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The aim of this consensus statement was to develop evidence-based recommendations on perioperative fasting, taking the growing global awareness of the negative effects of prolonged fasting before surgery into account, particularly with respect to clear liquids. A systematic literature search was conducted, including assessments of the risk of bias and the overall level of evidence using GRADE methodology to develop 13 preliminary recommendations on perioperative fasting. This was followed by a 3-stage Delphi process involving an international, multidisciplinary panel of 68 experts and nonexperts. Experts on perioperative fasting were selected via a focused literature search, while nonexperts were selected via relevant organizations. The panel comprised anesthetists, surgeons, nurses, cardiologists, gastroenterologists, other physicians, patient representatives and members of international organizations related to the topic, including patient safety organizations and enhanced recovery after surgery (ERAS) societies. The panel of 68 stakeholders subsequently agreed on 8 recommendations. These recommendations are intended for all healthcare professionals as guidance for perioperative fasting in adults undergoing sedation or anesthesia. The consensus statement supports current preoperative fasting practices for solid food and non-clear liquids, reflecting the lack of meaningful new evidence. Patients should fast for 6h with respect to non-clear liquids, including milk, milk products, meal replacement drinks and enteral feeding formulas. They should fast for at least 6h with respect to solid food; for large fatty meals fasting for 8h or longer may be necessary; however, with respect to clear liquids it reflects a fundamental shift towards more liberal liquid regimens. It is recommended that institutional protocols should be implemented to reduce liquid fasting times. These protocols can either encourage patients to drink clear liquids until 2 h before the start of anesthesia or sedation or permit the intake of clear liquids less than 2 h before the start of anesthesia or sedation within institutional protocols. Clear liquids include water, tea or coffee with sugar or honey (including a small amount of milk, up to one fifth of the total volume), clear juices, lemonade and clear carbohydrate drinks. The consensus statement further recommends that oral intake should be resumed as soon as clinically feasible and that preprocedural gastric ultrasound performed by a trained provider can be used to guide clinical decisions when additional information is required. These consensus-based recommendations are not an official guideline issued by any national or international professional society. Nevertheless, they are currently regarded as the most comprehensive and up-to-date review of the available evidence, based on robust methodology. The broad international consensus suggests that the recommendations published in Die Anaesthesiologie provide a reliable basis to improve the quality of patient care by minimizing periprocedural fasting times, within safe margins. To achieve this, preoperative liberal clear liquid regimens can be implemented with institutional protocols. EINLEITUNG: Ziel des vorgestellten Konsensus-Statements war es, evidenzbasierte Empfehlungen zur perioperativen Nüchternheit zu entwickeln, die dem weltweit wachsenden Bewusstsein für die negativen Auswirkungen verlängerter präoperativer Karenzzeiten – insbesondere für klare Flüssigkeiten – Rechnung tragen. Auf Grundlage einer systematischen Literaturrecherche wurden 13 vorläufige Empfehlungen zur perioperativen Nüchternheit entwickelt. Von diesen wurden nach Überarbeitung in einem dreistufigen Delphi-Prozess durch ein internationales, multidisziplinäres Gremium 8 Empfehlungen konsentiert. Insgesamt nahmen 68 Vertreter:innen verschiedener Interessengruppen – darunter Patient:innen, Anästhesist:innen, Chirurg:innen, Ärzt:innen weiterer Fachrichtungen, Pflegekräfte sowie Mitglieder:innen relevanter internationaler Organisationen – aus 5 Kontinenten teil. Das Konsensus-Statement bestätigt im Wesentlichen die Empfehlungen früherer Leitlinien zu nichtklaren Flüssigkeiten, fester Nahrung, Kaugummi und postoperativer oraler Nahrungsaufnahme. Hinsichtlich klarer Flüssigkeiten spiegelt es jedoch ein grundlegendes Umdenken hin zu liberaleren Flüssigkeitsregimen wider. Es wird empfohlen, institutionelle Protokolle zur Verkürzung der Flüssigkeitskarenzzeiten zu implementieren. Diese können entweder eine feste Mindestkarenzzeit von 2 h vor dem Eingriff vorsehen oder das Trinken klarer Flüssigkeiten bis zum Abruf in den OP erlauben. Diese internationale, multidisziplinäre Konsenserklärung zielt darauf ab, die Qualität der Patientenversorgung zu verbessern, indem präoperative Nüchternheitszeiten innerhalb sicherer Grenzen minimiert werden. Die Umsetzung liberalisierter präoperativer Flüssigkeitsempfehlungen durch klar definierte institutionelle Protokolle stellt hierfür einen zentralen Ansatz dar.
 For locally advanced cervical cancer (LACC), cisplatin-based chemoradiotherapy (CIS + RT) is the recommended treatment; however, its toxicity profile often limits clinical application. Thus, this study evaluated treatment outcomes and toxicity of carboplatin-based chemoradiotherapy (CARBO + RT) vs. CIS + RT.  This single-center observational study included patients with LACC (Federation Internationale de Gynecologie et d'Obstetrique stages IIA-IVA) treated with weekly CARBO (area under curve 2, calculated using the Calvert formula) or CIS (40 mg/m² intravenous weekly) concurrently with standard two-dimensional external beam radiotherapy (45 Gy in 25 fractions) with subsequent intracavitary brachytherapy (7 Gy per fraction for three insertions). A total of 146 patients were analyzed (CARBO + RT: n = 72 and CIS + RT: n = 74). Primary outcome measures were tumor response rate, overall survival (OS), and two-year progression-free survival (PFS). The secondary outcome measure was acute adverse events (AEs).  CARBO + RT and CIS + RT groups had comparable complete response (58.3% (n = 42) vs. 64.8% (n = 48); p = 0.692); however, treatment completion was significantly higher with CARBO + RT (94.4% (n = 68)) vs. CIS + RT (81.1% (n = 60); p = 0.014). CARBO + RT group had a higher hazard of OS (hazard ratio (HR): 1.06; 95% CI: 0.41-2.75; p = 0.901) and PFS (HR: 1.47; 95% CI: 0.70-3.072; p = 0.305), though the groups did not differ significantly. CARBO + RT was associated with significantly less vomiting (p = 0.005), while grade II-IV hematologic and nonhematologic AEs were comparable (p > 0.05).  CARBO + RT achieved oncologic outcomes comparable to CIS + RT, with superior treatment completion rates and favorable gastrointestinal tolerability. CARBO + RT represents a viable alternative, particularly in settings where CIS toxicity or hydration requirements pose clinical challenges.
This study evaluated the quality properties of fermented butter using 0.5% (v/v) extract solution from Korean traditional fermented soy pastes (KFSE; C: Cheonggukjang; D: Doenjang; and M: Meju). Samples were analyzed for pH, Commission Internationale de l'Éclairage (CIE) color, viscosity, moisture and fat contents, total plate count, lactic acid bacteria (LAB) count, electronic nose, electronic tongue, and sensory evaluation. The Con (fermented butter using commercial starter) showed a significantly lower pH than KFSE-treated samples (p < 0.05). The M exhibited significantly higher LAB counts as well as greater yellowness, fat, and moisture contents than the other samples (p < 0.05), while total plate counts were highest in C. Electronic nose and principal component analysis demonstrated distinct oily, buttery, and fermented flavor profiles in KFSE-treated samples. Electronic tongue analysis indicated that KFSE-treated samples had higher sourness, saltiness, and umami intensities. Sensory evaluation showed that M received the highest scores in most traits, indicating improved overall acceptability and functional properties of fermented butter.
The ESGO-ESTRO-ESP guideline 2025 integrates the molecular classification into prognostic risk stratification and therapeutic decisions for patients with endometrial cancer (EC). In particular, a refined stratification of the molecular subgroup No-Specific-Molecular-Profile (NSMP) has been recently introduced to better reflect its pronounced prognostic heterogeneity. Retrospective analyses by Jamieson et al. and Vermij et al. demonstrate that histological tumor grade and immunohistochemical estrogen receptor expression represent independent prognostic factors within the NSMP subgroup, allowing for the identification of a large subgroup with an excellent prognosis and a small subgroup with a poor prognosis. Additional exploratory post hoc analyses suggest a potential differential benefit of adjuvant chemotherapy in ER-negative NSMP EC. However, these observations remain hypothesis-generating and lack prospective validation. In addition, the exact cut-off for ER-positivity remains unclear. The ESGO guideline defines prognostic risk groups according to the estimated 5-year risk of recurrence and derives recommendations for adjuvant therapy accordingly. Key randomized trials, including PORTEC-1, PORTEC-2, PORTEC-3, GOG-249 and GOG-258, are incorporated alongside molecular subgroups, whose biological characteristics increasingly inform treatment intensity. In contrast, the German S3 guideline adopts a more conservative methodological approach, incorporating molecular markers primarily as supportive information, particularly in the absence of prospective evidence guiding specific therapeutic decisions. With respect to surgical management in early-stage disease (Fédération Internationale de Gynécologie et d'Obstétrique [FIGO] I-II), both guidelines show substantial agreement, especially regarding the preference for minimally invasive surgery and the avoidance of unnecessary radicality. Differences mainly relate to the indication for sentinel lymph node staging. This statement aims to provide a balanced contextualization of these conceptual differences and to support an informed discussion of current international developments.
Additive manufacturing (AM) has expanded in dentistry, yet the color and translucency stability of 3-dimensional-printed resin-based materials remain insufficiently understood. This study investigated the main and interaction effects of printing orientation, specimen thickness, and surface treatments on the color and translucency stability of a 3-dimensional printed resin-ceramic hybrid material. Ninety AM specimens were fabricated using a factorial design combining 3 printing orientations, 3 specimen thicknesses, and 2 surface treatments (3 × 3 × 2, n = 5 per condition) and compared with 30 subtractively manufactured control specimens (Vita Enamic). Aging was simulated by thermocycling (5000 cycles, 5-55 °C). Color coordinates were measured via the Commission Internationale de l'Éclairage L*a*b* color system, and color change and translucency change were calculated. Degree of conversion, water sorption, and surface roughness were also evaluated. Printing orientation and specimen thickness significantly affected color change and translucency change (P < 0.05), with the 90° orientation showing lower changes than 0° and 45°. Surface treatment had a limited influence on color and translucency stability, although glazing resulted in higher water sorption as compared with polishing (P < 0.05). No significant effects of printing orientation were observed for degree of conversion or surface roughness, whereas surface treatment significantly influenced surface roughness (P < 0.05). Despite these variations, all groups remained within clinically acceptable thresholds for color and translucency changes. Overall, the findings suggest that AM resin-ceramic restorations have potential for use in definitive restorations. Optimizing printing orientation and material thickness may enhance the color and translucency stability of AM resin-ceramic restorations, supporting their clinical applicability.
Background Color stability is a critical property for the long-term success of aesthetic composite restorations. Recently introduced single-shade composite resins, such as Omnichroma (Tokuyama Dental, Tokyo, Japan) and Vittra APS Unique (FGM Dental Group, Joinville, Santa Catarina, Brazil), exhibit a chameleon effect that enhances shade matching. However, their resistance to staining from commonly consumed beverages remains inadequately explored. Aim The aim of this in vitro study was to comparatively evaluate the effect of different commonly consumed beverages on the color stability of two single-shade composite resins: Omnichroma and Vittra APS Unique. Materials and methods This in vitro study included 96 composite disc specimens (n=48 per material), fabricated with standardized dimensions (10 mm diameter and 2 mm thickness). Specimens of each material were divided into four subgroups (n=12) based on immersion media: artificial saliva, turmeric solution, tea, and soft drinks. Baseline color measurements were recorded using a spectrophotometer based on Commission Internationale de l'Eclairage (CIELAB) parameters (L*, a*, b*). Samples were immersed in the respective beverages for 28 days, simulating long-term clinical exposure. Post-immersion color measurements were obtained, and color change (ΔE) was calculated. Statistical analysis was performed using the Shapiro-Wilk test, Wilcoxon signed-rank test, and Mann-Whitney U test, with significance set at p<0.05. Results All specimens exhibited statistically significant color changes after immersion in the tested beverages (p<0.05). Among the tested solutions, turmeric demonstrated the highest staining potential, followed by tea, while soft drinks exhibited the least discoloration. In artificial saliva, Omnichroma showed a significantly higher color change (ΔE=17.37±2.79) compared to Vittra APS Unique (ΔE=10.58±0.11) (p<0.001). In contrast, turmeric caused significantly greater discoloration in Vittra APS Unique (ΔE=30.00±4.69) than in Omnichroma (ΔE=18.60±2.47) (p<0.001). Similarly, tea resulted in higher color change in Vittra APS Unique (ΔE=17.80±4.38) compared to Omnichroma (ΔE=5.98±1.39), indicating increased susceptibility to staining. Soft drinks caused relatively minimal discoloration, with no statistically significant difference between the two materials (p>0.05). Overall, Vittra APS Unique demonstrated greater susceptibility to staining in highly pigmented solutions, whereas Omnichroma exhibited comparatively better color stability under similar conditions. Conclusion Within the limitations of this in vitro study, both single-shade composite resins were affected by exposure to staining beverages. Turmeric showed the greatest staining effect, followed by tea, while soft drinks had minimal impact on color stability. Omnichroma demonstrated superior resistance to discoloration compared to Vittra APS Unique in highly staining environments. These findings have important clinical implications in guiding the selection of restorative materials, particularly in patients with dietary habits that predispose restorations to staining.
Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder that often coexists with epilepsy and oromotor dysfunction, leading to poor oral hygiene, high caries burden, and limited cooperation during dental care. Comprehensive dental rehabilitation under general anesthesia (GA) may be required to deliver safe and definitive treatment in children with extensive disease and significant treatment barriers. This case report aimed to describe comprehensive oral rehabilitation under general anesthesia in a child with cerebral palsy and epilepsy, and to evaluate short-term mother-reported outcomes after treatment. A clinical case report was prepared based on history taking, extraoral and intraoral examination, perioperative documentation, and mother-reported follow-up. Tooth notation followed the Federation Dentaire Internationale (FDI) two-digit system. Radiographic examination was not performed because the patient was unable to maintain the required posture. A 9-year-old girl with spastic cerebral palsy and tonic-clonic epilepsy presented with fever and multiple untreated carious lesions. Examination revealed mixed dentition, poor oral hygiene, limited mouth opening, reversible pulpitis in teeth 62, 63, 72, 26, 16, 36, 46, and 83, and pulpal necrosis with non-restorable root remnants in teeth 85, 84, 75, 74, 55, and 54. Single-session full-mouth rehabilitation under GA included scaling and prophylaxis, composite restorations of teeth 62, 63, 72, 26, 16, 46, and 83, pulpotomy of tooth 36, extractions of teeth 85, 84, 75, 74, 55, and 54 and topical fluoride application. Transient postoperative facial edema occurred and was managed conservatively. At 1-month follow-up, the mother reported improved feeding comfort, pain-free sleep, and a 2-kg weight gain. Full-mouth dental rehabilitation under GA provided a feasible approach for managing extensive dental disease in a child with CP and epilepsy when conventional chairside treatment was not possible. The intervention enabled completion of definitive dental care in a single session and was associated with mother-reported improvements in feeding comfort, sleep, and short-term weight gain. Longer follow-up and standardized outcome measures are needed to evaluate sustained oral health, function, and quality-of-life benefits in similar patients.
Background/Objectives: Tooth discoloration can influence the esthetic outcome of restorative treatments. Recently, 3D-printed ceramic-filled hybrid materials have been introduced for dental restorations using digital workflows. The aim of this in vitro study was to evaluate the influence of 3D-printed ceramic-filled hybrid veneers on the final color of discolored teeth using spectrophotometric measurements. Methods: Twenty-five extracted human anterior teeth without caries or restorations were prepared for veneer restorations using standardized reduction protocols. Artificial discoloration was induced by applying light-cured color coatings to the buccal surfaces of the specimens. The prepared teeth were digitally scanned, and veneers with a thickness of 1 mm were designed and fabricated using a 3D printing system and a ceramic-filled hybrid material. Color measurements were performed with a spectrophotometer and recorded in the Commission Internationale de l'Éclairage L*a*b* (CIELAB) color system. Measurements were obtained at four stages: after creation of discoloration, after two weeks of immersion in physiological saline solution, after veneer placement using neutral try-in gel, and after two months of immersion following veneer placement. Color differences were calculated using three color difference formulas (ΔE*ab, ΔE94, and ΔE00). Results: The placement of the 3D-printed veneers produced substantial modifications in the optical characteristics of the discolored substrates, reflected by reduced chroma values and significant color differences between the baseline and veneer stages. After two months of immersion, only minor variations in color coordinates were observed. The calculated color differences between the veneer stage and the post-immersion stage remained low across all evaluated color difference formulas, indicating good short-term color stability of the veneered specimens. Conclusions: Within the limitations of this pilot in vitro study, 3D-printed ceramic-filled hybrid veneers demonstrated the ability to effectively modify the color of discolored substrates while maintaining relatively stable optical properties after two months of immersion. These restorations may represent a promising and cost-effective option for the esthetic management of discolored teeth.
Zero-dimensional (0D) cuprous-based metal halides have recently gained prominence as advanced luminescent materials owing to their structural tunability and distinctive broadband self-trapped exciton (STE) emission. Herein, a 0D structure, ETPA2Cu2Br2I2 (ETPA+ = ethyltripropylammonium) crystal, was synthesized via a solution growth method. The rigid dimer [Cu2Br2I2]2-, formed due to the mixed-halide effect, effectively suppresses nonradiative recombination at room temperature. Temperature-dependent photoluminescence and Raman spectroscopic analyses systematically reveal dual STE emission channels originating from multimode vibronic coupling, achieving full-visible-spectrum white light emission with Commission Internationale de l'Éclairage (CIE) coordinates (0.3337, 0.3449) and a near-unity photoluminescence quantum yield of 95.94%. A prototype white LED fabricated with a 295 nm UV chip exhibits a high color rendering index (CRI = 88.4) and warm-white emission, demonstrating its potential for next-generation solid-state lighting and visible light communication systems.
This study aimed to evaluate the efficacy of Mask regions with convolutional neural network (R-CNN) for the automated detection and segmentation of residual dental roots in panoramic radiographs and to compare its diagnostic performance against the semantic segmentation benchmark, U-shaped network (U-Net). A retrospective dataset comprising 224 patients with 505 annotated residual roots was utilized. Image preprocessing involved adaptive contrast enhancement using contrast limited adaptive histogram equalization in the Commission Internationale de l'Éclairage lab color space to improve root-to-bone definition. A Mask R-CNN model utilizing a ResNet-50 backbone and Feature Pyramid Network was trained using K-fold cross-validation. Performance was compared to U-Net based on sensitivity, specificity, accuracy, dice similarity coefficient, and receiver operating characteristic analysis. The Mask R-CNN model significantly outperformed U-Net across all evaluated metrics. It achieved an accuracy of 98.67% and a dice similarity coefficient of 91.34%. Most notably, the model demonstrated a sensitivity of 91.16%, presenting a marked improvement over U-Net (78.54%), while maintaining a specificity of 99.12%. The area under the curve was calculated at 0.9599, indicating superior discriminative capability. Mask R-CNN provides a robust solution for identifying residual roots, effectively addressing challenges related to low contrast and anatomical noise. By combining high sensitivity with high specificity, the system significantly reduces false negatives without causing alert fatigue, thereby serving as a reliable automated assistant for enhancing surgical safety and planning efficiency.
Multiple resonance thermally activated delayed fluorescence (MR-TADF) emitters are considered ideal candidates for high-definition displays; however, simultaneously accessing high-efficiency, narrowband, pure-green emission remains a significant challenge. Here, we propose an orientation-directed isomerization strategy on the indolocarbazole (ICz) building block to construct a previously unexplored syn-oriented para-N-π-N dual-boron-containing architecture. This design delicately balances the strong intramolecular charge transfer (ICT) arising from para-N-π-N topology and short-range charge transfer (SRCT) within a rigid ICz framework, achieving the desired narrowband emission. The proof-of-concept emitter DBN-cpICz shows pure-green photoluminescence in toluene (λPL = 520 nm, full-width at half-maximum (FWHM) = 20 nm, and Commission Internationale de l'Éclairage (CIE) coordinates = (0.17, 0.74)). An organic light-emitting diode using DBN-cpICz delivers pure-green electroluminescence at 522 nm, with an FWHM of 24 nm and CIE coordinates of (0.20, 0.73), exceeding the NTSC green requirement and approaching the BT.2020 standard, together with a maximum external quantum efficiency of 36.4%. The intrinsic relationship between the N-π-N electronic topology of ICz and its well-defined excited-state characteristics enables robust green spectral anchoring, thereby providing a solid molecular engineering principle for the development of efficient, narrowband, pure-green MR-TADF emitters.
Antimicrobial resistance (AMR) issues have emerged in New Caledonia, particularly involving methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Acinetobacter baumannii (CR-AB). However, a comprehensive overall picture is still required to guide an antimicrobial stewardship. A prospective collection of antimicrobial susceptibility testing results was performed over a 20-year period (2005-2024) in the Territorial Hospital Center, the main hospital in New Caledonia. This surveillance encompassed 22 different pathogens and 28 antimicrobial agents, covering 157 pathogen-drug combinations. Resistance rates over time were analyzed using logistic models. A focus was placed on high-priority pathogens, including MRSA, CR-AB, vancomycin-resistant Enterococcus faecium, ceftazidime-resistant Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacterales (ESBL-E), and carbapenemase-producing Enterobacterales (CPE). Multidrug-resistant (MDR) and possible extensively drug-resistant (pXDR) isolates were also identified and characterized. Across 111,022 included isolates, emergences of resistance were observed, notably to penicillins, third-generation cephalosporins, tetracycline, and fusidic acid. Temporal resistance trends were described, along with outbreaks of MRSA and CR-AB, and the emergence of ESBL-E and CPE, representing 3.7% [95% CI: 3.5-3.8] (N = 2208), and 0.1% [95% CI: 0.1-0.2] (N = 85) of the 59,954 Enterobacterales isolates, respectively. Overall, 11% [95% CI: 10.8-11.1] were MDR and 0.6% [95% CI: 0.5-0.6] were pXDR. Through trend analyses, this surveillance highlighted both the emergence and decline of AMR across diverse bacterial pathogens, helping inform which antibiotics may remain appropriate as first-line options and addressing the lack of data from Pacific Island settings. This work received financial support from the Pierre Ledoux Jeunesse Internationale scholarship (Fondation de France) and the Institut Pasteur, Paris.
In multiple-resonance-induced thermally activated delayed fluorescence (MR-TADF) materials with a meta B-π-B configuration, most studies mainly focused on linear multi-boron frameworks. In this study, we report two macrocyclic dual- and tetra-borated MR-TADF materials based on tetraazacyclophane (DPN2B and DPN4B). By rationally selecting boron sources and reaction conditions, one-pot double and quadruple borylation reactions were achieved. In toluene, DPN2B and DPN4B exhibit deep blue narrowband emission peaking at 451 and 442 nm, with full widths at half maximum of 22 and 25 nm, respectively. Solution-processed organic light-emitting diodes (OLEDs) based on DPN2B and DPN4B show pure-blue electroluminescence with peaks at 458 and 452 nm, with maximum external quantum efficiencies of 6.4% and 4.0%, respectively. The DPN2B-based device achieves Commission Internationale de l'Éclairage coordinates of (0.14 and 0.07). This work provides a practical macrocyclic molecular design strategy for developing multi-borated MR-TADF emitters and OLEDs.
Concussion is a high-profile and important brain injury, yet the on-pitch assessment of concussion in football (soccer) remains challenging due to the absence of a standardized, evidence-based assessment protocol that can be completed within a time-restrained on-pitch football-match environment. The objective of this study was to develop a football-specific, standardized on-pitch concussion assessment protocol informed by research evidence and expert opinion using an international consensus process and steering committee deliberation, which included medical experts from each of the 6 football confederations. Nominated global medical representatives with experience in the on-pitch assessment of concussion in football (≥5 assessments within previous year) from Fédération Internationale de Football Association (FIFA)-member associations completed a 2-round Delphi questionnaire to score all identified assessment items that have been used to assess an athlete with a suspected concussion within an on- or off-pitch environment (in any sport) along with expert recommendations. Consensus (≥80% agreement) was required for assessment items to be included in a football-specific on-pitch concussion assessment protocol. Results demonstrated that from 101 identified assessment items, 41 achieved greater than or equal to 80% agreement for inclusion in round 1, and 6 additional items achieved greater than or equal to 80% agreement in round 2. Four items (scoring 75%-79%) were added after steering committee review. Twelve items were merged to avoid duplication of items that assess the same issue. This resulted in the final Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) comprising 45 items categorized into 11 domains as follows: player medical history, mechanism of injury, visible signs, level of consciousness, cervical spine assessment, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment, with each structured for rapid on-pitch evaluation. FOCUS provided a standardized, evidence-informed protocol for the on-pitch assessment of a suspected concussion during football match play, addressing a critical gap in player health and safety. Adoption of FOCUS has the potential to harmonize concussion management globally; however, implementation feasibility and diagnostic accuracy require further evaluation.
Underwater endoscopic mucosal resection (UEMR) is widely used for colorectal polyp resection, but visualization may be impaired with poor bowel preparation. Gel-immersion endoscopy has been proposed to enhance image clarity. In this study, digital image analysis was applied to quantitatively compare lesion visibility during UEMR with water or gel immersion. In this prospective, randomized crossover trial, patients with non-pedunculated colorectal adenomatous lesions measuring 6-19 mm were sequentially examined with water and gel immersion using white light imaging (WLI), blue laser imaging (BLI), and linked color imaging (LCI). The primary endpoint was the color difference (ΔE) between the lesion and surrounding mucosa, calculated using the Commission Internationale d'Eclairage (CIE) L*a*b* color space. Visibility scores were assessed by blinded expert endoscopists (jRCTs062220033). In total, 72 lesions (median size, 8 mm) were analyzed. ΔE values were significantly greater with gel than water immersion in both WLI (p = 0.03) and BLI (p = 0.03), but not in LCI (p = 0.10). The improvement in ΔE values with gel immersion was more pronounced under poor bowel preparation. Visibility scores were significantly higher with gel immersion in both WLI and BLI overall and under poor bowel preparation, whereas no significant differences were observed under good bowel preparation. Gel immersion significantly improves colorectal lesion visibility during UEMR, particularly under poor bowel preparation and with WLI or BLI. This technique may serve as a valuable adjunct to enhance diagnostic and therapeutic precision in challenging endoscopic conditions.
Matrix-induced colour drift remains a major barrier to translating nanozyme-based colourimetric assays from buffer systems to Chinese medicinal matrices. Here, we report a sodium alginate (SA)-confined iron-based metal-organic framework (Fe-MOF) nanozyme chip, denoted as the Fe-MOF/SA chip, for smartphone-assisted screening of malathion in pretreated herbal extracts. The hydrogel does not merely carry the Fe-MOF catalyst; rather, it confines the Fe-MOF within a more stable H2O2-TMB chromogenic microenvironment, thereby converting a drift-prone inhibition response in the dispersed nanozyme system into a more reproducible colour readout based on the b* coordinate of the Commission Internationale de l'Éclairage L*a*b* (CIE L*a*b*) colour space, where b* represents the blue-yellow component. Under optimised conditions, the chip provided a linear response from 10 to 500 ng mL-1 with an LOD of 4.4 ng mL-1. Relative to the free Fe-MOF, the hydrogel-confined format markedly reduced matrix-dependent response deviations in chrysanthemum, honeysuckle and coptis extracts. Standard-addition recoveries of 93.5-108.3% with RSDs of 2.7-3.7% were obtained, and HPLC analysis of the same spiked extracts gave comparable concentrations. These results support the use of the Fe-MOF/SA chip as a portable front-end screening platform for malathion in chemically heterogeneous herbal matrices.
Former food products (FFP) are food industry leftovers that can be used as feed ingredients. We investigated the effects of sugary FFP on growth, feeding behaviour, carcass and meat quality of pigs fattened to a heavy weight. Three inclusion levels were tested: 0% (FFP-0 = control), 20% (FFP-20) and 40% (FFP-40) FFP in grower (20-60 kg BW), finisher 1 (60-100 kg BW) and finisher 2 (100-140 kg BW) phase. A total of 36 castrated pigs were used, with 12 pigs within a litter assigned to each treatment, housed in a single pen equipped with automatic feeders that allowed recording of individual (ad libitum) feed intake at each visit. The pigs were slaughtered in two batches at the age of 190.9 ± 1.5 days and BW of 144.7 ± 8.8 kg. At slaughter, carcass weight, longissimus dorsi (LD) pH and carcass traits were measured. The following day, body composition of carcasses was determined using dual-energy X-ray absorptiometry and then carcasses were dissected into primal cuts, and meat quality was assessed. Data were analysed with SASV9.4 (PROC MIXED), with diet as a fixed effect and litter (dam) as a random effect in the model. Linear effects of sugary FFP inclusion were tested. In the grower period, daily feed intake and daily gain decreased with increasing sugary FFP inclusion. In finisher periods, a tendency towards lower daily feed intake was observed with increasing sugary FFP inclusion, which did not affect daily gain, but led to better feed conversion in the finisher II period. In the grower period, no differences in feeding behaviour were observed, while in finisher II period, FFP-20 pigs spent the shortest time at the feeder, consumed more feed per minute, had a longer interval between visits, but tended to go to the feeder more often than the FFP-0 or FFP-40 pigs. Compared to control, the sugary FFP inclusion was associated with increased carcass protein and water and decreased fat content, in line with thinner backfat. The decrease in ultimate pH and CIE (Commission Internationale d'Eclairage) colour parameter L* of LD were the only significant effects on meat quality. The backfat fatty acid composition was affected by sugary FFP inclusion (more monounsaturated fatty acids and less polyunsaturated fatty acids with higher ∑n6:∑n3 ratio). In summary, the sugary FFP inclusion of up to 40% had a limited effect on growth performance and meat quality but resulted in less deposition of fat and altered adipose tissue fatty acids profile.
Caries is the most prevalent chronic disease in children, affecting more than 530 million people worldwide. Timely restoration of primary molars is critical for maintaining function and preventing premature tooth loss. The choice of restorative material in class II restorations directly influences clinical outcomes. Bulk-fill composites such as SDR Flow+ (SDR; Dentsply Sirona) and high-viscosity glass ionomer cements including EQUIA Forte HT Fil (EFHT; GC Corporation) provide esthetic and durable solutions. The authors evaluated the 12-month clinical performance of these restorative materials. In this randomized clinical trial, 118 children aged 4 through 8 years with class II caries lesions were allocated to receive either SDR (n = 59) or EFHT (n = 59). Clinical performance was assessed systematically at 3, 6, and 12 months using standardized Fédération Dentaire Internationale (now known as FDI World Dental Federation) criteria, covering functional, biological, and esthetic properties with appropriate statistical analyses. At 12 months, both SDR (98.3%) and EFHT (92.9%) restorations had high survival rates, with no significant difference (P =.164), indicating inconclusive results for longevity. The SDR had significantly greater overall clinical performance according to the FDI World Dental Federation criteria (P < .001), reflecting superior esthetic and functional outcomes, whereas the results for biological performance remained inconclusive (P = .322). Both SDR and EFHT achieved high short-term success and survival; SDR had superior esthetic and functional performance and inconclusive biological outcomes at 12 months. Both SDR and EFHT had high survival and satisfactory outcomes in Class II primary molar restorations. SDR offers a biocompatible, durable, and easy-to-handle material that better meets esthetic and longevity expectations. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT06166160.
Objective: To compare the performance of four deep learning instance segmentation models in tooth contour segmentation and Fédération Dentaire Internationale (FDI) tooth numbering recognition on intraoral occlusal images, and to preliminarily evaluate the clinical acceptability of the best-performing model. Methods: A total of 700 adult participants, comprising 343 males and 357 females aged 35-87 years, including individuals with complete dentition and those with dentition defects, who attended the Department of Prosthodontics, Hospital of Stomatology, China Medical University, between March 2022 and October 2024 and underwent standardized intraoral occlusal photography were enrolled, yielding 1 400 images; after quality screening, 1 300 images from 650 participants were finally included. The dataset was divided by images into a training set (910 images), a validation set (195 images), and a test set (195 images) at a ratio of 7.0∶1.5∶1.5, and only the training set was augmented to 2 730 images. Twenty-eight tooth categories, excluding third molars, were annotated according to the FDI two-digit notation system. Under unified training conditions, four models: Mask R-CNN, RTMDet, YOLOv8-seg, and YOLOv11-seg were compared, and test-set performance was evaluated using segmentation mean average precision at an IoU threshold of 0.5 (seg_mAP@50), precision, recall, and F1-score, while five attending prosthodontists were recruited to compare tooth numbering accuracy with that of the best-performing model and to assess its practical applicability. Results: YOLOv11-seg outperformed the other models across all metrics, achieving a seg_mAP@50 of 98.2%, a precision of 96.3%, a recall of 96.8%, and an F1-score of 96.5%. The tooth numbering accuracy of this model was 97.5% (2 145/2 200), showing no statistically significant difference from the mean accuracy of the five attending prosthodontists (98.6%±1.3%) (t=1.89, P=0.130), and 98.6% of the model outputs were rated as clinically acceptable. Conclusions: YOLOv11-seg achieved highly accurate tooth segmentation and tooth numbering recognition on intraoral occlusal images, with performance comparable to that of attending prosthodontists, thus providing a technical basis for subsequent dentition-defect analysis based on tooth-level information. 目的： 比较4种深度学习实例分割模型在口内(牙合)面像中完成牙齿轮廓分割与世界牙科联盟（FDI）牙位编号识别的性能，并对最优模型的临床可接受性进行初步验证。 方法： 回顾性收集2022年3月至2024年10月就诊于中国医科大学附属口腔医院修复科并完成口内(牙合)面像标准化拍摄的成年受试者700名，包括牙列完整和牙列缺损个体，其中男性343名，女性357名，年龄35~87岁，共获得1 400张图像，经质量筛选最终纳入650名受试者的1 300张图像。以图像为单位按7.0∶1.5∶1.5划分训练集（910张）、验证集（195张）与测试集（195张），仅对训练集施加图像增强，将数量扩充至2 730张。参照FDI两位数记录法标注28个牙位（不含第三磨牙）。统一训练条件下对比基于区域的掩膜卷积神经网络（Mask R-CNN）、实时目标检测模型（RTMDet）、单次多框检测器v8实例分割模型（YOLOv8-seg）与单次多框检测器v11实例分割模型（YOLOv11-seg）4种模型，以交并比阈值为0.5时的分割平均精度均值（seg_mAP@50）、精确率、召回率及F1分数评估测试集性能，并设置5名主治医师与最优模型比较牙位识别准确率并评估最优模型的实际适用性。 结果： YOLOv11-seg各项指标均优于其他模型，seg_mAP@50为98.2%，精确率为96.3%，召回率为96.8%，F1分数为96.5%。该模型牙位识别准确率为97.5%（2 145/2 200）与5名主治医师的牙位识别准确率（98.6%±1.3%）差异无统计学意义（t=1.89，P=0.130），98.6%的模型输出结果被评为临床可接受。 结论： YOLOv11-seg能在口内(牙合)面像中高精度完成牙齿分割与牙位识别，其判读能力与口腔修复专业主治医师水平相当，可为后续基于牙位信息的牙列缺损分析提供技术基础。.