Atypical meningiomas have higher recurrence and mortality than benign variants, and age may influence treatment decisions and outcomes. We evaluated associations between age, treatment modality, and survival in patients with atypical meningioma. Adults with histologically confirmed intracranial atypical meningioma were identified from the 2000-2021 Surveillance, Epidemiology, and End Results database. Multivariable Cox regression assessed overall survival (OS) and cancer-specific survival (CSS), and logistic regression evaluated predictors of gross total resection (GTR) versus subtotal resection (STR). Among 3,882 patients, advanced age was associated with worse OS and CSS. Compared with patients aged <40 years, those aged ≥60 years had higher overall mortality (aHR 5.29, 95% CI 3.78-7.39) and cancer-specific mortality (aHR 3.15, 95% CI 1.99-4.99; both p < 0.001). Patients aged 40-59 years showed intermediate OS risk but no significant difference in CSS. Older patients received radiotherapy less often, whereas age was not an independent predictor of GTR. STR, male sex, unmarried status, tumor ≥5 cm, and Black race were associated with poorer survival. Advanced age independently predicted inferior OS and CSS but not a lower likelihood of GTR, supporting individualized, age-sensitive management.
Dizziness is a prevalent clinical complaint, and determining the underlying etiology can be challenging. Posterior fossa masses have been observed to cause vertigo, with presentations very similar to Meniere's disease. In this report, we describe a case of a patient who presented with recurrent episodes of Meniere's-like vertigo in the setting of a posterior fossa meningioma, who underwent surgical resection of the tumor with significant improvement postoperatively. We postulate that these symptoms were caused by secondary endolymphatic hydrops and were able to demonstrate improvement in high-frequency vestibulo-ocular reflex with pre- and postoperative video head impulse testing.
Although social media is widely used in plastic surgery, differences in content and posting patterns across practice settings are poorly understood. This study characterized Ontario plastic surgeons Instagram posting patterns and audience engagement by practice setting. This observational cross-sectional study analysed publicly accessible professional Instagram profiles of registered academic, community, or mixed practice plastic surgeons in Ontario. Up to 30 posts (posted on or after January 1, 2020) per account were coded by content type and clinical domain. Chi-square, Kruskal-Wallis, and analysis of variance tests were used to evaluate the association between surgeon characteristics, posting patterns, and engagement rates. Eighty-six of 261 (33%) plastic surgeons had professional Instagram profiles, yielding 2032 posts. Pre-/post-procedure results (32%) and facial aesthetics (20%) were the most represented content type and domain, respectively. Academic surgeons posted significantly more announcements, research, and reconstructive content (P < .001), while community surgeons posted significantly more advertising/promotional (P = .02) and facial aesthetics (P < .001) content. Engagement rates were highest for academic surgeons, personal posts, and craniofacial content, with significant differences among practice types, content categories, and domains (P < .001). Instagram use among plastic surgeons varies substantially by practice setting. Cosmetic content dominates posting volume, whereas reconstructive and academic content, despite higher observed engagement, remains under-represented. These findings identify content-practice mismatches that warrant further qualitative, longitudinal, and interventional study before practice recommendations can be made. Même si les médias sociaux sont largement utilisés en chirurgie plastique, les différences de contenu et de modèles d’affichage dans les divers milieux de pratique sont mal comprises. Cette étude caractérise les modèles d’affichage sur Instagram des chirurgiens plasticiens ontariens et l’engagement de l’auditoire par milieu de pratique. Dans la présente analyse transversale observationnelle, les chercheurs ont analysé les profils Instagram professionnels accessibles au public de chirurgiens universitaires, communautaires ou en pratique mixte agréés de l’Ontario. Les chercheurs ont codé jusqu’à 30 publications (affichées à compter du 1er janvier 2020) par compte, en fonction du type de contenu et du domaine clinique. Ils ont utilisé le test du chi carré, le test de Kruskal-Wallis et l’analyse de variance pour évaluer les associations entre les caractéristiques des chirurgiens, les modèles d’affichage et les taux d’engagement. Au total, 86 des 261 chirurgiens plasticiens (33%) détenaient un profil Instagram professionnel et avaient produit 2 032 publications. Les résultats avant et après les interventions (32%) et l’esthétique faciale (20%) constituaient les types de contenu et les domaines les plus représentés, respectivement. Les chirurgiens universitaires affichaient beaucoup plus d’annonces, de résultats de recherche et de contenu de reconstruction (p < 0.001), tandis que les chirurgiens communautaires affichaient beaucoup plus de contenu publicitaire et promotionnel (p = 0.02) et sur l’esthétique faciale (p < 0.001). Les taux d’engagement étaient plus élevés chez les chirurgiens universitaires sur le plan des affichages personnels et du contenu craniofacial, et les différences étaient importantes selon les types de pratique, les catégories de contenu et les domaines (p < 0.001). Chez les chirurgiens plasticiens, l’utilisation d’Instagram varie considérablement en fonction du milieu de pratique. Le contenu esthétique dominait le volume d’affichages, tandis que le contenu de reconstruction et le contenu universitaire, malgré un engagement observé plus élevé, demeurait sous-représenté. Ces observations font ressortir un décalage entre le contenu et la pratique qui devra faire l’objet d’une étude qualitative, longitudinale et interventionnelle plus approfondie avant qu’il soit possible de formuler des recommandations pour la pratique.
Morbid obesity is a major medical, social, and economic challenge worldwide and in Israel. Approximately 49% of Israeli adults aged 20 years and above are overweight or obese, and about a quarter of a million meet criteria for morbid obesity. This condition significantly increases the risk of type 2 diabetes, cardiovascular disease, cancer, and premature mortality, while imposing a substantial financial burden on the healthcare system and the national economy. Current treatment options for morbid obesity include lifestyle modification, pharmacotherapy, and metabolic surgery. Lifestyle intervention is considered first-line therapy, yet its effectiveness is often limited, particularly in cases of morbid obesity. Over the past decade, the use of glucagon-like peptide-1 receptor agonists (GLP1RA) has increased considerably, yielding an average of 10% weight loss and meaningful improvements in obesity-related comorbidities. However, these medications are associated with side effects, relatively high discontinuation rates, limited accessibility, and high long-term costs. Metabolic surgery typically results in more than 25% weight loss, substantial improvements in obesity-related diseases, and reduced mortality. Although surgery involves higher upfront costs and the potential for complications, recent studies show that it becomes more cost-effective than continuous pharmacotherapy within months to a few years.
Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related mortality worldwide, with over 1.9 million new cases and 0.9 million deaths reported in 2020. The role of Helicobacter pylori infection in CRC pathogenesis remains a significant area of research. This study aimed to investigate the association between H. pylori infection, and genetic alterations in CRC patients. A total of 110 blood and tissue biopsy samples were collected from CRC patients at Ghazi AL-Hariri Specialized Surgery Hospital in Baghdad, Iraq, between November 2023 and August 2024. An additional 36 samples from non-cancer patients were used as controls. Enzyme-linked immunosorbent assay (ELISA) was employed to detect H. pylori-specific immunoglobulins (IgG). Gene expression analysis of ELASTIN, TIMP3, K-RAS, and BRAF was performed using RT-qPCR. The study found that H. pylori infection was present in 79.5% of CRC patients, with significant IgG seropositivity (p < 0.05). Gene expression analysis revealed a significant downregulation of TIMP3 and alterations in ELASTIN, K-RAS, and BRAF (p < 0.01). In conclusion, chronic H. pylori infection may contribute to CRC pathogenesis through sustained inflammation and genetic dysregulation. The study highlights TIMP3 suppression as a potential factor in CRC progression, warranting further investigation into its clinical implications.
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While young breast cancer patients exhibit lower overall survival (OS) than older groups, it remains unclear whether OS differs between breast-conserving therapy (BCT) and mastectomy specifically in this younger population. Although BCT carries a higher recurrence risk than mastectomy in young patients, OS appears similar across all ages. This meta-analysis therefore directly compares OS and breast cancer specific survival (BCSS) in young patients treated with BCT versus mastectomy. Our review included 6 studies that compared OS between BCT and mastectomy in patients aged 40 years or younger diagnosed with stage I-III breast cancer. The endpoint was OS/BCSS, and only studies presenting hazard ratios (HRs) were included in the analysis. Meta-analyses used inverse-variance random effects (REML with Hartung-Knapp confidence intervals [CIs]); heterogeneity was assessed with Q and I 2. Leave-one-out, fixed-effect, and DerSimonian-Laird models tested robustness; Egger's test explored small-study effects. Analyses were performed in RevMan 5.3 and Stata 17, with p < 0.05 or 95% CIs excluding 1.00 considered significant. OS showed no difference between BCT and mastectomy (pooled HR = 0.99, 95% CI: 0.88-1.10, I 2 = 54%). BCSS favored BCT with a small but significant reduction in mortality (HR 0.92, 95% CI: 0.86-0.98, I 2 = 0%). Subgroup analyses of OS suggested stage dependence: benefit with T1-2 (HR 0.93, 0.87-0.99) and N0-1 (HR 0.93, 0.87-0.99), but no advantage in T1-3 or N2-3 disease (both HR 1.19, 0.99-1.44). Leave-one-out and model checks did not change inference; unadjusted estimates suggested benefit but this attenuated after adjustment. In women ≤40 years with stage I-III breast cancer, BCT with radiotherapy achieves OS comparable to mastectomy and may yield a modest BCSS benefit, particularly in lower-burden disease (T1-2 or N0-1). Given the observational nature of the evidence and residual heterogeneity, results should be interpreted cautiously and individualized clinical decision-making is recommended; randomized or prospectively adjusted data are still needed.
Asthma poses unique challenges in aviation medicine. While strict criteria typically dictate waiver approvals in military aviators with asthma, the Israeli Air Force (IAF) applies a more individualized approach. Still, evidence to guide correct management is scarce. To assess the characteristics and long-term outcomes of military aircrew diagnosed with asthma. This retrospective study included active and reserve aircrew who were diagnosed with asthma during annual assessments at the Israeli Aeromedical Unit between 1998 and 2024. Baseline characteristics, treatment regimes, pulmonary function tests (PFTs), and asthma exacerbations were analyzed. Thirty-two aircrew personnel (median age 30 years at diagnosis) were included in the study, with 44% serving at high-performance platforms. Six participants (19%) were classified as Global Initiative for Asthma step 4 or 5. Over an average follow-up period of 18.5 years, seven exacerbations were documented (4.0 per 100 patient-years), with no safety incidents reported. Participants' pulmonary function remained stable. Forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) declined around asthma diagnosis (median of 82% predicted and 0.73, respectively) but recovered remarkably while on treatment (median 91% predicted and 0.78, respectively). Aircrew who experienced exacerbations had no statistically significant differences in demographics, disease severity or baseline PFTs. With individualized management and regular monitoring, a new diagnosis of asthma in military aircrew was not associated with a significant impact on service. Our study supports a flexible, individualized approach to aeromedical management of aircrew with asthma.
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Combat-related penetrating neck injuries (PNI) present distinct challenges in surgical settings. Accurate identification and removal of metallic fragments are crucial for minimizing complications. Although computed tomography (CT) remains the gold standard for preoperative assessment, use of intraoperative metal detectors may offer supplementary advantages by enhancing surgical accuracy and efficiency. To assess the technical feasibility of intraoperative metal detector assistance vs. a CT-guided primary approach. Cadaver heads were implanted with metallic fragments from verified military-grade ordnance and subsequently underwent a CT scan. Two extraction approaches were evaluated: intraoperative metal detector assistance vs. CT-guided primary approach. Key metrics included incision length, dissection time, incision extension, and surgeon workload as assessed by the Surgery Task Load Index questionnaire. Metal detector-assisted extraction resulted in reduced initial incision lengths (3.50 cm vs. 4.87 cm) and smaller incision extensions (0.33 cm vs. 0.67 cm), indicating improved precision. However, the average dissection time was longer in the metal detector group (15:00 vs. 12:20 minutes), likely due to learning curves and additional scanning requirements. Surgeons reported lower situational stress (2.25 vs. 4.5) and reduced task complexity (4.0 vs. 4.5) when using a metal detector, despite noting increased mental demand associated with interpreting device signals during surgery. Intraoperative metal detection technology shows significant potential as an adjunctive modality for shrapnel localization in combat-associated PNIs. It facilitates minimized incisions and improved surgical precision. While further optimization and clinical adaptation are necessary, this method holds promise for improving outcomes in both military and civilian trauma scenarios.
Noise-induced hearing loss (NIHL) is a prevalent hearing impairment, second only to age-related hearing loss. A change in the listening habits of adolescents may have contributed to the documented increase of hearing impairments in that age group. To examine the prevalence of NIHL among healthy young adults. We conducted a retrospective study to examine audiograms of healthy candidates for the Israeli Air Force flight academy between 2018 and 2023. Hearing tests were performed by an expert audiologist using an audiometer. A total of 1940 audiograms were analyzed. The age range of the patients was 17-19 years. Using the British Society of Audiology classification, 174 (8.97%) audiograms and 313 frequencies were classified as impaired. The 8 kHz was the most affected frequency, accounting for 116 cases (37%). Hearing impairment prevalence increased from 1% at entry into the education system to 8.45% at the end, respectively. Detecting hearing impairments early may minimize future disability and may reduce future disability and rehabilitation costs. Hearing screens for young adults due to the change in listening habits of adolescents may prove useful.
Superior orbital fissure syndrome (SOFS) is a rare, vision-threatening condition caused by injury or compression of cranial nerves III, IV, and VI. We report a 16-year-old male who sustained extensive craniofacial trauma, including a displaced left sphenoid wing fracture, after a motorized scooter accident. Initially, he had limited extraocular motility, but by hospital day 5, he developed complete ophthalmoplegia due to progressive nerve compression. Urgent surgical decompression of the superior orbital fissure and reduction of the fracture were performed via a pterional craniotomy on day 7. Postoperatively, the patient experienced full restoration of ocular motility and pupillary function, with no complications. This case highlights the potential for delayed neurological deterioration in sphenoid wing fractures and emphasizes the importance of close serial examination and timely operative intervention once SOFS develops, demonstrating that even delayed intervention can result in complete neurological recovery.
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.
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Healthcare systems are considered critical infrastructure and are therefore required to maintain continuous operation during wartime and large-scale emergencies. This reality places healthcare professionals in a complex position, as they are expected to sustain professional performance while facing personal safety threats, increased workload, and concerns for their families. This paper examines the key patterns characterizing the behavior of healthcare teams during wartime, integrating current research literature with organizational experience from the Israeli healthcare system. The literature highlights several recurring features, including a heightened sense of professional mission, increased team cohesion, and organizational adaptability. At the same time, significant emotional burdens are documented, which may lead to burnout and compassion fatigue. The article also presents an organizational case study from Assuta Medical Centers, describing measures implemented to maintain operational continuity while supporting staff during a period of armed conflict. These measures included adjustments in clinical activity, establishment of protected care environments, continuous managerial communication, and the provision of support mechanisms for employees and their families. The findings underscore the central role of organizational factors, particularly leadership, communication, and perceived organizational support, in shaping staff resilience and commitment during crisis situations. The authors conclude by proposing directions for future empirical research to systematically examine the relationship between organizational practices and healthcare workers' resilience and engagement in wartime.
Variations in the communication between the musculocutaneous nerve (MCN) and the median nerve (MN) have been described in several classification systems. However, rare and complex variants that do not fit neatly into existing schemes continue to be reported. This case report describes a morphologically complex anatomical configuration characterized by early bifurcation of the MCN and transient fusion with the MN. The MCN divided into medial and lateral branches; the medial branch merged with the MN to form a temporary common trunk, which subsequently gave rise to a communicating branch that rejoined the lateral branch. This "fusion-separation" pattern is consistent with the concept of a continuous anatomical spectrum rather than discrete variant types. Clinically, the presence of a transient common trunk may pose potential risks during axillary surgery and nerve blocks, suggesting that careful ultrasound identification of nerve boundaries should be considered.
Optimization of the mixture composition for mixed solvent-based battery electrolyte systems and determination of the underlying governing factors are critical for the advancement of high-performance lithium-ion batteries (LIBs). In this study, we have made an attempt to identify the factors that dictate the optimal composition of a representative binary solvent mixture and electrolyte system containing 1 M LiTFSI in a mixture of ethylene carbonate (EC) and adiponitrile (ADN). For this, we have performed differential scanning calorimetry (DSC) and dielectric relaxation spectroscopy (DRS) measurements at different EC mole fractions (XEC). Subsequently, the molecular-level aspects related to composition optimization have been explored by examining the solvation structure, ion transport, and ion-ion dynamical correlations via molecular dynamics (MD) simulations. DSC measurements reveal a nonmonotonic dependence of the melting temperature (Tm) on solvent composition, with a minimum value of 250 K at XEC = 0.6. Furthermore, both the ionic conductivity (σ) and average DR time (τDR) exhibit composition-dependent inflection points between XEC = 0.4 and 0.6 in the temperature range of 298 K-323 K. MD simulations have revealed identical self-diffusivities of cations and anions at XEC = 0.6, while both EC and ADN maintain a balanced presence inside the Li+ solvation shell. Moreover, the composition dependence of the solvent coordination number inside the Li+ solvation shell correlates with the experimentally observed crossovers in σ and τDR. Notably, an optimized presence of both EC and ADN molecules inside Li+ solvation shell facilitates balanced ion transport with Li+ transference number t+ ≈ 0.5 at XEC = 0.6, suitable for battery operation, while simultaneously suppressing the anion-anion dynamical anticorrelation.
Right ventricular-pulmonary arterial coupling is a known prognostic marker in patients with tricuspid regurgitation (TR). However, its assessment by cardiac magnetic resonance and its clinical implications have not been evaluated. We aimed to assess the prognostic role of a cardiac magnetic resonance surrogate of right ventricular-pulmonary arterial coupling in a large cohort of patients with a spectrum of TR severity. Comprehensive data were collected from patients referred for cardiac magnetic resonance from 2019 to 2024 who had TR quantification. Right ventricular-pulmonary arterial coupling was calculated by dividing the forward right ventricular stroke volume (f-RVSV) by the right ventricular end-systolic volume (ESV). The outcome of interest was the composite of all-cause death and heart failure hospitalization, under medical management. In the 631 patients included, median age was 66 (interquartile range [IQR], 54-75) years, median tricuspid regurgitant volume was 18 (IQR, 12-30 mL), median left ventricular ejection fraction was 53 (IQR, 41-61)%, median RV ejection fraction was 53 (IQR, 45-58)%, and median f-RVSV/ESV ratio was 0.82 (IQR, 0.58-1.11). In restricted spline curve analysis, the f-RVSV/ESV ratio cutoff associated with a hazard >1 for the composite outcome was ≤0.57. At baseline, a low f-RVSV/ESV ratio was strongly associated with subjective and objective signs of right heart failure, higher TRI-SCORE, and worse right-sided chamber remodeling (all P<0.001). After a median follow-up of 1.8 years (IQR, 1.5-2.0), patients with a low f-RVSV/ESV ratio showed worse survival (P<0.001). After comprehensive adjustment for clinical and imaging confounders, f-RVSV/ESV ≤0.57 remained a powerful predictor of outcome (adjusted hazard ratio, 2.36 [95% CI, 1.27-4.37]; P=0.004). Finally, patients with low f-RVSV/ESV displayed a worse long-term prognosis across mild, moderate, and severe TR groups (P<0.001, P<0.001, and P=0.018, respectively). In this large cohort of patients with a wide spectrum of TR severity, right ventricular-pulmonary arterial coupling assessed by cardiac magnetic resonance was strongly associated with right-sided heart failure and worse long-term prognosis, even after comprehensive adjustment.
High-speed continuous fluids transport within enclosed pipelines is a core driving technology in biomedicine, chemical analysis, and soft robotics. However, conventional pumping technologies rely on bulky compressors that suffer from excessive power consumption (>3 × 107 W), high noise (>60 dB), and considerable weight (>2 kg). Although emerging liquid metal (LM)-based micropumps offer silent and portable alternatives, the inherent clogging of chambers by deformed LM restricts operation to the high frequency (>100 Hz) and low duty cycle (<50%) of the electrical signal, inevitably leading to flow rate decay (<5000 μL min-1). Herein, we introduce a magnetic LM-based electro-magnetic fluid pump (mEMFP) that synergizes electric and magnetic fields for efficient liquid transport. By integrating core-shell Fe@PDA@Ag magnetic particles into LM, we generate magnetically responsive LM droplets (MLM) that can be precisely anchored within the pump chamber, thereby eliminating clogging. This design enables the operating frequency to be reduced to 10 Hz and the duty cycle to be increased to 80%, extending the effective actuation duration. Under 12 V square wave signal (12 Vp-p, 6 V DC offset), mEMFP equipped with a single MLM droplet achieves a flow rate of 1.59 × 104 μL min-1, while four serially integrated MLMs deliver 2.20 × 104 μL min-1 with power consumption below 20 mW. What's more, the mEMFP is successfully demonstrated in versatile applications including multifunctional liquid transport, phase-change valving, and personalized thermal management, offering a feasible pathway toward high-performance microfluidic systems.
The Transoral endoscopic thyroidectomy vestibular approach (TOETVA) reportedly has a high safety profile in adults, but data on its application in children are limited. To review a case series of pediatric patients who underwent total thyroidectomy by a scar-free TOETVA. The authors conducted a retrospective review of pediatric patients who underwent total thyroidectomy by TOETVA during 2022 at the Tel-Aviv Sourasky Medical Center. Data on clinical, pathological, and intraoperative parameters, postoperative sequelae, and complications were retrieved. Four patients were included in the study, all females, with a median age 14 years. The median duration of the surgery was 239.5 minutes. There were no recorded surgery related complications. Two patients experienced transient hypocalcemia, while no patient sustained recurrent laryngeal nerve injury. The median hospitalization duration was 2.5 days. The results highlight a high safety profile of TOETVA, and support its applicability for thyroidectomy in children, while bearing significant social and psychological advantages that are especially relevant to young patients.