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.
Complex head and neck defects often require chimeric anterolateral thigh (ALT) perforator flaps for reconstruction. However, the variable anatomy of the lateral circumflex femoral artery (LCFA) makes preoperative perforator mapping essential for successful harvest of multiple skin paddles. We developed a standardized protocol combining computed tomography angiography (CTA) with color Doppler ultrasound (CDU). First, bilateral lower extremity CTA scans from 52 patients (104 thighs) were analyzed to characterize perforator distribution from the descending branch of the LCFA. This protocol was then applied to 12 patients with complex head and neck defects. CDU was used to localize and mark cutaneous perforator exit points before CTA scanning. Perforator characteristics were analyzed, and three-dimensional models created. Detailed vessel data were then transferred through a coordinate system to optimize flap design. All 12 chimeric ALT flaps were harvested successfully according to the preoperative plan, with satisfactory flap viability and favorable clinical outcomes. Integrating CDU identification with subsequent CTA mapping provides a reliable preoperative strategy that enhances the precision and safety of chimeric ALT flap reconstruction for complex head and neck defects.
Our goal was to develop a simulation platform for photon-counting CT (PCCT) imaging in mouse models of head and neck squamous cell carcinoma (HNSCC). High-resolution vasculature from an energy-integrating detector micro-CT scan of a barium-enhanced mouse was transferred to the mouse whole-body (MOBY) digital phantom using affine warps. To generate tumors with contrast agent distributions derived from real data, we trained a denoising diffusion probabilistic model (DDPM) on material-decomposed iodine- and barium-enhanced mouse tumors from a prior PCCT study. DDPM synthesized tumors were fused with the vascularized MOBY to create mouse HNSCC phantoms. We improved the accuracy of images from MATLAB PCCT simulation through an adjustment that utilizes matrix multiplication and a multi-layer perceptron (MLP) trained on matched real and simulated material phantoms. We passed MOBY HNSCC phantoms into the adjusted simulation, decomposed PCCT images into water, iodine, calcium, and barium maps, and compared these outputs to the true HNSCC phantoms using quantitative metrics from iodine- and barium-enhanced regions of the tumor. DDPM synthesized tumors had similar mean iodine and barium concentrations to real tumors. In a test set phantom, our matrix multiplication and MLP adjustment substantially reduced the root mean square error of attenuation measurements in reconstructed images from PCCT simulation. In this phantom, material decomposition of the adjusted image using a real sensitivity matrix produced similar material concentrations and cross-contamination patterns to those from real PCCT imaging. Material maps from adjusted simulations of MOBY HNSCC phantoms suggest that default PCCT settings slightly overestimated iodine content, while barium content was slightly underestimated in high barium tumors and overestimated in low barium tumors. This work established a PCCT simulation pipeline with ground truth digital mouse HNSCC phantoms, enabling evaluation of PCCT performance within a calibrated imaging configuration while minimizing radiation exposure to live mice.
Surgical stabilization of Pauwels Type III femoral neck fractures remains a significant challenge due to high vertical shear forces. While the medial buttress plate is a recognized solution, it requires extensive deep dissection. This study aims to compare the biomechanical performance of various screw configurations combined with either a medial buttress or anteromedial support plate. Twenty-five third-generation synthetic femurs were used to create a standardized 70-degree (Pauwels III) fracture model. Specimens were divided into five groups (n = 5): (A) Inverted triangle (IT) screws with a Pauwels screw, (B) Inverted triangle (IT) with medial buttress plate (MBP), (C) Inverted triangle with anteromedial support plate (ASP), (D) L-configuration with medial buttress plate (MBP), and (E) L-configuration with anteromedial support plate (ASP). Axial loading was applied at 2 mm/min until construct failure, defined objectively by the real-time force-distance curve. Although no statistically significant difference was found between groups (p = 0.102), a large effect size was observed (η² = 0.309). Group C (IT + ASP) demonstrated the highest mean failure load (1695 ± 494.6 N). Conversely, Group E (L-configuration + ASP) exhibited the lowest stability (977.2 ± 195.4 N) with a remarkably narrow standard deviation. The majority of failures occurred as transverse subtrochanteric fractures distal to the implants. The combination of an inverted triangle screw arrangement with an anteromedial support plate demonstrated comparable biomechanical stability to the medial buttress plate, while offering a potentially safer surgical corridor. Conversely, pairing L-shaped screw configurations with anteromedial support plates resulted in the lowest mean ultimate load-to-failure among the tested constructs, likely due to potential stress riser effects.
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.
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.
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.
Brucellosis is a zoonosis acquired direct contact with infected animals or by consumption of unpasteurized animal by-products. The most common complications involve the musculoskeletal system, such as sacroiliitis or vertebral osteomyelitis. However, skin and soft tissue involvement is uncommon, and cervical abscess are rarely reported. We report the case of a 19-year-old male patient, with no medical history, from the metropolitan region of Caracas, Venezuela, with no history of travel or direct contact with farm animals, but regular consumption of cheese. In July 2024, he presented with undulating fever, hypor1exia and general malaise. One month later his fever intensified, preceded by chills, followed by the development of a painful, erythematous, warm swelling in the anterior neck, which evolved into an abscess requiring drainage. Purulent material yielded Brucella abortus biovar 1 confirmed by Polymerase Chain Reaction (PCR). The patient received Rifampicin and Doxycycline with full recovery. To our knowledge, this is the first recorded case of human brucellosis with this presentation in Venezuela, and the first reported case of cervical abscess caused by Brucella abortus. These findings underscore the importance of maintaining epidemiological surveillance of brucellosis and strengthening quality control and hygiene measures throughout the dairy production and distribution chain.
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.
Myofascial pain (MP) is a leading cause of disability globally. Pain quality and severity vary widely for people with MP, making it difficult to accurately assess the spectrum of symptoms and develop appropriate treatments. We assessed potential contributors to variability in the clinical spectrum of unexplained neck/shoulder pain and associated myofascial component(s). Prospective cross-sectional study of adults reporting neck/shoulder pain and pain-free individuals. Participants were recruited from the community and assessed in a research laboratory. Of the 96 adults recruited for the study, 84 had complete records (age 32.7 ±13.2 years, 58.3% women). On physical exam, were assessed to be in an active group (those with spontaneous MP without provocation, N=25), a latent group (those with MP upon provocation, N=38), or a normal group (no MP in neck and shoulder, N=21). Pain intensity and interference (PEG); Symptom burden measured using patient-reported outcomes and objective measures: pain catastrophizing (PCS); PROMIS physical function (PF); sleep disturbance; anxiety (GAD-2); depression (PHQ-2); hypermobility (Beighton/Brighton); Objective measures in the medial upper trapezius: pressure pain threshold (PPT) and quantitative sensory testing (QST). The symptom burden explained 75% of the variance in PEG in the overall sample, 82% in the active group and 92% in the normal group. PF and PCS are key predictors of PEG. Network analysis identified unique symptom clusters in the active and latent groups. The multi-dimensional symptom burden explains the variability in the clinical spectrum of pain intensity and interference in unexplained neck/shoulder MP. Network analysis can further improve clinical risk stratification. These findings represent a step towards an eventual goal of developing multidisciplinary clinical guidance for managing the whole patient, rather than the current emphasis on regional pain contributors in MP.
This study aimed to evaluate and compare the efficiency, safety and accuracy of robot-assisted internal fixation and traditional freehand percutaneous screw in talar neck fracture treatment. This study included 23 patients in the robot-assisted group and 23 patients in the traditional group. Age, injured side, average post-operative follow-up time, time from injury to surgery, operation time, intraoperative blood loss, intraoperative fluoroscopic dose, fracture healing time, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, Visual Analogue Scale (VAS) score and 12-item Short-Form Survey (SF-12) score were recorded and compared. This study revealed no statistical difference in baseline characteristics between the two groups, as well as the average post-operative follow-up time, injury to operation time, intraoperative blood loss, fracture healing time, VAS score, 12-item Short-Form Survey (SF-12) score and AOFAS score (P > 0.05). A significant difference was found between the robot-assisted group and the traditional group at the time of operation and intraoperative fluoroscopic dose (P < 0.05). Robot-assisted screw placement for talar neck fractures achieved clinical outcomes comparable to those of traditional surgery, with the advantages of significantly shorter operation time and lower intraoperative fluoroscopic dose. Robot-assisted surgery appears to be a safe, effective, and low-radiation alternative for selected talar neck fractures (Hawkins type II).
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.
Computed tomography scans (CTs) are routinely obtained before hip preservation surgery or to evaluate pelvic and/or hip fractures. Analyzing bone mineral density (BMD) using CT Hounsfield units (HU) before surgical intervention may improve surgical management and outcomes. This systematic review summarizes the current literature on reliability and placement of regions of interest (ROIs) within the hip, pelvis, and sacrum, and their correlation with local and systemic BMD. A systematic review in PubMed, Scopus, and Web of Science was performed. Twenty-four studies reported intraclass correlation coefficients of HU measurements and/or compared the HU value obtained from CT and t-score of DXA for predicting regional BMD within the hip, pelvis, and sacrum. Twenty-four studies were included, enrolling 7,035 patients. The HU measurement was most frequently made at the femoral neck (n = 10). Femur and pelvis intrarater and interrater reliability was moderate to excellent. Moderate to strong correlations between femoral head and femoral neck CT HU and DXA, and poor to moderate correlations between the pelvis CT HU and DXA were found. A variety of ROIs have been described around the pelvis and proximal femur all with reasonable reliability for the measurement of CT HU. The strongest correlations between CT HU and DXA were reported between HU of the femoral neck and DXA of the hip/femur suggesting this ROI may be used for opportunistic BMD screening using preoperative hip/pelvis CT scans. III.
Penile squamous cell carcinoma (PSCC) can affect men of any age, but we know little about the differences between non-old and old patients with PSCC, which severely limits the precise diagnosis and treatment of PSCC. We collected 2 non-old and 3 old PSCC samples and performed single-cell RNA sequencing and single-cell TCR-Seq analysis. All samples were subjected to UMAP clustering, and subcluster analyses were carried out on tumor cells, T cells, and myeloid cells. Furthermore, cell trajectory analyses were completed for tumor cells and T cells. We performed immunohistochemistry for DCN, KITLG, GPX4, and EPCAM and immunofluorescence for CD24 and MIF, as well as Masson staining and β-galactosidase staining on tissues. Macrophages were cultured for flow cytometry to detect the expression of HLA-DR on the cell surface after MIF treatment. We found that tumor cells in older PSCC demonstrated a more pronounced senescence-associated secretory phenotype (SASP) and gave rise to a subcluster of senescence-associated tumor cells, which exhibited stronger malignant features. Interestingly, we observed similar alterations in old head and neck squamous cell carcinoma (HNSC) samples. In addition, older PSCC samples also had more dysfunctional-like CD24 + T cells and more angiogenic macrophages. Finally, we revealed enhanced MIF signaling between fibroblasts and other cells to be another significant feature of aging PSCC. Our study systematically addressed the effects of aging on PSCC and identified IL1B as a potential prognostic marker for PSCC, offering a framework for the classification management and treatment of PSCC patients.
Real-world evidence on comparative treatment patterns and cost is limited for botulinum toxin type A (BoNTA) treatments for cervical dystonia (CD). This study aims to evaluate treatment switch rates, healthcare resource utilization (HCRU), and healthcare costs among patients with cervical dystonia initiating BoNTAs in the USA. This retrospective study analyzed real-world data from Optum's de-identified Clinformatics® Data Mart Database between January 1, 2016 and December 31, 2024. Eligible adults with CD with ≥ 12-month continuous enrollment before and after the first BoNTA treatment were included. The first date of BoNTA administration after the first CD identification in the study period was assigned as the index date. Treatment switch rates were assessed during the first 12 months following BoNTA initiation and at anytime before the study period end. Annual healthcare resource use and healthcare costs were also assessed in the 12 months following treatment initiation. Overall, 1756 adults with CD initiated therapy on BoNTAs. OnabotulinumtoxinA (onabotA) (88.6%; 1555/1756) was utilized most, followed by incobotulinumtoxinA (incobotA) (9.3%; 163/1756), and abobotulinumtoxinA (2.2%; 38/1756). As a result of the small sample size of abobotulinumtoxinA, comparative analysis was focused on onabotA and incobotA. Treatment switch was comparable between onabotA and incobotA during 12-month follow-up. Treatment switch at anytime before study period end was lower for onabotA versus incobotA initiators (2.6% vs. 6.8%; P = 0.007). Annual HCRU and costs were comparable between onabotA and incobotA, except CD-related costs and toxin-related costs were lower for onabotA. Patients with CD who initiated therapy on onabotA had comparable switch rates at 12 months but were less likely to switch to another BoNTA at anytime and had lower or comparable costs to incobotA. Cervical dystonia (CD) is a condition of sustained involuntary muscle contractions that result in abnormal or repetitive muscle movements in the neck and upper shoulders. These movements can be painful and may be associated with a significant decrease in quality of life, work productivity, and cause severe economic burden. Many studies have shown that botulinum toxin type A (BoNTA) treatments are safe and effective in reducing muscle tightness and improving the normal range of motion. It is therefore important to understand the treatment switch rates, and healthcare costs of BoNTA among patients with CD in the USA for the proper management of this disease. This study was conducted to better understand real-world BoNTA treatment patterns, use of healthcare services, and the resulting costs in patients with CD.
Recent modern characterizations of human meningeal lymphatic vessels have reframed long-standing views of central nervous system neurofluid drainage. However, gross anatomical data on lymphatic vessels remains sparse. In this cadaveric study, we combined dissections and immunohistochemical analysis in formalin-fixed human body donors to characterize lymphatic vessels associated with cervical spinal nerves. Using manual, low-pressure peroxide-dye injections via the thoracic duct and left jugular lymphatic trunk, we effervesced and identified candidate lymphatic pathways extending toward the head and neck, highlighting vessels accompanying cervical spinal nerves at the interface between the vertebral canal and surrounding soft tissues. Dye-identified vessels and adjacent dural and perineural tissues were harvested and processed for D2-40 immunohistochemistry, targeting the lymphatic endothelial marker podoplanin. Across four of nine donors, we observed D2-40-positive, thin-walled luminal structures within epineurial and peridural compartments at the craniovertebral junction, along cervical intervertebral foramina, and near brachial plexus roots, consistent with lymphatic vessels. These findings identify D2-40-positive vessel profiles consistent with lymphatic vasculature extending along spinal nerves without directly demonstrating intradural channels or cerebrospinal fluid outflow. They provide an anatomical framework for future studies probing how cervical lymphatic networks at CNS interfaces contribute to neurofluid drainage, immune cell trafficking, and neurological disease.
The scarcity of high-quality annotated datasets hinders the development of reliable AI for hip joint pathology diagnosis. To address this, we present Hip-35, a comprehensive 2D hip radiograph dataset for orthopedic abnormalities, with 35,000 curated synthetic images in 35 pathology categories and 76 expert-annotated clinical radiographic examinations. Our key innovation is a three-stage quality control framework ensuring anatomical fidelity and clinical relevance: (1) Chromatic artifact detection via RGB channel-difference thresholding with edge masking, significantly reducing contamination; (2) Multi-metric deblurring with Manhattan distance, cosine similarity, and SSIM-guided fusion; (3) Anatomical hashing deduplication with U-Net-derived ROI signatures and temporal checks. Leveraging Diffusion Mamba's (DiM) efficiency, we generate and refine synthetic candidates through our quality pipeline, achieving 92% acceptance in radiologists' blinded validation. The final dataset includes key clinical variations, such as femoral neck fractures, acetabular deformities, and post-surgical cases. By publicly releasing the dataset and our open-source quality toolkit, this work establishes a new benchmark for medical image augmentation, enabling reproducible AI diagnostic development for rare orthopedic conditions.
The rapid integration of generative artificial intelligence (AI) into scientific writing has ignited intense debate across biomedical publishing, with journals adopting divergent and often contradictory policies ranging from outright prohibition to conditional acceptance with disclosure. In this Perspective, we examine the ethical and practical implications of AI‑assisted authorship specifically as they relate to Head & Neck Pathology and Springer Nature publishing policies. We examine whether AI‑assisted writing truly represents an ethical threat to scientific integrity, or whether the current controversy reflects a misplaced focus on the mechanics of writing rather than on scientific substance. We argue that efforts to regulate AI use are fundamentally undermined by the inability to reliably detect AI‑generated text and by the growing convergence between human and machine writing styles. More importantly, we contend that authorship should remain grounded in intellectual contribution, intent, and responsibility for scientific claims and not in the tools used to draft prose. By contextualizing generative AI as a natural extension of long‑accepted assistive technologies, we highlight the ethical risks of over‑enforcement, including false accusations and barriers to dissemination of valid science. Ultimately, we call for a recalibration of editorial priorities toward scientific rigor, accountability, and public benefit, rather than fixation on the provenance of text.