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The objective of this study was to evaluate the success rate, stability, and complications of Bollard-modified miniplate anchorage for bone-anchored maxillary protraction (BAMP) in a large cohort of growing patients treated by a single surgeon with long-term follow-up. This retrospective cohort study included 299 growing patients with maxillary hypoplasia and Class III malocclusion who underwent Bollard-modified miniplate placement for BAMP between January 2007 and December 2019. A total of 1196 miniplates were placed. The mean follow-up duration was 4.2 years. Outcomes were assessed at both the miniplate level and the patient level. Patient-level logistic regression analysis was performed to evaluate the association of age at surgery and sex with adverse events. The overall success rate of Bollard-modified miniplate anchorage was 96.5%. During orthodontic loading, 50 miniplates (4.2%) developed mobility or inflammation; after conservative management, 18 regained stability, 24 were removed and successfully replaced, and 8 were removed and not replaced. Complications were more frequent in the maxilla than in the mandible (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.70-5.61; P <0.001). Younger age at surgery was independently associated with a higher likelihood of complications (OR, 0.70; 95% CI, 0.51-0.96; P = 0.025), miniplate removal (OR, 0.68; 95% CI, 0.48-0.98; P = 0.036), and miniplate replacement (OR, 0.62; 95% CI, 0.42-0.92; P = 0.018). Sex was not significantly associated with any of these outcomes. Bollard-modified miniplate anchorage for BAMP showed high long-term success and low complication rates in growing patients. Complications were more frequent in the maxilla than in the mandible, and younger age was associated with a higher likelihood of adverse events. These findings support the use of Bollard-modified miniplates as a reliable skeletal anchorage system for BAMP in children and adolescents.

To reduce drug prices and improve access to essential medicines, the Chinese government implemented the National Volume-Based Procurement (NVBP) policy, leveraging economies of scale. Montelukast sodium, widely prescribed for respiratory diseases, was included in the first round. This study evaluates the impact of the NVBP policy, offering insights for global pharmaceutical policy reform. Utilizing national procurement data from the National Healthcare Security Administration (January 2019 to December 2020), we conducted an interrupted time-series analysis, employing autoregressive integrated moving average models to correct for autocorrelation. We evaluated changes in procurement volume (in defined daily doses), procurement expenditures, and defined daily dose costs of montelukast sodium before and after NVBP implementation. The NVBP policy triggered a substantial decline in total procurement expenditures and defined daily dose costs, significantly improving drug affordability. Unlike the volume surge observed in other NVBP-covered drugs, the total procurement volume of montelukast sodium remained stable, suggesting rational clinical demand. Structurally, the policy successfully drove a "generic substitution" effect, where bid-winning generics rapidly replaced high-priced originators. The market share of non-equivalent generics contracted significantly, marking a quality consolidation of the market. The NVBP successfully achieved cost containment for chronic respiratory disease medications. By promoting high-quality generic substitution and reducing the market share of high-priced originators and low-quality generics, the policy effectively optimized the market structure. These findings provide a replicable China Model for low- and middle-income countries seeking to balance affordability and accessibility in chronic disease management.

Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery has demonstrated survival benefits in advanced ovarian cancer. However, the safety of HIPEC administration in patients with indwelling ventriculoperitoneal (VP) shunts remains unknown, as no prior cases have been reported. Theoretical risks include shunt infection, chemical ventriculitis, and potential central nervous system (CNS) metastasis via retrograde flow through the shunt catheter. The absence of established management guidelines poses a significant challenge for clinicians treating ovarian cancer patients with concurrent VP shunts. A 60-year-old G1P1 with a 6-year history of a programmable VP shunt for hydrocephalus secondary to cerebellar hemangioblastoma presented with high-grade serous ovarian carcinoma, FIGO stage IIIA2. Following neoadjuvant chemotherapy, she underwent interval debulking surgery with cisplatin-based HIPEC. A multidisciplinary approach was employed: neurosurgery externalized the VP shunt catheter from the peritoneal cavity and wrapped it in metronidazole-soaked gauze during HIPEC administration and the shunt was replaced at case completion. Postoperative vancomycin, cefepime, and metronidazole were provided for five days for meningitis prophylaxis. The patient experienced no shunt-related complications and was discharged on postoperative day 4. At 10-month follow-up, she demonstrated excellent oncologic response with CA-125 normalization and no evidence of shunt malfunction or CNS involvement. This case demonstrates that HIPEC can be safely performed in patients with indwelling VP shunts when a multidisciplinary strategy incorporating intraoperative shunt externalization and antimicrobial prophylaxis is utilized. This approach expands treatment options for ovarian cancer patients with VP shunts who may otherwise be excluded from potentially beneficial HIPEC therapy.

The genus Rosa, celebrated for centuries for its aesthetic and aromatic qualities, is increasingly recognized as a potent source of bioactive compounds with significant applications in the cosmetic industry, particularly in antiaging formulations. Traditional extraction methods, often reliant on harsh organic solvents and high energy consumption, are being progressively replaced by innovative green extraction technologies. This review provides a comprehensive and critical analysis of the state-of-the-art green strategies for extracting bioactives from various Rosa species, including Rosa damascena, Rosa canina, and Rosa rugosa. We meticulously examine key technologies such as Ultrasound-Assisted Extraction (UAE), Microwave-Assisted Extraction (MAE), Supercritical Fluid Extraction (SFE), Enzyme-Assisted Extraction (EAE), and the use of Deep Eutectic Solvents (DES). The core focus of this review is to dissect the profound impact of these methods on the resulting chemical profile of the extracts, specifically the yield and composition of valuable phytochemicals like phenolic acids, flavonoids, anthocyanins, and volatile compounds. Furthermore, we critically correlate these compositional variations with the demonstrated in vitro and in vivo antiaging efficacy of the extracts, including their antioxidant, anticollagenase, and antielastase activities. The review delves into the controversies and challenges associated with each technique, analyzing the conflicting evidence regarding their efficiency and selectivity. Finally, we address the critical aspects of industrial scalability, providing insights into techno-economic considerations, life-cycle assessments, and future prospects, such as the development of hybrid extraction systems and the integration of nanotechnology for enhanced delivery of rose bioactives. This work aims to guide future research and industrial implementation toward more sustainable, efficient, and effective utilization of rose-derived compounds in next-generation cosmetic products. Distinct from prior reviews that treat extraction technologies, rose essential oil, or rosehip dermatological effects as separate themes, this review links extraction mechanism, phytochemical fingerprint, antiaging end points, and scale-up constraints in a single evidence chain.

Regenerative medicine is an emerging field that combines biotechnology with aspects of medicine, cell and molecular biology, materials science and bioengineering to regenerate, repair or replace tissues. Since 1990, growth factors and platelet concentrates have been considered novel and have been widely used in oral and maxillofacial surgery. In the following years, biomaterials, as well as various types of scaffolds and autologous tissues, were increasingly used. Stem cells are defined as special cells that have the capacity to both self-renew and give rise to a cell population that can be differentiated. The aim of this study was to investigate and compare the yield of primary cells from dental pulp and gingival tissue. This study was designed to investigate the growth potential of dental pulp tissue and gingival tissue by assessing the colony-forming units. Primary cells were isolated from dental pulp and gingival tissues collected from patients undergoing third molar extraction. Colony-forming unit (CFU) assay and scratch wound assay were performed to evaluate clonogenicity and proliferative potential. Gingival stem cells demonstrated faster proliferation and higher colony-forming efficiency compared to dental pulp stem cells. Gingival stem cells also showed quicker wound closure in the scratch wound assay. Gingival tissue may serve as a more accessible and efficient source of stem cells for regenerative applications due to its rapid growth and enhanced clonogenic potential.

Claustrophobia during MRI may lead to examination interruption, motion artifacts, prolonged acquisition time, and reduced diagnostic quality, frequently requiring intravenous sedation to ensure successful examination completion and adequate image acquisition. A pharmacological alternative that could maintain examination completion while reducing procedural complexity would be beneficial. To determine whether sublingual zolpidem is noninferior to conventional intravenous sedation for successful MRI completion in claustrophobic adults and to evaluate safety outcomes and procedural costs. Prospective, open-label, non-randomized noninferiority clinical trial. 282 claustrophobic adults undergoing clinical MRI, 229 of whom received sublingual zolpidem while 53 underwent conventional intravenous sedation. 1.5-T; institutional imaging protocols. Claustrophobia severity was assessed using a Claustrophobia Questionnaire. Successful MRI completion without interruption due to claustrophobia was the primary endpoint. Physiological parameters (heart rate, blood pressure, peripheral oxygen saturation, blood glucose) were evaluated before and after MRI examination. A structured post-examination questionnaire was used to assess adverse events and direct procedural costs were evaluated from institutional administration records. Continuous variables were analyzed using Student's t-tests, while categorical variables were analyzed using chi-square or Fisher's exact tests. Noninferiority was assessed using a predefined margin of -10%. Statistical significance was defined as p&#x2009;<&#x2009;0.05. There was no significant difference in the claustrophobia severity score between groups (p&#x2009;=&#x2009;0.235). MRI completion was achieved in 96.9% (222/229) of patients receiving zolpidem and 100% (53/53) of patients receiving conventional sedation. The absolute difference between groups was -3.06% (95% confidence interval: -5.29% to -0.83%), remaining within the predefined noninferiority margin. No respiratory compromise occurred in either group. Mild adverse events occurred in 20.7% of zolpidem-treated patients, mainly dizziness (8.5%). Mean procedural cost was significantly and substantially lower with zolpidem (USD 0.16) than with conventional sedation (USD 114.27). Sublingual zolpidem was noninferior to conventional intravenous sedation for MRI completion in selected claustrophobic adults, demonstrating favorable safety and substantially lower procedural cost. 2. Stage 5. The trial was registered at the (ReBEC) under registration number RBR-23pfcg5. Magnetic resonance imaging (MRI) requires patients to lie still inside a narrow tunnel, which can cause intense fear (claustrophobia) and lead to failed or incomplete examinations. We tested whether a simple pill placed under the tongue (zolpidem) could help patients complete their MRI just as well as standard intravenous sedation, which requires an anesthesiologist. In a study of 282 fearful adults, 97% completed the scan with zolpidem, compared to 100% with sedation. The cost per procedure dropped from $114 to only $0.16. This suggests that a low&#x2010;cost, easy&#x2010;to&#x2010;administer pill can effectively replace complex sedation for selected patients, improving access and efficiency.

Listeria monocytogenes is known to colonize food production environments and cross-contaminate finished foods. We investigated 30&#x202f;L. monocytogenes isolates collected from artisan raw milk cheese production facilities in Vermont from 2006 to 2008, Sixteen of which represented a putatively persistent ribotype (DUP-1042B) found in one facility over two years. To determine persistence mechanisms, we evaluated the whole genome of the isolates as well as their sanitizer tolerance and biofilm formation capacity. For a representative subset (six isolates), we evaluated their mature biofilm properties on stainless steel. Isolates of the putatively persistent ribotype all aligned into ST191 and were 0-6 Single Nucleotide Polymorphisms (SNPs) different, confirming they represented a persistent strain. SSI-1 and an enrichment of genes in DNA repair and biosynthetic pathways were also exclusively confirmed in the core and accessory genome respectively, of the persistent strain. However, no significant differences in sanitizer tolerance were found between persistent and non-persistent strains, and none of the 30 isolates carried sanitizer resistance genes (bcrABC or qacH). Some ST 191 isolates formed visually more complex biofilms as shown by SEM and maintained significantly higher biomass over five days on polystyrene but were indistinguishable from non-persistent strains over ten days on stainless steel. No clear persistence mechanism was thus identified, but evidence for biofilm formation was stronger in the ST191 isolates than in the non-persistent strains. Our results highlight the importance of regular environmental testing and strain typing for rapid detection of L. monocytogenes colonization attempts while they can still be removed without major renovations or equipment replacement.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major threat to hospitalised patients, particularly in intensive care units and orthopaedic wards where implant-associated infections are common. However, the genomic and biofilm characteristics of CRAB in orthopaedic specialty hospitals remain poorly understood. A total of 97 non-duplicate CRAB isolates collected between 2024 and 2025 were included. Antimicrobial susceptibility testing was performed using the VITEK-2 system, and biofilm formation was quantitatively assessed by the crystal violet method. Whole-genome sequencing (WGS) was carried out on the Illumina platform to analyse multilocus sequence typing (MLST), capsular types, resistance genes and virulence genes. A phylogenetic tree was constructed based on single-nucleotide polymorphisms (SNPs). ST2 was the dominant clone (95.88%) among the 97 isolates, and KL3 was the most prevalent capsular type (83.51%). All isolates carried intrinsic blaOXA-51-like genes, predominantly blaOXA-66 (95.88%). The most common acquired carbapenemase gene was blaOXA-23 (98.97%), and two isolates carried metallo-&#x3b2;-lactamase (MBL) genes (blaNDM-1 and blaNDM-5, respectively). All isolates exhibited a multidrug-resistant phenotype, with low resistance rates to tigecycline (6.19%) and minocycline (7.22%), and all remained susceptible to colistin. Strong biofilm formers accounted for 91.75% of isolates, and the carriage rates of biofilm-associated genes (bap, csuABCDE, pgaABCD) exceeded 90%. Phylogenetic analysis grouped the isolates into three clonal clades, with the majority (88.66%) falling into Clade C (ST2/KL3). This clade had been circulating in China as an outbreak lineage since 2018, gradually replacing Clade B (ST2/KL2), and became the dominant clone in 2024-2025. CRAB isolates in this orthopaedic specialty hospital are dominated by the ST2/KL3 clone, which carries multiple resistance and virulence genes, exhibits a remarkably strong biofilm-forming ability, and shows a capsular switch trend from KL2 to KL3. Enhanced molecular surveillance of this dominant clone and increased attention to anti-biofilm strategies for orthopaedic implant-related infections are strongly recommended.

Pediatric hypothyroidism is an endocrine disorder where early thyroid replacement therapy is recommended to support healthy development. This study characterized prevalence and treatment patterns of pediatric hypothyroidism among children in the US. Children aged 0-17 years with hypothyroidism were identified from two large US claims databases from 2013 to 2022, using age-specific algorithms based on diagnosis and prescription claims. Annual prevalence of hypothyroidism and treated hypothyroidism were analyzed separately by database and as a pooled dataset, and stratified by age group, sex, and calendar year. Two-sample tests of proportion were used to compare prevalence across groups. Among 7,214,633 children, the overall hypothyroidism prevalence (per 1000 children) was 3.49 in 2022. From 2013 to 2022, annual hypothyroidism prevalence (per 1000 children) increased by 43% in children <1 year (0.62 to 0.88) and by 33% in children aged 1-3 years (0.70 to 0.94), but decreased by 9% to 18% in children aged 4-17 years. Prevalence was higher in female than male children, and differences between sexes increased with age. In 2022, approximately two-thirds of children with hypothyroidism received thyroid replacement therapy. Female children were significantly more likely than males to receive treatment, with the largest difference among those aged 8-11 years (70.1% vs 61.5%). Distinct age- and sex-dependent trends in pediatric hypothyroidism prevalence were observed over time. A substantial subpopulation of patients did not receive treatment despite known developmental risks. Enhanced efforts to identify and treat pediatric hypothyroidism are warranted to ensure optimal developmental outcomes for affected children.

Recurrent tricuspid regurgitation (TR) after surgical annuloplasty is a common challenge, and redo surgery carries high risk. Transcatheter valve-in-ring approaches are often limited by paravalvular leak (PVL), especially with incomplete bands. The novel transcatheter tricuspid valve replacement (TTVR) system TOPAZ (TRiCares) offers a therapeutic option for high-risk patients with severe TR. The TOPAZ dual-stent design includes a conformable outer frame that may improve annular sealing, reduce paravalvular leak, limit patient-prosthesis mismatch, and minimize right ventricular interaction. This case describes the first-in-human use of TOPAZ TTVR to treat recurrent TR in a failed incomplete surgical annuloplasty band. TOPAZ TTVR is feasible in failed annuloplasty rings/bands. Its conformable design may reduce paravalvular leak and provide a treatment alternative to patients with large surgical rings/bands.

Corticosteroids are indispensable in the management of inflammatory, autoimmune, and respiratory disease, yet prolonged or unsupervised systemic use can produce iatrogenic Cushing's syndrome, and abrupt withdrawal risks life-threatening adrenal crisis. We report five male patients, aged 12 to 65 years, who developed Cushingoid features following systemic corticosteroid exposure for type two diabetes-associated dermatosis, bronchial asthma, epileptic encephalopathy, rheumatoid arthritis, and osteoarthritis. All five presented with moon facies; additional findings included purple striae, cutaneous thinning, abdominal hyperpigmentation, and impaired wound healing. Where measured, serum cortisol was low or low-normal, consistent with hypothalamic-pituitary-adrenal (HPA) axis suppression by exogenous steroid and thereby confirming an iatrogenic rather than endogenous origin. Opportunistic fungal infection masked by corticosteroid-mediated immunosuppression was a recurring complication. In one patient, abrupt discontinuation of dexamethasone precipitated adrenal crisis, multi-organ failure, and death. The remaining four patients recovered fully following structured tapering or physiological corticosteroid replacement. This report illustrates the clinical spectrum of iatrogenic hypercortisolism, emphasises the diagnostic significance of a suppressed endogenous cortisol, and underscores the imperative of gradual steroid withdrawal. It highlights the essential role of clinical pharmacists in rational prescribing, early adverse-effect recognition, and safe steroid tapering within a multidisciplinary care framework.

Ultrasound-guided thermal ablation (U-GTA) techniques, including radiofrequency ablation (RFA) and microwave ablation (MWA), have recently been proposed as minimally invasive alternatives to surgery or radioiodine (RAI) therapy for patients with Graves' disease (GD) who are unresponsive to antithyroid drugs. However, evidence supporting its effectiveness and safety remains limited. A PubMed/MEDLINE, Web of Science, and Scopus research updated until January 31, 2026, was performed. The review question was: What is the euthyroidism rate (outcome) one year after U-GTA (intervention) in Graves' disease (population)? Two reviewers independently conducted the study screening, data extraction, and risk of bias assessment. A random-effects model was adopted to pool the prevalence with corresponding 95% confidence intervals. Four studies comprising 82 patients (88% female) were included in the analysis. Approximately 2.4% of patients required levothyroxine replacement after U-GTA. Thyroid volume significantly decreased following treatment, and baseline thyroid volume was identified as a predictor of relapse in one study. A transient increase in anti-TSH receptor antibodies was observed one month after U-GTA, followed by a subsequent decline. No worsening or new onset of Graves' orbitopathy was reported. Post-procedural adverse events occurred in 6.1% of patients and were transient. At 12 months, pooled euthyroidism rate was 67.0% (95% CI 54-78), with low heterogeneity (I&#xb2; = 0%). U-GTA appears to induce biochemical remission in approximately two-thirds of selected patients with persistent or relapsed GD, with a favourable short-term safety profile and preservation of thyroid function in most cases. However, remission rates remain lower than those typically reported for definitive surgical treatment, and current evidence is limited to small, non-randomized studies with relatively short follow-up. Larger prospective comparative trials with standardized protocols are required to define the role of U-GTA within current management strategies for GD.

The present study evaluated the effects of replacing fish oil with microalgal oil on growth performance, nutrient utilization, chemical composition, metabolism and gut functionality in Sparus aurata. Three experimental diets were formulated with increasing levels of oils derived from the microalgae Microchloropsis gaditana and Isochrysis galbana for replacing fish oil: 50% (MO50), 75% (MO75) to 100% (MO100) of total oil. All diets were also supplemented with a protein hydrolysate obtained from Arthrospira platensis to partially replace fishmeal, as well as with an algal carotenoid extract. A total of 198 fish (initial body weight 10.5&#x2009;&#xb1;&#x2009;0.4&#x2009;g) were randomly distributed into 12,400&#x2009;L tanks and fed the experimental diets ad libitum for 83 days under controlled conditions. Growth performance, feed efficiency and somatic indices were assessed, while muscle proximate composition, fatty acid and carotenoid profiles, plasma metabolites, and tissue glycogen were analyzed using standard biochemical and chromatographic techniques. Digestive enzyme activities (trypsin, chymotrypsin, leucine aminopeptidase, alkaline phosphatase) and well as intestinal histology were also evaluated. The results evidenced that use of microalgal oil did not affect fish growth. Fish fed diets supplemented with microalgal products tended to reduce muscle lipid content. Fish fed diets devoid fish oil showed an increase in eicosapentaenoic acid (EPA) content when microalgal oil was included. Plasma cortisol did not vary among experimental groups. The activity of foregut trypsin and alkaline phosphatase increased with the use of microalgal oil, while in the hindgut trypsin and leucine aminopeptidase activities were enhanced. The use of algal products promoted longer intestinal villi and reduced lamina propria thickness in the distal intestine. Overall, the results indicate that total replacement of fish oil with microalgal oil has no detrimental effects on growth performance, and exerts positive effect on specific fatty acids and intestinal functionality.

In glioblastoma, standard first-line chemoradiation since the 2005 EORTC/NCIC trial is 30x2Gy with concurrent and adjuvant temozolomide. A phase II study suggested ultra-hypofractionation (6x6Gy) may offer comparable survival, with reduced treatment time and costs, potentially improving health-related quality of life (HRQoL). This phase III randomized trial (Netherlands Trial Registry, NL72953.041.20) evaluated non-inferiority of ultra-hypofractionated temozolomide chemoradiation in glioblastoma patients. Adults with newly diagnosed glioblastoma and a Karnofsky performance status &#x2265;70 were randomized (1:1) to ultra-hypofractionated (6x6Gy in 2 weeks) or standard (30x2Gy in 6 weeks) radiotherapy, both with concurrent and 6 cycles of adjuvant temozolomide. The primary endpoint was 2-year overall survival (OS); the non-inferiority margin was a hazard ratio of 1.2. Secondary outcomes included progression-free survival (PFS) and toxicity. Enrollment stopped early, due to slow accrual (n=135/474 planned, 67 experimental, 68 standard). Median OS was shorter in the experimental arm: 13.0 months (95% CI 10.3-15.7) versus 21.0 months (95% CI not estimable). In a time-dependent analysis, survival was similar in the first 6 months (HR 0.99, 95% CI 0.39-2.50), but mortality was higher thereafter (HR 2.54, 95% CI 1.57-4.09, p < 0.001). Radiation necrosis or pseudoprogression was more frequent after ultra-hypofractionation (47.8% vs 16.2%; HR 5.20, 95% CI 2.56-10.58), with increased dexamethasone use at 6-12 months. No grade 4-5 toxicities were observed. Non-inferiority of the 6x6 Gy chemoradiation regimen could not be demonstrated. This ultra-hypofractionated regimen was associated with inferior survival and increased radiation necrosis, and therefore should not replace standard chemoradiation.

Several countries and regions have established regulations or guidelines specifying permissible limits for elemental impurities in cosmetic products. Surveys of commercially available cosmetics have shown that lipsticks often contain significant amounts of elemental impurities, which are of particular concern due to the high risk of oral exposure. In this study, the elemental impurities in eight commonly used cosmetic ingredients were analyzed, namely silicon dioxide, titanium oxide, iron oxide, synthetic mica, natural mica, beeswax, Ricinus communis (castor) seed oil, and Lithol Rubine B. Total dissolution of the samples was achieved via microwave digestion, employing an ammonium fluoride solution as a safer alternative to highly toxic hydrofluoric acid (HF). Subsequently, 14 elements-chromium, manganese, cobalt, nickel, copper, zinc, arsenic, selenium, strontium, cadmium, tin, antimony, mercury, and lead-were quantified by inductively coupled plasma mass spectrometry. The limits of detection and quantification, as well as the accuracy and precision of the analytical method, were validated, confirming its suitability for the reliable determination of total elemental impurities in cosmetic ingredients. The inorganic ingredients contained relatively higher concentrations of elemental impurities than the organic ingredients. Se, Cd, and Hg were not detected in any samples. The developed analytical method eliminates the requirement for HF, thereby enhancing analyst safety. Accurate determination and control of elemental impurity levels-particularly in inorganic cosmetic ingredients-are essential for minimizing contamination and ensuring product safety. By avoiding the use of highly toxic HF, the analytical method presented in this study enhances analyst safety while maintaining high accuracy, rendering it a practical tool for cosmetic quality control and research and development.

Morbidly obese (MO) patients undergoing total hip arthroplasty (THA) are at increased risk of postoperative complications. The effect of surgical approach on outcomes in this population remains unclear. This study compared perioperative outcomes and 90-day complications between direct anterior (DA) and postero-lateral (PL) approaches in MO and non-MO patients. We retrospectively reviewed 5,933 primary THAs between January 2017 and March 2022. The surgeons included had performed at least 50 DA cases. Among 365 MO patients (body mass index [BMI] &#x2265; 40), 238 underwent DA and 127 underwent PL. Demographics, operative characteristics, and 90-day complications were analyzed. Multivariable logistic regressions adjusted for age, sex, BMI, American Society of Anesthesiology (ASA) class, and operative time; rare events were evaluated using penalized logistic regression. Propensity score-based sensitivity analyses were performed to account for confounders. In MO patients, operative times were significantly shorter with DA (71 &#xb1; 18 versus 92 &#xb1; 26 minutes, P < 0.001). On penalized multivariable analysis, there was a reduced risk of periprosthetic fracture for the DA group (OR [odds ratio] 0.08, 95% CI [confidence interval] 0.01 to 0.89); however, interpretation is limited by higher rates of cementation in the DA group. In sensitivity analysis, the risk of revision surgery remained significantly lower with DA (OR 0.31, 95% CI 0.11 to 0.85). Complication rates were otherwise statistically similar between approaches on adjusted analysis. Compared to non-MO patients, MO patients had longer operative times and higher overall complication rates, regardless of approach. In MO patients undergoing THA, the DA approach was associated with shorter operative times. After multivariate adjustment, overall complication risks were similar between approaches across two analytical frameworks. These findings suggest that both DA and PL can be safely utilized in MO patients undergoing THA, without an increased 90-day complication profile attributable to either approach.

Image-guided surgical procedures have spatial constraints that complicate workflow, contributing to repetitive awkward turning and leaning postures. These postures, coupled with lead aprons for radiation protection, can cause Work-Related Musculoskeletal Disorders in the spine/shoulders. This study evaluates an intervention table for equipment in front of operators to reduce spatial constraints and physical risks. Nine attending clinicians (8 male) and 3 fellows (2 male) performed Transcatheter Aortic Valve Replacement (TAVRs) at a quaternary academic hospital at baseline and with an intervention table. Postural data, turning patterns, and subjective workload were collected. 120 cases were collected (67 baseline, 53 intervention). The intervention table significantly reduced high-risk postures for the neck and the torso for attendings; while increasing risky postures for both shoulders compared to baseline. The intervention table may help neck and torso postures, with the trade-off being increased risks to the arms and shoulders.

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A dissolvable microneedle system (SFP-MNs) loaded with seven principal Sanfu Herbal Patch components was developed to assess transdermal delivery feasibility and therapeutic efficacy in a rat model of allergic asthma. SFP-MNs were fabricated using a two-step centrifugation-assisted template molding method and characterized in terms of morphology, mechanical strength, skin penetration capability, and in vitro drug release behavior. An ovalbumin (OVA)-induced allergic asthma model was established in Sprague-Dawley (SD) rats to investigate the in vivo performance of the microneedles. Pulmonary interstitial fluid was continuously sampled by microdialysis following transdermal administration, and drug concentrations were quantified using UPLC-MS/MS. Pharmacodynamic responses were evaluated by measuring histamine (HIS), immunoglobulin E (IgE), interleukin-10 (IL-10), and tumor necrosis factor-&#x3b1; (TNF-&#x3b1;) levels using ELISA, together with histopathological examination by hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) staining. A pharmacokinetic-pharmacodynamic (PK-PD) model was subsequently established to characterize the relationship between drug exposure and therapeutic response. The prepared SFP-MNs exhibited excellent mechanical properties, efficient skin penetration, and sustained drug release. In vivo, SFP-MNs achieved effective transdermal delivery of the encapsulated components and produced superior therapeutic outcomes compared with an equivalent-dose conventional Sanfu Herbal Patch gel. Specifically, high-dose SFP-MNs markedly alleviated airway inflammation, reduced inflammatory biomarker levels, and attenuated pulmonary histopathological injury in allergic asthmatic rats. These findings demonstrate that SFP-MNs represent a promising transdermal drug delivery platform with the potential to replace conventional Sanfu Herbal Patch for the treatment of allergic asthma while providing sustained drug release and improved therapeutic efficacy.