The expanding utility of axial chirality across the chemical sciences has intensified the search for structurally novel atropisomeric skeletons. Drawing inspiration from the electronic properties of aryl-amides, we have developed a new class of atropisomeric aryl-hydrazone architectures. Their atroposelective construction was accomplished via stereospecific addition of hydrazines to axially chiral vinyl quinone methides, generated in situ from aryl-alkynes under chiral Brønsted acid catalysis. This transformation exhibits remarkable Z/E- and enantioselectivity, along with broad functional group compatibility. The key to overcoming this synthetic challenge lies in the precise enantiocontrol of the transient aryl-enamine species, which subsequently undergoes stereospecific enamine-to-imine tautomerization to afford the Z-configured atropisomers. Furthermore, the chiral Brønsted acid acts as a sophisticated proton shuttle, enabling a privileged pathway for the seamless transfer of stereochemical information while enhancing selectivity through precise spatial discrimination of the enamine conformers. This work not only expands the repertoire of atropisomeric frameworks but also delivers atropisomers with excellent structural and axial stability, positioning them as promising candidates for asymmetric catalysis and materials science.
Enteroatmospheric fistulas (EAFs) are characterised as an abnormal connection between the gastrointestinal tract and the atmosphere. They present a formidable challenge in surgical practice. Negative pressure wound therapy (NPWT) has become the standard for management of large open abdominal wounds. However, an EAF can make application of this dressing challenging. This case report highlights the authors' experience in managing an EAF-containing large open wound in a 52-year-old male patient following a motorcycle collision. He sustained an 'open-book' pelvic fracture and mesenteric contusions requiring exploratory laparotomy. The patient underwent multiple abdominal surgeries and his abdomen was left open using a temporary abdominal closure device. He had an extended hospital course complicated by a necrotising soft tissue infection requiring large abdominal wall debridement, pelvic hardware infection requiring hardware removal and external fixation, and fascial dehiscence culminating with the development of an EAF. Several iterations of wound care were attempted before succeeding at achieving a fistula-sparing NPWT dressing. Once this was achieved there was rapid improvement in the size of the patient's wound. His wound and overall clinical status continued to improve, with spontaneous resolution of fistula and near complete re-epithelialisation of the wound at eight months. The practice of damage control laparotomy with an open abdomen and temporary abdominal closure devices exposes the bowel to potential damage from iatrogenic serosal injuries, adhesion-induced wall splitting, and serosal irritation from dressing changes. Wound care that minimises soilage of the remainder of the wound from enteric effluent is essential for wound healing. Each wound requires a tailored approach that adjusts for its individual characteristics to ensure optimal patient outcomes.
Accurate assessment of shoulder kinematics in Modified Mallet Scale (MMS) movements is essential for clinical evaluation and treatment planning in brachial plexus birth injury (BPBI). However, inconsistencies in reporting methods affect the reliability of kinematic data. This study aims to determine the optimal Euler sequence for reporting shoulder kinematics during MMS movements. Kinematic data from the unaffected arms of ten children with BPBI were collected using inertial measurement units and analyzed retrospectively. Three commonly adopted Euler sequences (ZXY, XZY, YXY) were analyzed. The occurrence of discontinuities, including gimbal lock, phase angle discontinuities, was quantified. Additionally, amplitude coherence was evaluated by comparing reported joint angles with clinically expected values. The ZXY sequence was the only method that exhibited gimbal lock, particularly in global abduction (M1), global external rotation (M2), and hand-to-neck (M3). XZY and YXY showed no gimbal lock; however, YXY showed two instances of phase angle discontinuities. Amplitude coherence analysis identified XZY and YXY as most suitable for M1 and M2, YXY for M3 and hand-to-mouth (M5), XZY for hand-to-back (M4), ZXY for hand-to-belly (M6). The method used to report shoulder kinematics has a major impact on the accuracy of MMS movement analysis. Our findings highlight the need for movement-specific, standardized reporting approaches that reduce discontinuities and maintain amplitude coherence. Establishing such standards is essential for enhancing clinical relevance and ensuring meaningful comparisons across studies, particularly in the evaluation of BPBI.
Cellulosic aerogels, owing to their renewable origin, lightweight porous structure, and excellent structural tunability, have shown broad application prospects in triboelectric energy harvesting. However, cellulosic triboelectric aerogels typically rely on large mechanical deformations to generate electrical signals, making it difficult to achieve efficient energy conversion under weak mechanical disturbances such as acoustic vibrations. Meanwhile, their single surface chemical composition and limited charge trapping capability also restrict triboelectric output performance. In this study, an in situ limited crystallization strategy is proposed, in which coordination interactions are utilized to induce the confined growth of nanocrystals on the fiber network, enabling uniform dispersion of nanostructures within the three-dimensional skeleton while effectively suppressing particle aggregation. Combined with directional freezing technology and surface hydrophobic modification, a cellulosic triboelectric aerogel with both environmental robustness and high output performance is successfully constructed. The aerogel exhibits significantly enhanced triboelectric output performance, achieving a power density of 396 mW m-2 and is capable of harvesting and converting noise energy in industrial environments. This work provides a new material design strategy for regulating the growth behavior of nanocrystals in three-dimensional porous fiber networks and offers guidance for the application of cellulosic triboelectric aerogels in weak vibration energy harvesting and intelligent acoustic sensing.
Although the causal association between aging and osteoarthritis (OA) has been documented, our understanding of the underlying mechanism remains incomplete. To define the regulatory molecules governing chondrocyte aging, we performed transcriptomic analysis of young and old human chondrocytes from healthy donors. The data predicted that GATA-binding protein 4 (GATA4) may play a key role in mediating the difference between young and old chondrocytes. Results from immunostaining and western blot showed significantly higher GATA4 levels in old human or mouse chondrocytes when compared to young cells. Moreover, overexpressing GATA4 in young chondrocytes remarkably reduced their cartilage-forming capacity in vitro and induced the upregulation of proinflammatory cytokines. Conversely, suppressing GATA4 expression in old chondrocytes, through either siRNA or a small-molecule inhibitor NSC140905, increased the production of aggrecan and collagen type II, and also decreased levels of matrix-degrading enzymes. In OA mice induced by surgical destabilization of the medial meniscus, intra-articular injection of lentiviral vectors carrying mouse Gata4 resulted in a higher OA severity, synovial inflammation, and pain level when compared to control vectors. Mechanistically, we found that overexpressing GATA4 significantly increased the phosphorylation of SMAD1/5. Our work demonstrates that the aging-associated increase of GATA4 in chondrocytes plays a vital role in OA progression, which may also serve as a target to reduce OA in the older population.
Objective:To evaluate the clinical efficacy of endoscopic repair of medial orbital wall fractures using an autogenous ethmoid perpendicular plate-septal cartilage complex. Methods:A total of 27 patients with medial orbital wall fractures who underwent endoscopic reconstruction using the ethmoid perpendicular plate-septal cartilage complex were enrolled in Department of Otolaryngology, the Third Affiliated Hospital of Anhui Medical University[the First People's Hospital of Hefei]. The follow-up period was at least 6 months. Improvements in diplopia, restricted ocular motility, enophthalmos, and orbital volume were assessed before and after surgery. Results:All surgeries were successfully completed, with no complications such as infection, graft displacement, or vision loss observed during the follow-up period. Postoperative CT scans showed restoration of the structural continuity of the medial orbital wall. Diplopia, ocular motility disorders, and enophthalmos significantly improved in all patients. Compared to the preoperative measurements, the postoperative reduction in the orbital volume difference between the normal and fractured orbits was statistically significant （mean reduction:[1.54±0.93] cm³, P<0.05）. Postoperatively, the mean volume difference between the healthy and affected sides was not statistically significant （mean difference:[0.78±0.41]cm³，P＝0.287）, indicating that the orbital volume on the affected side approached that of the contralateral side. Conclusion:Endoscopic repair of medial orbital wall fractures using an autologous composite graft of the perpendicular plate of the ethmoid bone and nasal septal cartilage demonstrates favorable surgical outcomes. 目的：探讨鼻内镜下自体筛骨垂直板鼻中隔软骨复合体治疗眼眶内侧壁骨折的临床疗效。 方法：收集安徽医科大学第三附属医院（合肥市第一人民医院）耳鼻咽喉科27例行鼻内镜下筛骨垂直板软骨复合体眼眶重建术的眶内侧壁骨折患者。随访时间至少6个月。评估手术前后复视、眼球运动障碍、眼球内陷、眼眶容积的改善情况。 结果：所有手术均成功完成，随访期间未出现感染、移植物移位或视力下降等并发症，术后CT扫描显示眶内侧壁结构连续性恢复。所有患者复视、眼球运动障碍、眼球内陷显著改善。与术前比较，术后正常眼眶与骨折眼眶容积差异的降低程度有统计学意义（P<0.05），差异变化均值为（1.54±0.93） cm³，术后健侧和患侧的平均眼眶容积差异无统计学意义（P=0.287），差异均值为（0.78±0.41）cm³，表明患侧眼眶容积接近健侧水平。 结论：鼻内镜下采用自体筛骨垂直板鼻中隔软骨复合体修复眶内侧壁骨折，手术效果较好。.
The North American thescelosaurine ornithischian Fona herzogae (Cenomanian Mussentuchit Member of the Cedar Mountain Formation) is represented by one of the largest samples of isolated cranial elements among early diverging neornithischians. Here, we present a comprehensive cranial description of F. herzogae, utilizing advanced digitization and visualization techniques to reconstruct individual elements in high resolution with a particular focus on taxonomically and phylogenetically significant morphology. The abundance of disarticulated cranial material permits comprehensive documentation of individual elements from multiple orientations, substantially expanding the known cranial anatomy of F. herzogae and improving character evaluation across Thescelosauridae. We use these new anatomical details, together with targeted character revisions and firsthand recoding of Koreanosaurus, to improve resolution among thescelosaurid evolutionary relationships. Our analyses recover Koreanosaurus within Thescelosaurinae, strengthen support for the inclusion of several Asian taxa within this clade, and reinforce a biogeographic distinction between an Asian-North American Thescelosaurinae and a geographically restricted North American Orodrominae.
The foramen magnum (FM) is the largest opening at the cranial base and serves as a critical anatomical structure connecting the cranial cavity to the vertebral canal. Owing to its functional and clinical importance, the morphology and morphometry of the FM have been extensively examined in anatomical and anthropological research. The present study evaluates the morphometric variability of theFM in a historical European population, focusing on differences by sex and age. The analysis included 101 adult human skulls from the historical osteological collection of the Museum of Anthropology "Giuseppe Sergi" at Sapienza University of Rome. The skulls date to the 17th-19th centuries. We measured the anteroposterior length and transverse width of the foramen magnum using a digital caliper. We also calculated theFM index and surface area. Shape was classified according to the morphological types described by Richards and Jabbour (2011). Statistical analyses were conducted to assess differences associated with sex and age. The mean FM length and width measured 34.98 mm and 29.63 mm, respectively. No statistically significant differences were identified between males and females for any of the analyzed parameters. Likewise, no significant differences were observed between younger and older individuals. Morphological analysis revealed variability in FM shape, with the two-semicircle type being the most frequently observed configuration in both sexes. The morphometric parameters of theFM in the ROMA skeletal series are consistent with ranges reported for other human populations. No significant sex- or age-related differences were found, indicating relative developmental stability of this structure. FM measurements may contribute to anthropological and forensic analyses. However, their utility for sex estimation is limited.
This study was conducted to evaluate the morphometric of the C2 vertebra in relation to screw fixation surgery and to establish standards for safe entry points and trajectories for pedicle screws. Computed tomography images of 323 individuals, comprising 163 females and 160 males aged 20-59 years, were used in the study. In the retrospective study, pedicle length (PL), pedicle thickness (PT), pedicle height (PH), pedicle angle (PA), pedicle-lamina angle (PLA), sagittal angle (SA), and ideal entry length (EL) parameters were evaluated on the right (R) and left (L) sides. The measured parameters were analysed in a total of 4 groups divided into age deciles. As a result of our study, it was found that PL, PH, and EL parameters were higher in males compared to females on both sides (p < 0.05). It was found that RPL and RPA parameters were smaller than LPL and LPA, respectively, while the RPLA parameter was larger than the LPLA parameter (p < 0.05). In males, RPA, RSA, and LSA parameters were higher in group 1 than in group 4 (p < 0.05). In females, RPH and LPH parameters were found to be the largest in group 1 (p < 0.05). It has been observed that C2 morphometry is greater in male and decreases with age. These findings highlight the need for individual assessment in surgical planning and the importance of taking age and sex into account for clinical safety in interventional procedures such as screw placement.
Concurrent blockade of aerobic glycolysis and oxidative phosphorylation (OXPHOS) holds great promise in lung cancer therapy yet challenged by tumor cell metabolic plasticity. To address this, we herein grafted dichloroacetic acid into perylenediimide (PDI) skeleton via ionic or covalent bond to create PDIC-AC and PDIC-NAC. Studies demonstrate that ionic bond-driven primary amine positive nitrogen remodeling and mitochondrial localization endow PDIC-AC with significantly stronger inhibitory activity on pyruvate dehydrogenase kinases (PDHKs) than PDIC-NAC. Notably, PDIC-AC targets the Rieske iron-sulfur polypeptide 1 (UQCRFS1) subunit of complex III in mitochondria, triggering electron leakage from the electron transport chain, thereby more efficiently inducing reactive oxygen species (ROS) production relative to PDIC-NAC. Superior PDHKs inhibiting efficacy and ROS generation capacity functionalize PDIC-AC as an efficient inhibitor to block glycolysis and OXPHOS, which not only repolarize macrophages toward anti-tumor M1 phenotype via suppression of lactate production, but also trigger immunogenic cell death via PERK-eIF2α-ATF4-CHOP axis to activate immune response, ultimately reaching effective chemo-immunotherapy against the primary and distant tumors. Overall, this work defines the unambiguous mechanism for PDI-triggered endogenous ROS generation, and meanwhile clarifies small-molecule regulators' energy metabolism intervention mechanism and establishes an innovative chemical bond engineering strategy for energy-targeted chemo-immunotherapy.
Correct identification of Rhea americana and Rhea pennata in the fossil record has important paleoenvironmental implications; however, the strong similarity between their postcranial skeletons complicates taxonomic assignments. This study analyzes hindlimb morphology in both species to identify diagnostic characters useful for fossil and archaeological material and to reassess previously reported remains. Femora, tibiotarsi, and tarsometatarsi of adult and juvenile R. americana and R. pennata, comprising a total of 37 specimens, were comparatively analyzed using qualitative morphology and linear measurements. Several osteological differences were identified, particularly in distal tibiotarsal and tarsometatarsal morphology, including trochlear configuration and divergence patterns. Some differences are maintained in juvenile specimens, although ontogenetic variation may complicate identification in certain cases. Reevaluation of fossil and archaeological specimens supported revised taxonomic interpretations for several specimens, whereas poorly preserved or morphologically ambiguous materials were conservatively assigned to Rheidae indet. Although hindlimb bones of R. americana and R. pennata are broadly similar, distal tibiotarsal and especially tarsometatarsal morphology provide useful diagnostic characters. Trochlear configuration and divergence appear to be among the most consistent features, whereas other traits are affected by ontogenetic, intraspecific, and preservational variation. These results contribute to a more robust framework for identifying fossil rheids and highlight the importance of evaluating multiple characters when dealing with fragmentary material.
This narrative review aimed to summarize the consequences of hamstring tendon (HT) harvest for anterior cruciate ligament reconstruction (ACLR), with reference to tendon regeneration, knee flexor morphology, clinical assessment of knee flexion strength, and rehabilitation strategies for optimizing recovery. The available evidence suggests that the harvested semitendinosus (ST) and gracilis (GR) tendons regenerate in ∼70-86% of cases after ACLR. Despite tendon regeneration, ACLR with HT autograft results in morphological alterations in both the ST and GR. These changes include tendon elongation, proximal migration of the musculotendinous junction, muscle atrophy, shortened fascicles, and increased fatty infiltration, which may persist for several years after ACLR. Growing evidence also suggests that assessment of knee flexion strength after ACLR cannot rely on a single test position, and that knee flexion strength should be evaluated in both hip-flexed and hip-extended positions to provide a more comprehensive evaluation of the recovery. We propose that optimizing the recovery of knee flexion strength may benefit from a multifaceted approach: (1) early, symptom-guided initiation of isometric and low-load exercises to minimize early strength deficits, (2) progressive loading of the knee flexors across multiple hip-and knee-joint angles, including the seated leg-curl to promote a high ST activation, (3) subsequent incorporation of eccentric loading as part of progressive strengthening strategies, with the aim of enhancing ST and GR muscle volumes and fascicle lengths, and (4) strength assessments across multiple hip and knee-joint positions to monitor recovery, as testing in a seated position may underestimate residual deficits in the ST and GR.
This study aimed to predict hand-wrist developmental stages, the most reliable indicator of skeletal maturation, from panoramic radiographs (PRs) and lateral cephalometric radiographs (LCRs) using deep learning and to compare the two methods. The goal was to provide a rapid and objective method for growth assessment in orthodontic planning without additional radiation exposure. A total of 3703 patients who underwent hand-wrist radiographs (HWRs), PRs, and LCRs prior to orthodontic treatment were retrospectively analyzed. HWRs were classified according to Björk's 9-stage system and reduced to 5- and 3-group schemes. YOLOv5 was used for automated reference point detection, and the extracted regions were classified using a multimodal deep learning framework. EfficientNet-B0 was used for 9-stage classification, and EfficientNet-B4 was used for 5- and 3-group classifications. Clinical variables (age, gender) were included, and hybrid loss strategies addressed class imbalance while preserving sequential stage relationships. Performance metrics included accuracy, recall, mAP@0.5, balanced accuracy, Cohen's Kappa coefficient, and detailed error analysis; 5-fold cross-validation and ensemble learning were used to improve robustness. YOLOv5 detected tooth roots in PRs (accuracy 92.5%, recall 93.3%, mAP@0.5 = 0.942) and cervical vertebrae in LCRs (accuracy 98.9%, recall 99.9%, mAP@0.5 = 0.995). In PRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.3648, 0.5307, and 0.7520, respectively, while in LCRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.4350, 0.6336, and 0.8975, respectively. Deep learning can reliably automate skeletal maturation assessment across imaging methods and resolutions. Appropriately optimized models provide valuable decision support in orthodontic treatment, increasing efficiency and consistency.
In France, the absence of weekday on-call dental services leaves general dental practitioners (GDPs) as primary providers of urgent dental care. This study examined territorial inequalities in unscheduled and urgent dental care demand and provision and how GDPs adapt their organisation amid unequal workforce distribution. A national cross-sectional online survey was conducted among 945 licensed general dental practitioners. The main outcome measures were the weekly number of emergency consultations and calls per GDP and the answer-to-demand rate. Territorial workforce distribution was assessed using the Localized Potential Accessibility (LPA) index. Multivariable negative binomial regression examined associations with weekly emergency consultations. GDPs reported a median of 7 emergency consultations per week. Emergency demand and organisational patterns varied across workforce density gradients. The lowest and intermediate LPA terciles showed similar emergency pressure, while highly supplied areas showed lower demand and fewer consultations. In under-served areas, practices reported higher daily patient flows and more restrictive acceptance of unknown patients. Distance to the nearest hospital dental service was independently associated with emergency activity. The answer-to-demand rate varied across territorial gradients: over-served areas converted 80% of calls into consultations compared with 60% in under-served and 63% in adequately served areas, suggesting demand rationing in high-pressure territories. Overall, unscheduled and urgent dental care activity appears structured along a territorial continuum shaped by workforce distribution, secondary care accessibility, and practice-level organisational adaptation. Improving access to urgent dental care requires systemic approaches considering territorial configuration of services, referral pathways, and continuity of care rather than workforce numbers alone.
Despite the improvement of protocols for eliminating diastema in children and adolescents, there are some cases of orthodontists prescribing the wearing of elastic bands, which, if worn uncontrollably and without retention points on the teeth, can enter the periodontium, causing destruction of the tissues surrounding the teeth. This iatrogenic complication, if unfavorable, may necessitate the extraction of teeth. The article presents a clinical case of removing elastic bands from periodontal tissues in a 9-year-old child which remained in periodontal tissues for more than 2 months. Несмотря на совершенствование протоколов устранения диастем у детей и подростков, встречаются отдельные случаи назначения ортодонтами ношения эластических колец, которые при бесконтрольном ношении и в отсутствие ретенционных пунктов на зубах могут внедряться в пародонт, вызывая деструкцию тканей, окружающих зубы. Подобное ятрогенное осложнение при неблагоприятном исходе может привести к необходимости удаления таких зубов. В статье представлен клинический случай удаления эластических колец из тканей пародонта у ребенка 9 лет, которые оставались в тканях пародонта дольше 2 мес.
The development of fluorescent probes with large Stokes' shifts and high sensitivity remains a critical objective in chemical sensing and bioimaging. In this study, we report the design, synthesis, and comprehensive photophysical characterization of a novel regioisomeric bis(2-(2'-hydroxyphenyl)benzoxazole) scaffold, bis(HBO) 3, expanding the limited family of ESIPT-enabled bis(HBO) systems. This newly developed probe integrates two HBO units within a distinct C2'-symmetric framework, enabling systematic investigation of regio-effects on excited-state intramolecular proton transfer (ESIPT) behavior and analyte responsiveness. Photophysical studies reveal that bis(HBO) 3 exhibits characteristic ESIPT-driven emission with a large Stokes' shift (Δλ ≈ 160-180 nm) and solvent-independent fluorescence centered around λem ≈ 530 nm. In-depth spectroscopic analysis, including low-temperature fluorescence measurements, demonstrates the presence of multiple emissive keto rotamers, providing insight into the role of conformational dynamics in modulating emission behavior. Compared with previously reported bis(HBO) analogues 1 and 2, bis(HBO) 3 displays distinct emission features due to a pronounced regio-effect. Bis(HBO) 3 exhibited selective responsiveness toward several chemical analytes. The probe shows high stability under acidic conditions but undergoes deprotonation in the presence of strong bases and certain metal ions, particularly Cu(II), Ni(II) and Fe(II), resulting in pronounced spectral changes. Notably, bis(HBO) 3 exhibits a distinct and sensitive response toward fluoride anions, characterized by the emergence of a new absorption band (~ 415 nm) and a blue-shifted emission (~ 485 nm). Quantitative analysis using the Benesi-Hildebrand method confirms a 1:1 binding stoichiometry with moderate binding affinity, distinguishing its sensing behavior from previously reported bis(HBO) systems that exhibit 1:2 binding stoichiometry. Overall, this work summarizes bis(HBO) 3 as a unique ESIPT-based fluorescent skeleton and highlights the critical role of molecular symmetry and regio-effects in governing photophysical and sensing properties.
Bio-derived composite foams with lightweight, highly porous structures have attracted increasing attention for applications in biomedicine, sensing, thermal insulation, oil-water separation, and environmental remediation due to their sustainability and multifunctionality. In this work, we reported a novel composite foam (CBF), mainly composed of coir fiber, a cellulose fiber renowned for its excellent mechanical strength, durability, low density, and abundant availability as an agricultural waste. The obtained natural coir fiber-based foams owned a porous network skeleton with an ultralow density of 8.08 mg/cm3 and ultrahigh porosity of 99.28%, demonstrating low thermal conductivity (0.038 W/(m·K)), which is comparable to conventional bio-derived thermal insulation materials. After subsequent hydrophobic modification, the hydrophobic (a water contact angle of 147.4°) and oleophilic foam was capable of absorbing a variety of oils and organic solvents (60.63-164.83 g/g), showing good oil retention capacity and reusability. These results underscore the potential of the fiber-based foam as a multifunctional material for thermal management and environmental protection applications.
Lumbar spinal stenosis (LSS) is a common and disabling condition in older adults, and current treatment options leave a therapeutic gap between conservative management and open surgical decompression. Minimally invasive lumbar decompression (MILD) is a percutaneous, image-guided procedure that targets the hypertrophic ligamentum flavum as a primary driver of central canal narrowing. This systematic review evaluates the effectiveness and safety of MILD for the treatment of LSS. A systematic search of MEDLINE, Embase, Cochrane CENTRAL, and Web of Science was conducted for studies published between January 2016 and the first quarter of 2026. Studies were included if they enrolled adults with LSS who underwent the MILD procedure and reported validated clinical outcomes, such as the Visual Analog Scale, Numeric Rating Scale, Oswestry Disability Index, or Zurich Claudication Questionnaire. Sixteen publications representing 11 unique studies, including two randomized controlled trials and nine observational studies, met the inclusion criteria. Study quality was assessed using the Newcastle Ottawa Scale. Across the included studies, MILD was associated with consistent improvements in pain and disability compared with baseline and comparator treatments. In the MiDAS ENCORE trial, MILD produced significantly greater reductions in pain and disability than epidural steroid injections at 6 months. The MOTION trial demonstrated sustained improvements in pain, disability, and walking tolerance through three years compared with conventional medical management. Observational studies supported these findings and reported low rates of subsequent surgical intervention, generally at or under 12% within five years. Safety outcomes were favorable overall, with low rates of device-related complications. However, one propensity-matched comparison found a higher rate of postoperative neurologic symptoms following MILD relative to open decompression. MILD is an effective and generally safe treatment option for appropriately selected patients with LSS and neurogenic claudication driven by ligamentum flavum hypertrophy. Patient selection based on classic claudication symptoms, imaging confirmed hypertrophy, and failure of conservative therapy appears critical to optimizing outcomes. Further research is needed to clarify long-term comparative effectiveness relative to surgical alternatives and to standardize outcome reporting across studies.
The supraorbital foramen or notch constitutes an important anatomical landmark for maxillofacial surgery, regional anesthesia, and ophthalmologic procedures. Considerable variability in its morphology and location has been reported in different groups. The aim of the study was to assess the morphological and morphometric variability of the supraorbital foramen in medieval and contemporary skulls and to analyze its asymmetry and clinical relevance. The study included 234 adult male skulls originating from Central European skeletal samples: 87 contemporary skulls from the early 20th century and 147 medieval skulls (11th-16th centuries). Morphological assessment included identification of the supraorbital notch, complete foramen, and incomplete foramen. Morphometric measurements were performed using an electronic caliper and included distances between the supraorbital foramen and selected anthropometric landmarks. Statistical analysis was performed using Student's t-test, paired Student's t-test, and chi-square test with Yates correction. The supraorbital notch occurred in 54.5% of contemporary skulls and 71% of medieval skulls. The frequency of a complete supraorbital foramen did not differ significantly between the groups. In the contemporary group, significantly greater distances were observed between the supraorbital foramen and the frontozygomatic suture as well as the superior temporal line. Most other morphometric parameters did not show statistically significant differences between the groups. A small but consistent side asymmetry of the supraorbital region was observed. The supraorbital notch is the predominant morphological variant in both medieval and contemporary groups. Although certain differences in lateral frontal bone measurements were observed, the general topography of the supraorbital foramen appears relatively stable. The observed variability and asymmetry should be considered during surgical and anesthetic procedures involving the supraorbital region.
Dysregulated bone metabolism is the core pathological trigger of osteoporosis (OP) and other orthopedic disorders. Puerariae Lobatae Radix (PLR; kudzu) is a classic traditional Chinese medicinal herb, and its bioactive constituents including isoflavonoids and triterpenoid saponins exert well-documented bone-modulating effects. However, the specific mechanisms underlying PLR's regulation of bone metabolism have not been systematically elucidated, due to the complexity of bone metabolic signaling networks. Based on 127 relevant literature retrieved from Web of Science, Scopus and PubMed, this review systematically summarizes the molecular mechanisms of PLR and its core active components in regulating bone metabolism. We focus on PLR's regulation of pathways implicated in metabolic bone diseases (MBDs), including NF-κB, RANKL/RANK/OPG, PI3K/AKT, and MAPK, via multiple mechanisms including anti-inflammation, anti-oxidative stress, modulation of ferroptotic signaling, ie, regulation of iron-dependent lipid peroxidation-related cell death, autophagy modulation, and osteoimmune regulation, ie, modulation of interactions between immune responses and bone cells. This review suggests that PLR regulates bone homeostasis through multi-component and multi-pathway mechanisms, with potential effects on inhibiting osteoclast activity, promoting osteoblast function and maintaining bone microenvironment stability. It also provides a theoretical reference for further research on PLR, and highlights that future studies should focus on high-quality clinical trials and multi-omics exploration of signaling crosstalk to promote its clinical translation in MBDs.