criteria were applied to published literature regarding websites in other medical specialties for comparison. Fellowship type served as the primary predictor variable, classified into head and neck oncology, cleft and craniofacial surgery, and other craniomaxillofacial subspecialties. Additional variables included practice setting, geographic region, number of faculty, and number of fellows. OMSFWs met 58.6% of recruitment-related criteria but only 14.2% of educational criteria, representing a substantial gap and a significant deficiency when compared with fellowship websites in other surgical disciplines (P < .0001). These findings demonstrate notable shortcomings in the online presence of OMS fellowship programs compared to other specialties and emphasize the need for improved website content to better support applicants seeking clear, complete, and reliable information.
in locked dislocation of the shoulder, instead of reducing back to the glenoid, the humeral head remains incarcerated on the glenoid in a locked fashion. This clinical situation is fairly uncommon. It is essential to conduct an individual evaluation of each patient to determine the appropriate treatment. the aim of this study was to evaluate the functional outcomes of reverse total shoulder arthroplasty (rTSA) in the treatment of locked shoulder dislocation. patients with locked shoulder dislocation who underwent reverse shoulder prosthesis surgery and were admitted to our center between 2007 and 2023 were reviewed. The primary outcome was the Constant score. Secondary outcomes included the adjusted Constant, UCLA and DASH scores. Additionally, any signs of radiologic loosening were also documented. the series consisted of 10 patients, six men and four women, with a mean age of 68.0 years. The average time from the traumatic injury to surgery was 7.5 months. All patients showed improved Constant, Adapted Constant, UCLA, and DASH scores compared to their preoperative values. When comparing the outcomes of chronic posterior and anterior dislocations, no differences in functional outcomes or shoulder motion were observed after rTSA implantation. There were no complications during or after surgery. The results of the present study have shown that patients with locked shoulder dislocation can achieve reliable short-term functional results when treated with rTSA. This proceduredecreases pain, improves functionality and enhances patient satisfaction. IV.