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Global and community-driven initiatives have recently achieved considerable success in overcoming key challenges that hinder the widespread adoption of advanced microscopy and bioimage analysis tools in under-resourced settings. To build upon this progress, we held a workshop in May 2025 at the University of York, UK to address the needs and barriers associated with implementing time-lapse imaging and machine learning-based phenotyping in low-resource research environments. We focussed on identifying the specific challenges faced by the existing networks represented at the meeting, emphasising how integrating combined imaging hardware and machine learning-based approaches can solve these problems. This article summarises the key observations and actionable strategies made at the workshop. These proposed steps aim to significantly increase the dissemination and uptake of these powerful technologies to advance biological research in low-resource settings globally.
Pathological risk stratification of prostate cancer (PCa) guides treatment decisions. Preoperative noninvasive assessment of PCa risk stratification holds promise for reducing unnecessary invasive biopsies. Elevated levels of iron and fat, along with metabolic disorders in PCa significantly correlate with tumor proliferation and aggressiveness, yet its predictive value in risk stratification remains unclear. We aimed to noninvasively measure fat content as well as iron deposition of PCa lesions by multiparametric magnetic resonance imaging (mpMRI) and investigate their effectiveness in predicting PCa risk. We prospectively collected patients suspected of PCa with preoperative MRI from 2019 to 2022, and ultimately included 109 pathologically confirmed PCa patients. The Gleason score (GS) and International Society of Urological Pathology grade group (ISUP GG) were determined by two uropathologists who evaluated independently and reached a consensus. Patients were stratified based on the ISUP GG, with 42 in the pathological low-risk (PL) group (ISUP GG ≤2; 69.9±6.08 years), 67 in the pathological high-risk (PH) group (ISUP GG ≥3; 71.82±5.86 years). We also collected clinical, pathologic, and imaging data from the patients. Based on the variables screened by Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, an improved fusion (IF) model was established and visualized with a nomogram plot. The conventional fusion (CF) model was constructed by removing the non-conventional image variables in the IF model. Model performance was evaluated using 10-fold cross-validation, receiver operating characteristic (ROC) analysis, DeLong test, and decision curve analysis (DCA). P<0.05 was considered statistically significant. Significant differences were observed in the prostate-specific antigen (PSA), prostate volume (PV), Prostate Imaging Reporting and Data System (PI-RADS) scores, fat fraction (FF), T2*, and average apparent diffusion coefficient (ADC) values of the lesions between the two groups. These variables were selected to construct the IF model. The CF model was developed by removing FF and T2* values. The IF model demonstrated higher accuracy than the CF model [IF model: sensitivity =0.952, specificity =0.761, area under the curve (AUC) =0.920; CF model: sensitivity =0.762, specificity =0.761, AUC =0.819; DeLong test: P=0.002, <0.05]. mpMRI‑derived FF and T2* values were significantly associated with ISUP GG in PCa. Intergrating FF and T2* values with ADC, PI-RADS, PSA and PV may predict pathological risk classification more effectively.
A 66-year-old man with acute coronary syndrome underwent emergency percutaneous coronary intervention (PCI) using Impella CP (Abiomed, Danvers, MA, USA) via the left common femoral artery (CFA). After PCI, he experienced shock and severe anemia. A computed tomography scan revealed a large retroperitoneal hematoma caused by femoral puncture-site bleeding. He was in hemorrhage and cardiogenic shock, so we needed to achieve hemostasis without removing Impella CP. We performed endovascular therapy (EVT) through the radial artery system. Angiography showed ongoing bleeding in the left CFA. Initially, we attempted balloon tamponade with an 8-mm semi-compliant balloon, but this was unsuccessful. We then performed percutaneous thrombin injections combined with balloon tamponade. Ultimately, we achieved hemostasis at the puncture site. Our case suggests that trans-radial EVT combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding. Trans-radial endovascular therapy combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding, even in patients requiring mechanical circulatory support.
Respiratory failure is a serious condition caused by impaired gas exchange, leading to hypoxemia or hypercapnia. Nasal high-flow therapy (NHFT) has emerged as an alternative to standard oxygen therapy (SOT). This meta-analysis evaluates the efficacy and safety of NHFT versus SOT by incorporating newly published trials to guide current clinical practice. This systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) comparing NHFT with SOT in acute respiratory failure were included. Primary outcomes were mortality and hospital stay. Data were pooled using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using GRADE. Sixteen RCTs (n = 5805) were included. NHFT showed no significant difference in 28-day mortality [risk ratio (RR) = 1.00; 95% confidence interval (CI): 0.85-1.17] or 90-day mortality (RR = 0.87; 95% CI: 0.58-1.29), length of hospital stay, length of ICU stay, or need for intubation. Oxygen saturation improved with NHFT after sensitivity analysis. Certainty of evidence ranged from moderate to very low using GRADE assessment, with heterogeneity addressed by removing outlier studies. NHFT shows comparable safety and efficacy to SOT in acute hypoxemic respiratory failure, with no significant differences in mortality, length of hospital stay, or intubation rates. Oxygen saturation improved with NHFT, reflecting its physiological advantages. Variability in study design limits generalizability. These findings support the individualized use of NHFT. Future research should explore patient-specific benefits, standardize protocols, and assess long-term outcomes.
A data-driven and expert/patient consensus-based project to develop a revised Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) is under way supported by SLICC, ACR, and the Lupus Foundation of America. Our objective is to report the item generation and reduction phase results for a revised SDI. Item generation included a literature review by literature review groups and a Delphi exercise of international systemic lupus erythematosus experts and patients. Item reduction involved Delphi rounds in which items with a median appropriateness score of ≤4 of 9 were excluded. A 14-member item reduction committee assessed remaining items and removed those that did not reflect the damage construct, were rare, or were not feasible to assess. The clinical domain groups then refined the remaining items and their definitions. The Delphi panel included 146 individuals from 35 countries. The Delphi exercise nominated 2,256 items, and the literature review identified 117 items. After removing redundancies, 226 candidate items remained. Subsequent Delphi rounds, followed by review by the item reduction committee and clinical domain groups, resulted in 39 items across 13 domains. Eleven items from the original SDI, including proteinuria and cranial neuropathy, were removed and several new items were proposed, including growth failure/reduced final height and adrenal insufficiency. Severity-based subitems are proposed for 17 items (43.6%). This data-driven and expert/patient consensus-based process has proposed 39 candidate items, some with subitems, and definitions for a revised SDI. Weighting of items and subitems is underway to develop a clinical scoring system.
Large language models (LLMs) are increasingly deployed in decision-support systems for high-stakes domains such as hiring and university admissions, where choices often involve selecting among competing alternatives. While prior work has noted position biases in LLM-driven comparisons, these biases have not been systematically analyzed or linked to underlying preference structures. We present the first comprehensive study of position biases across multiple LLMs and two distinct domains: resume comparisons, representing a realistic high-stakes context, and color selection, which isolates position effects by removing confounding factors. We find strong and consistent order effects, including a quality-dependent shift: when all options are high quality, models favor the first option, but when quality is lower, they favor later options. We also identify a previously undocumented bias: a name bias, where certain names are favored despite controlling for demographic signals. To separate superficial tie-breaking from genuine distortions of judgment, we extend the rational choice framework to classify pairwise preferences as robust, fragile, or indifferent. Using this framework, we show that order effects can lead models to select strictly inferior options. These results indicate that LLMs exhibit distinct failure modes not documented in human decision-making. We also propose targeted mitigation strategies, including a novel use of the temperature parameter, to recover underlying preferences when order effects distort model behavior.
The placenta serves as a vital channel for maternal-fetal substance exchange and is a crucial organ for maintaining pregnancy. Placental diseases can severely affect maternal health and fetal growth. Given the limitations of single-dimension segmentation models and traditional fusion strategies in meeting the demands of automatic placental magnetic resonance imaging (MRI) segmentation, this study developed an automatic placental MRI segmentation method based on a multi-dimensional interaction fusion network (MDIFN). This study included 267 placental MRI cases that met the inclusion criteria. After preprocessing steps, such as bias field correction, resampling, intensity normalization, and dimension matching, a dual-branch foundational architecture combining two-dimensional UNet (2D-UNet) and three-dimensional UNet (3D-UNet) was constructed. An interaction fusion bidirectional gated cross-dimension module was designed to achieve layer-wise synergistic fusion of two-dimensional (2D) detail features and three-dimensional (3D) contextual features. A global context recalibration module and a residual refinement module were introduced to optimize feature quality. A homoscedastic uncertainty-based multi-task weighted loss function was employed to balance the training process. Model performance was compared against six mainstream models using 10-fold cross-validation, and ablation studies were conducted to validate the contribution of core modules. The model achieved a Dice coefficient of 0.8749±0.0132 (P<0.05) on the test set, representing an improvement of 16.2% compared to pure 2D-UNet and 8.4% compared to pure 3D-UNet. The sensitivity was 0.8999±0.0172 (P<0.05), and the F1 score was 0.8749±0.0132, which were the optimal values among all models. The relative volume difference was 0.0301±0.0173, and the 95% Hausdorff distance was 7.67±1.04. Ablation experiments showed that removing the gating mechanism, global context module, or bidirectional interaction reduced the Dice coefficient to 0.8554, 0.8551, and 0.8566, respectively, confirming that each component contributes to performance improvement. This study addresses the limitations of single-dimension segmentation and traditional fusion models, providing an efficient and objective technical approach for automatic placental segmentation.
The adaptive immune system monitors cellular integrity by recognizing short peptides from intracellular proteins presented on major histocompatibility complex class I (MHC-I) molecules, collectively termed peptide-MHC complexes (pMHC), enabling detection of foreign or mutated proteins. With the rising importance of immunotherapies targeting cancer neoantigens, accurately predicting which peptides bind to MHC alleles is critical. Current computational methods for pMHC-I binding prediction fall into sequence-based methods, which rely heavily on large training datasets, and structure-based methods that leverage structural modeling and pMHC binding energetics. Although sequence-based methods are widely used, their performance depends on the size and quality of the training data. Structure-based approaches, by contrast, can generalize better across diverse MHC alleles, but they traditionally depend on identifying a single global minimum-energy conformation, an assumption that may be inadequate for the promiscuous binding of MHC-I molecules. To address these limitations, we developed STRUMP-I (STRUcture-based pMHC Prediction for class I), a novel pMHC-I binding prediction tool that directly leverages a broad set of force-field-derived energy terms as machine learning features. In the standard benchmark set, STRUMP-I achieved performance comparable to state-of-the-art sequence-based models overall and showed a clear advantage for alleles with limited or imbalanced representation. Furthermore, STRUMP-I complemented sequence-based methods by removing method-specific false positives and improving precision, with a more favorable precision-recall tradeoff than AF-FT. These evaluations reinforced the value of STRUMP-I as a structure-informed prioritization method, particularly for underrepresented alleles and as a high-precision post-prediction filter.
Stroboscopic visual training (SVT) is a perceptual-cognitive training paradigm that uses liquid-crystal eyewear to alternate between transparent and opaque states during sport-specific motor tasks, creating repeated cycles of vision and occlusion. By intermittently removing visual feedback, SVT compels the central nervous system to sustain internal predictions of moving targets rather than passively receiving real-time sensory input, placing concentrated and repeated demands on the predictive processing circuits that underpin performance in interceptive sports such as handball, volleyball, and soccer. Despite consistent behavioral evidence that SVT improves reaction speed, anticipatory skill, visuomotor performance, and sensorimotor balance control, the neural mechanisms driving these adaptations remain poorly characterized. This narrative review synthesizes evidence from SVT intervention studies, perceptual learning neuroscience, and sport neuroscience to propose a mechanistic account of how SVT may influence brain function. The review proposes that four neural systems may be engaged by SVT: the dorsal visual stream and MT/V5, which are repeatedly stressed by motion extrapolation demands during occlusion; the fronto-parietal attention network, which sustains predictive target representations across each occlusion cycle; the primary visual pathway, for which the only published SVT electrophysiology study demonstrated significantly reduced P100 latency following 6 weeks of stroboscopic training; and sensorimotor integration circuits, evidenced by SVT-induced changes in postural control and landing biomechanics. These findings are consistent with a proposed multi-level neuroplasticity model for SVT, though direct confirmation through concurrent EEG and fMRI designs remains an essential priority for future research.
Chronic obstructive pulmonary disease (COPD) poses a significant public health burden, particularly in China. This study mainly assessed the quality of clinical information and prevalent misinformation related to COPD-related short videos on TikTok, RedNote, and Bilibili. A cross-sectional observational study was conducted using videos collected on November 15, 2025. "Chronic obstructive pulmonary disease" was used as the search keyword on TikTok, RedNote, and Bilibili. After removing duplicate and irrelevant videos, 510 videos (167 from TikTok, 167 from RedNote, and 176 from Bilibili) were included in the analysis. Video characteristics, uploader types, and content categories were documented. The quality of information was assessed using the Global Quality Scale (GQS) and the modified Decision-Making Information Support Criteria for Evaluating the Reliability of Non-randomized Studies (mDISCERN) instrument. TikTok videos exhibited significantly higher user engagement (likes, comments, shares, and saves) than RedNote and Bilibili videos (P<0.001). However, regarding information quality, Bilibili videos achieved significantly higher GQS and mDISCERN scores than TikTok and RedNote videos (P<0.001). Content produced by professional institutions and individuals received significantly higher scores than that produced by nonprofessional institutions. A strong positive correlation was found among the popularity metrics, but no significant correlation was found between popularity indicators and quality scores. COPD-related short videos displayed uneven clinical information quality despite broad public exposure. Viral popular content cannot guarantee medical authenticity, and widespread misinformation may interfere with regular patient care. Sufficient professional participation and strict platform content supervision are therefore required to standardize online COPD health education and reduce clinical risks.
School refusal behavior (SRB) is a prevalent and functionally heterogeneous problem among children and adolescents that can lead to serious academic, social, and psychological consequences. The School Refusal Assessment Scale-Revised (SRAS-R) is the most widely used instrument for identifying the functional motivations underlying school refusal, yet its psychometric properties have not been examined in Chinese clinical populations. The present study aimed to translate and culturally adapt the SRAS-R into Chinese and to evaluate its psychometric properties in a clinical sample of adolescents with depressive disorders. A total of 171 adolescent outpatients (age range 12-19 years; M = 15.5, SD = 1.90; 67.3% female) diagnosed with DSM-5 depressive disorders and meeting criteria for school refusal behavior completed both child and parent versions of the Chinese SRAS-R. Confirmatory factor analysis (CFA) using diagonally weighted least squares estimation was conducted. After removing Items 20 and 24, the four-factor model yielded strong CFI and RMSEA values for both parent (CFI = 0.99, RMSEA = 0.021, SRMR = 0.094) and child reports (CFI = 0.98, RMSEA = 0.028, SRMR = 0.097), although SRMR values were marginally above the prespecified threshold. Internal consistency reliability ranged from marginal to good across subscales (Cronbach's α: parent = 0.664-0.815; child = 0.700-0.864), with parent-reported Factor 4 showing the weakest reliability. Factor 1 (avoidance of aversive school situations) obtained the highest mean scores for both informants, consistent with the depression-related negative affectivity characteristic of this clinical sample. Cross-informant discrepancy analyses revealed that children reported significantly higher scores than parents on Factor 2 (escape from social/evaluative situations; p = .017, d = 0.18) and Factor 4 (pursuit of tangible reinforcement; p <.001, d = 0.27), suggesting that parents may underestimate internally driven motivations. Intraclass correlation coefficients indicated fair to good parent-child agreement (ICC = 0.45-0.62), with the highest agreement for Factor 1 and the lowest for Factor 4. The findings provide initial internal-structure and reliability evidence for the Chinese SRAS-R in this single-site clinical sample and underscore the need for multi-informant assessment, while future studies should examine convergent, discriminant, criterion-related, and predictive validity in more diverse samples.
Distributed arrays of wireless neural interfacing chips with 1-2 channels each, known as "neural dust," could enhance brain machine interfaces (BMIs) by removing wired connections through the scalp and increasing biocompatibility with their submillimeter size. Although several neural dust designs have emerged, currently reported procedures for implanting them in batches place the chips directly inside the brain, which can damage or displace large numbers of neurons. Therefore, a procedure for safely implanting neural dust in batches such that only ultrasmall microwire elements enter the brain is needed. Here, we demonstrate the feasibility of implanting batches of wireless motes that rest on the cortical surface and reach 1 mm brain depths via penetrating carbon fiber electrodes (6.8-8.4 μm diameter) without employing disruptive insertion shuttles. To simulate their implantation, we assembled over 230 mechanically-equivalent carbon fiber motes and affixed them to insertion tools with polyethylene glycol (PEG), a quickly dissolvable and biocompatible material. Then, we implanted batches into rat cortex in vivo and evaluated insertion success and their arrangement on the brain surface. When positioning motes for insertion, we discovered that they readily aggregated in molten PEG such that average array pitches were 5% longer than an individual mote's dimensions (240 × 240 μm). Overall, 187/214 (87%) motes tightly-packed in 4 × 4 (N = 4) and 5 × 5 (N = 6) square grid configurations successfully inserted into rat cortex. After implantation, measurements of how much motes tilted (22 ± 9°, X̄ ± S) and had been displaced from their original positions were smaller than those measured in the literature for devices implanted inside the brain. Collectively, these data establish the mechanical viability of assembling and safely implanting motes with ultrasmall electrodes and epicortically-situated chips, motivating the use of arrays with similar geometries in future BMIs.
Three-dimensional (3D) graphene foams are attractive as lightweight conductive scaffolds with large surface area and broadband light absorption but achieving reproducible porosity and preserving the architecture after metal-template removal remain challenging. Here we report a stepwise route to freestanding 3D multilayer graphene foams based on (i) hydrogen-bubble-assisted electrodeposition of porous Ni on Cu foils, (ii) time-controlled pre-annealing at 1000 °C to drive Cu diffusion and form porous Ni-Cu alloy templates, (iii) in situ graphene CVD at 1000 °C under fixed growth conditions, and (iv) wet etching to remove the metal scaffold without a polymer support. The influence of pre-annealing (0, 1, 3, and 7 h) on template evolution, graphene growth, and foam stability was systematically investigated via SEM, EDS, XRD and Raman studies. Before etching, Raman spectroscopy indicates low-defect graphenic coatings with locally heterogeneous few-layer-like to multilayer-like signatures. Only samples pre-annealed for at least 3 h preserved the porous 3D architecture after metal removal, indicating the formation of self-supporting graphenic networks with improved post-etch morphological stability. Raman and XRD analyses further revealed a progressive reduction in structural degradation, residual strain, and stacking disorder with increasing pre-annealing time. Among the investigated samples, the foams obtained after 3 and 7 h of template pre-annealing combined preserved 3D morphology with low sheet resistance (10-20 Ω/□), negligible optical transmittance (<5%), and strong broadband visible-light absorption (75-90%).
Medical air is essential for the safe delivery of anaesthesia, critical care and emergency care. We report a hospital-wide medical air contamination event caused by failure of ageing desiccant dryers. Water was detected in the intensive care unit medical air outlets, before moisture contamination was confirmed within the medical air pipeline system and operating theatre pendants. This resulted in shutdown of the central medical air plant, suspension of non-urgent surgery, surgical bypass and a 5-day disruption to normal hospital services. The principal clinical challenges were the loss of reliable medical air supplied via the pipeline system, potential moisture exposure of anaesthetic ventilators and other equipment, limited capacity to provide ventilatory support and initial inability to use available medical air cylinders with anaesthetic workstations because of pressure regulator incompatibility. Management required immediate cessation of use of the medical air pipeline system, use of alternative medical air supplies, liaison with the anaesthetic machine manufacturer, installation of a temporary dehydrator, moisture removal and compliance testing. This case highlights that visible water at a medical gas outlet is a serious infrastructure failure requiring urgent escalation and multidisciplinary management. The primary educational message is that medical air-drying systems require proactive maintenance, lifecycle replacement and continuous dew-point monitoring linked to hospital alarm systems. Secondary lessons include the importance of tested backup medical air plans, equipment-compatible regulators and staff education to recognise moisture ingress as a high-risk patient safety event.
Osteochondral allograft (OCA) transplantation has demonstrated reliable long-term outcomes in treating chondral and osteochondral lesions of the knee. Although several pre- and intraoperative factors associated with graft failure have been identified, the temporal distribution of graft failures after OCA transplantation has not been described. To evaluate the timing and rate of graft failure after knee OCA transplantation and to report conditional survivorship (CS) to inform postoperative patient counseling. Case series; Level of evidence, 4. We identified 288 knees (267 patients) that underwent OCA transplantation by a single surgeon between 1997 and 2015, with a minimum follow-up of 10 years. Graft failure was defined as any reoperation requiring removal of the allograft. Nonfailure reoperation was defined as any surgical procedure on the affected knee that did not involve graft removal. Rates of graft failure and nonfailure reoperation were estimated using piecewise linear regression applied to inverse Kaplan-Meier curves. Kaplan-Meier analysis estimated overall and 10-year CS. The median patient age was 33.1 years (range, 11-68 years), and 58% were male. Overall graft survivorship was 78% at 10 years. Graft failure occurred in 64 knees (22%) at a median of 2.7 years (range, 0.3-23.6) postoperatively. Annual failure rates were 4.9% in the first 3 years postoperatively and decreased to 1.5% from 3 to 10 years. Nonfailure reoperations occurred in 48 knees, with a median of 1.5 years postoperatively, and followed a similar temporal pattern, with most occurring in the early postoperative period. CS analysis demonstrated that grafts remaining in situ at 4 years postoperatively had a 90% probability of survival to 10 years. OCA transplantation of the knee demonstrated an overall 10-year graft survivorship of 78%. Graft failures were not uniformly distributed over time, with the highest failure rates occurring during the early postoperative period and substantially decreasing after 3 years postoperatively to a low steady-state of 1.5% annually. This temporal pattern was also noted with nonfailure reoperations, which occurred predominantly during the early postoperative period. CS analysis offers a patient-centered approach for interpreting these findings and may inform postoperative patient counseling.
The excessive use of glyphosate herbicide in agriculture adversely affects the environment and soil health. Bioremediation using microbial consortia offers an efficient approach for transforming pesticides into less harmful products. The study investigated glyphosate biodegradation by the RH1 consortium and identified suitable kinetic models to support bioremediation. Glyphosate biodegradation was investigated at concentrations of 1-200 mg/L using the RH1 microbial consortium comprising four Streptomyces strains (SPA2, IT, Herb, and SC). These strains had been previously isolated and validated for their individual glyphosate-degrading capacity. Consortium activity was assessed under optimized conditions (30 °C, pH 7.2, and 4% inoculum). Degradation kinetics were modeled using several established approaches, including Haldane-Andrews, Yano and Koga, Tseng and Wayman, and Webb. Comparative functional analysis was further performed at 50 mg/L using total organic carbon (TOC) quantification and ATR-FTIR spectroscopy to distinguish consortium performance relative to single-strain treatments. Following 15 days of incubation under optimized conditions, the RH1 consortium achieved high glyphosate removal efficiencies of 92.2%, 87.2%, 91.72%, 92.06%, 54.11%, and 37.085% at initial concentrations of 1, 10, 25, 50, 100, and 200 mg/L, respectively. Notably, at 50 mg/L the consortium demonstrated the highest degradation rate compared with pure-culture treatments. Kinetic evaluation indicated that the Haldane-Andrews model best described the degradation behavior (F = 65.49, P = 0.00074, R 2 = 0.976). At the same concentration (50 mg/L), total organic carbon (TOC) decreased by 91.03%, corroborating substantial mineralization or conversion of organic constituents. ATR-FTIR spectroscopy further confirmed glyphosate transformation by showing alterations in the pesticide's chemical bonding patterns after biodegradation, consistent with structural modification of the molecule. The RH1 actinobacterial consortium efficiently degraded glyphosate, fitting best to the Haldane-Andrews kinetic model. Significant TOC reduction and ATR-FTIR-confirmed structural changes indicate effective glyphosate transformation, highlighting RH1's potential for bioremediation of glyphosate-contaminated soils.
Impacted teeth of mandibular third molars have been associated with disruptions in full-mouth occlusal force distribution, potentially affecting mandibular movement, masticatory muscle activity, and temporomandibular joint function. The present investigation employed the TeeTester occlusal analyzer to obtain quantitative data on the occlusal characteristics associated with impacted mandibular third molars (IM3Ms), both prior to and following surgical extraction. This approach enabled a dynamic assessment of occlusal function and provided clinical insights regarding functional changes post-intervention. A total of 54 individuals presenting with unilateral IM3M were included and stratified into three groups based on impaction type: vertical, mesioangular, and horizontal, with 18 participants allocated to each category. Occlusal parameters were measured using the TeeTester device before extraction and one week post-extraction. Within the mesioangular impaction group, the mean occlusal contact time significantly decreased from 0.45 seconds pre-extraction to 0.27 seconds post-extraction (P<0.05). No statistically significant changes were detected in occlusal characteristics in either the vertical or horizontal impaction groups when comparing pre- and post-extraction measurements. According to the findings of this study, surgical removal of a unilaterally mesioangular IM3M resulted in a statistically significant reduction in occlusal contact time between the maxillary and mandibular dental arches on the affected side. This reduction may contribute to improved occlusal stability and function.
Left atrial appendage occlusion is an alternative therapy to oral anticoagulation for patients with non-valvular atrial fibrillation. Despite design refinements, device-related thrombus (DRT) remains a clinical concern, even with the latest WATCHMAN FLX Pro device (Boston Scientific, Marlborough, MA, USA). We report a case of surgical removal of the WATCHMAN FLX Pro device due to DRT. Despite appropriate antithrombotic therapy, a 77-year-old patient developed DRT leading to cardioembolic cerebral infarction. The thrombus was initially small and nonmobile but rapidly progressed over 45 days to a large, pedunculated, highly mobile thrombus with minimum attachment to the device, necessitating urgent surgical intervention. Subsequent hematologic evaluation revealed previously unrecognized essential thrombocythemia as the underlying prothrombotic condition. This case demonstrates that DRT can occur in patients with unrecognized prothrombotic conditions. Preprocedural thrombophilia screening should be considered in patients with suggestive clinical or laboratory findings, such as unexplained thrombocytosis, along with careful post implantation monitoring. •Preprocedural evaluation for underlying prothrombotic disorders, including essential thrombocythemia, should be considered in patients with suggestive clinical or laboratory findings, such as ischemic stroke despite adequate anticoagulation or unexplained thrombocytosis.•Careful post-procedural monitoring is essential, as initially low-risk device-related thrombus may progress rapidly to high-risk forms requiring surgical intervention.
To explore the clinical efficacy of mini-incision oblique lumbar interbody fusion (OLIF) and anterolateral screw-rod fixation through the approach between the great vessels and the psoas muscle for the surgical treatment of L5 spondylolisthesis. From December 2019 to February 2021, patients with L5 spondylolisthesis undergoing OLIF51 (L5-S1 OLIF) using the OLIF25 (L2-5 OLIF) cage and anterolateral screw-rod fixation were enrolled in this retrospective study. The gender, age, BMI, BMD, operation time, intraoperative blood loss, intraoperative fluoroscopy, surgical segments, cage length and height, incision length, drainage removal time, hospitalization time, intraoperative and postoperative complications, and other relevant data of all patients were recorded. Visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the symptoms, signs, and neurological function of all patients before surgery and during postoperative follow-up. There were 26 cases of L5 spondylolisthesis enrolled. The average operation time was 117.3 ± 13.0 minutes. The mean intraoperative fluoroscopy usage was 11 (8-19) times. The mean blood loss was 20 (10-55) mL, and the average incision length was 48.5 ± 3.7 mm. The drainage removal time was 2 (1-3) days. The mean hospital stay duration was 5 (3-6) days, and the follow-up duration was 29.8 ± 4.1 months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (P < 0.01), and the ODI significantly decreased from 73.2 ± 12.5% to 13.8 ± 4.3% 2 years after surgery (P < 0.01). Anterior intervertebral space height, posterior intervertebral space height, lumbar lordosis, and segmental lordotic angle significantly improved after surgery (P < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 20 segments (76.9%) and grade II in six segments (23.1%). No patients experienced any form of permanent iatrogenic nerve damage or major complications. This study introduces a promising novel approach for treating L5 spondylolisthesis using a mini-incision OLIF51 with a larger OLIF25 cage and anterolateral screw-rod fixation. This method may offer advantages such as reduced blood loss, rapid postoperative recovery, and enhanced support and biomechanical stability.
Ureteroplasty using autologous grafts or flaps has emerged as an important reconstructive option for complex proximal or mid-ureteral strictures. Among available tissues, vesical mucosa may be a promising graft material because it is covered by urothelium, readily available, and well adapted to the urinary environment. This study aimed to present our surgical technique and perioperative outcomes of robot-assisted vesical mucosal graft (VMG) ureteroplasty for a mid-ureteral stricture. A 36-year-old woman with progressive left hydronephrosis was admitted to our hospital after failed prior endourological management. Preoperative antegrade and retrograde pyelography demonstrated an approximately 5-cm stricture in the left mid-ureter. In addition, the patient was scheduled to undergo dental implantation, making oral mucosal graft harvest less desirable. Robot-assisted VMG ureteroplasty was therefore performed. The procedure consisted of four main steps: identification of the ureter and longitudinal incision of the stricture segment; harvesting and ex vivo tailoring of the VMG; double-J stent placement and ventral onlay anastomosis; and mesenteric fat wrapping of the graft with closure of the bladder incision. During graft preparation, the serosal and muscular layers were removed, and the submucosal tissue was carefully thinned while preserving the lamina propria as much as possible. A previously reported "two-point" fixation technique was used to stabilize the VMG during anastomosis, and indocyanine green was administered intravenously to confirm satisfactory perfusion before suturing. The procedure was completed successfully in 146 minutes, with an estimated blood loss of 10 mL. Postoperative hospital stay was 5 days, and no perioperative complications occurred. During 6 months of follow-up, the patient remained asymptomatic, renal function was stable, and computed tomography showed improvement of hydronephrosis. In conclusion, robot-assisted VMG ureteroplasty appears to be a safe and feasible option for selected patients with mid-ureteral stricture. Larger series and longer follow-up are needed to further validate this technique.