Background: Burn wound healing is a complex biological process requiring coordinated interactions among inflammatory cells, keratinocytes, fibroblasts, endothelial cells, extracellular matrix components, and neural structures. Increasing evidence suggests that sensory nerves actively regulate tissue repair through modulation of inflammation, angiogenesis, epithelial regeneration, and tissue remodeling. However, the role of sensory innervation in burn wound healing remains incompletely understood. The aim of this study was to investigate the effects of sensory denervation on healing of experimental second- and third-degree burns in rats. Methods: Thirty-two adult male Wistar albino rats were randomly allocated into four groups: denervated second-degree burns (Group 1), denervated third-degree burns (Group 2), innervated second-degree burns (Group 3), and innervated third-degree burns (Group 4). Bilateral T5-T7 sensory denervation was performed microsurgically in denervated groups. Standardized contact burns were subsequently created. Histopathological assessment of inflammation, neovascularization, epithelialization, fibroblast proliferation, and collagen deposition was performed on postoperative days 3, 7, 14, and 21. Results: Sensory denervation adversely affected multiple parameters of burn wound healing. Delayed epithelialization, impaired fibroblast proliferation, and reduced collagen deposition were most pronounced in denervated third-degree burns. Significant differences were identified between denervated and innervated wounds, particularly during proliferative and remodeling phases of healing. Conclusions: Sensory denervation significantly delays burn wound healing, particularly following third-degree thermal injury. Intact sensory innervation appears essential for successful epithelial regeneration, fibroblast activation, and extracellular matrix remodeling.
This report describes the surgical management and long-term follow-up of a dentigerous cyst associated with an ectopic mandibular third molar located in the condylar process. A 55-year-old female presented with pain, limited mouth opening, and a "cyst near the ear." Imaging revealed a radiolucent lesion in the left mandibular ramus associated with an impacted tooth in the condyle. Histopathologic analysis following incisional biopsy confirmed a dentigerous cyst. Given the lesion size and the inaccessible position of the tooth, surgical excision was performed through a preauricular approach under general anesthesia, including removal of the tooth and associated cyst. A 2.0-mm osteosynthesis plate was placed to reduce the risk of iatrogenic fracture. Although rare, ectopic third molars in the condyle are frequently associated with odontogenic lesions. In such cases, an extraoral approach may be required to achieve adequate exposure. A 10-year follow-up demonstrated complete bone healing and no recurrence.
Shigella spp. is recognized by the World Health Organization as a high-priority pathogen due to its global prevalence, unique pathogenic mechanisms, and growing antimicrobial resistance (AMR). Nearly half of all Shigella strains worldwide are now multidrug-resistant (MDR), and the emergence of extensively drug-resistant (XDR) variants-resistant to ciprofloxacin, ceftriaxone, and azithromycin-has severely limited effective treatment options. The present study is based on prospective laboratory surveillance involving 323 Shigella isolates collected during 2021-2023, with pre-COVID-19 pandemic data included from a previously published study solely for historical comparison. The presence of antibiotic resistance genes (ARGs) was investigated, and whole-genome sequencing (WGS) was performed on representative isolates to assess phylogenetic relatedness with global isolates. Approximately 10% of isolates exhibited resistance to third-generation cephalosporins. While only 3% of Shigella isolates carried the blaCTX-M-15 gene from 2013 to 2019, its prevalence increased to 26% by 2022-2023. Among 38 ceftriaxone-resistant S. sonnei isolates, 33 were also resistant to azithromycin, categorizing them as XDR. These isolates showed 48% clonal similarity and high phylogenetic resemblance to the isolates reported from England. Hybrid genome assembly revealed a plasmid harboring both the blaCTX-M-15 and mphA ARGs. Conjugation experiments and plasmid profiling confirmed the plasmid's transferability. We report a rising trend in third-generation cephalosporin resistance among Shigella spp., primarily driven by the spread of extended-spectrum β-lactamase-producing S. flexneri and the emergence of XDR S. sonnei. These findings underscore the urgent need for strengthened national AMR containment strategies and enhanced international surveillance of cephalosporin-resistant Shigella to mitigate this growing public health threat.IMPORTANCEShigella is a leading cause of diarrheal disease globally and has been prioritized by the World Health Organization due to its rapid acquisition of antimicrobial resistance. Our prospective surveillance in Kolkata, India, reveals a worrisome escalation of third-generation cephalosporin resistance over the past decade, primarily associated with the spread of blaCTX-M-15 and the emergence of extensively drug-resistant (XDR) S. sonnei. The detection of plasmids carrying both blaCTX-M-15 and mphA, coupled with evidence of their transferability, highlights the potential for accelerated dissemination of multidrug resistance. When compared with a global data set of international genomes, the Kolkata XDR isolates were found to cluster closely with isolates reported from England. By linking local surveillance with global genomic context, our findings provide critical insights for treatment guidelines, antimicrobial stewardship, and the design of international containment strategies aimed at curbing the rise of cephalosporin- and azithromycin-resistant Shigella.
Humans often struggle to accurately determine whether two different unfamiliar voice samples or face images belong to the same person. One method shown to boost face-matching performance is to have participants perform the task in pairs, which results in subsequent improvements for the poorer performers. This is a phenomenon known as 'the pairs training effect'. Previous studies have explored the pairs training effect using simultaneous face matching tasks whereby the two face images are presented side by side at the same time. Here we tested the efficacy of the pairs paradigm in unfamiliar voice matching (Experiment 1) which requires sequential presentation of the voices. We also tested sequential face matching (Experiment 2) to align the face task with the temporal demands of the voice task. In both experiments, participants completed one third of trials individually, one third in a pair, and a final third individually again. Across both tasks, we found that participants who initially performed poorly in the first individual task improved when completing the task in a pair and, importantly, retained this improvement in the final individual phase. Our findings show that the pairs training effect extends to identity matching of unfamiliar voices and remains even when stimuli are presented sequentially.
to report three cases of Silicone Oil-related Vision Loss (SOVRL) with an unreported Optical Coherence Tomography sign before and after removal. Three patients with SOVRL underwent multimodal retinal imaging, including spectral-domain OCT. Three male patients underwent pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). SO was used as intraocular tamponade in two cases with giant retinal tear (GRT) retinal detachment, and one case of macula-on retinal detachment and epiretinal membrane (ERM). In all cases, a foveal columnar hyperreflectivity (FOCOH) was identified before silicone oil removal (ROSO). Following ROSO, all the patients experienced reduction in visual acuity after an initial recovery. Two patients demonstrated regression of the FOCOH sign-one with concurrent visual recovery, while the other experienced persistent visual impairment despite disappearance of the sign (final VA 20/20 and 20/200). In the third case the hyperreflectivity persisted, accompanied by inner retinal cystoid spaces and poor final visual acuity (final VA 20/200). In the first case FOCOH disappeared after three months, in the second case the sign disappeared after one month from ROSO, and in the third case the FOCOH persisted for more than 2 months. The early presence of FOCOH under SO suggests its potential role as a predictive biomarker of visual decline. Recognizing FOCOH may provide additional clues for the early diagnosis of SOVLR and guide therapeutic interventions.
Tooth avulsion accounts for 0.5% to 16% of dentoalveolar traumas, and prognosis depends on immediate management. The International Association of Dental Traumatology developed an educational poster to guide laypeople in responding to such injuries. This study evaluated children's perceptions of the "Save a Tooth" poster and the knowledge acquired from it. Children aged 8 to 10 years were recruited. The poster's illustrations, children's comprehension, and readability were assessed using instrument 1, while knowledge acquired about emergency management of avulsion was assessed using instrument 2. Both instruments were administered after the poster presentation. Responses to instrument 1 were analyzed by categories, and responses to instrument 2 were classified as correct or incorrect. A total of 58 children from third to fifth grade participated. Most children reported that the poster was easy to understand, used accessible language, presented a new topic, required only one reading, had an adequate length, and would be understandable to peers of the same age. However, participants did not identify with the characters depicted, and fourth-grade students suggested that the poster could include more illustrations. The reported frequency of dental trauma among acquaintances ranged from 36.8% to 65%. All participants expressed interest in reading similar materials. Regarding knowledge acquisition, 65% of third graders, 63.16% of fourth graders, and 66.67% of fifth graders answered the sequence of emergency procedures incorrectly. Although the "Save a Tooth" poster was perceived as engaging and accessible, children demonstrated limited identification with the characters and a low level of knowledge retention regarding the correct sequence of emergency management for tooth avulsion.
Anthracosilicosis is a legally recognized occupational disease that imposes a significant public health and economic burden on developing countries. Environmental exposure to mixed metals may influence the onset and progression of the disease, but relevant evidence among Chinese coal miners remains inconclusive. To evaluate the association between exposure to individual metal elements and their mixtures and the risk of anthracosilicosis using a case-control design. This case-control study included 154 coal miners (84 anthracosilicosis cases and 70 controls) who applied for occupational disease diagnosis at the Third People's Hospital of Xinjiang Uygur Autonomous Region between 2020 and 2024. Controls were frequency-matched to cases by age and work tenure. Plasma levels of seven metal elements (Al, Cd, Co, Cu, Ga, Mn, Sr) were measured by inductively coupled plasma mass spectrometry (ICP-MS). Single-metal exposure was analyzed using binary logistic regression and restricted cubic splines (RCS). Mixture effects were evaluated using quantile g-computation (QGC), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). The case group had higher concentrations of Cd, Co, Cu, and Mn than the control group (P < 0.05). Serum levels of Cd, Cu, Mn, and Sr were positively correlated with the risk of anthracosilicosis (P < 0.05), whereas an inverse association was observed for Ga (P < 0.05). Both QGC and WQS analyzes indicated that the mixture of seven metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with anthracosilicosis risk (P < 0.05). The BKMR model indicated that when the overall mixture exposure level exceeded the 50th percentile, the joint exposure to metals was positively associated with an increased risk of anthracosilicosis (P < 0.05). Mn may be the largest contributor to the cumulative effect of mixed metal exposure on risk, and Ga was negatively associated with the risk of anthracosilicosis. The combined exposure to 7 metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with the risk of anthracosilicosis.
Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population.
Metachromatic leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency of the enzyme arylsulfatase A (ARSA, MIM #250100), which leads to progressive demyelination in the central and peripheral nervous systems, resulting in severe neurodegeneration and premature death. With the recent approval of the first ex vivo gene therapy for MLD, newborn screening (NBS) programs have begun to implement pilot studies for early detection, as identifying affected individuals during the pre-symptomatic therapeutic window is crucial. We present the analytical workflow and the NBS algorithm developed during the first year of MLD screening in Lombardy. The screening strategy comprised a first-tier test (1TT) using mass spectrometry to quantify sulfatide concentrations, a second-tier test (2TT) measuring ARSA enzymatic activity, and a third-tier test (3TT) based on whole-exome sequencing. A total of 16,130 newborns were screened for MLD. Of these, 6.41% required retesting (1TT), 1.53% underwent duplicate 2TT, and 0.36% proceeded to 3TT. No neonates were recalled, and no cases of MLD were identified through the screening program. The first-year implementation of MLD NBS in Lombardy demonstrates that a mass spectrometry-based sulfatide assay combined with a multi-tiered screening algorithm is feasible and reliable. Incorporating genetic analysis alongside expanded validation of additional sulfatide species may enhance specificity, reduce false positives, and facilitate timely identification of infants affected by MLD.
To investigate content validity, test-retest reliability, and inter-rater reliability, and agreement between in-person and video-call assessments of the Modified Bradykinesia Rating Scale (MBRS), a new instrument to assess different components of bradykinesia (speed, amplitude, and rhythm). This methodological study followed the COSMIN guidelines. Content validity was evaluated by experienced health professionals using the Content Validity Index (CVI). For reliability analysis, two trained raters assessed individuals with PD using the MBRS and, 7 to 14 days later, rater 1 performed the second assessment in-person and a third assessment via video call. Intraclass Correlation Coefficient (ICC) was used (α = 5%). Nine professionals confirmed adequate content validity (CVI ≥ 0.80) for all items. Fifty-two individuals with PD (66.9 ± 6.2 years; 61.5% men) were included. The MBRS showed adequate measurement properties: test-retest reliability (ICC: 0.464 ≤ ICC≤ 0.745; p ≤ 0.001), inter-rater reliability (ICC: 0.266 ≤ ICC ≤ 0.537; p ≤ 0.003), and agreement between in-person and video-call assessments (ICC: 0.488≤ ICC≤ 0.741; p ≤ 0.001). The MBRS demonstrated adequate content validity, test-retest, and inter-rater reliabilities and can be used in both in-person and video-call assessments. Bradykinesia is one of the most common and disabling symptoms in individuals with Parkinson’s disease (PD); however, the assessment of this outcome in this population is still limited and needs to be improved.The Modified Bradykinesia Rating Scale (MBRS) is a measurement instrument developed for the specific assessment of each component of bradykinesia (speed, amplitude, and rhythm).In addition to presenting good clinical applicability, the MBRS demonstrated adequate test-retest reliability, inter-rater reliability, and agreement for use via video calls, and it can be used with Brazilian individuals with PD.These findings may contribute to the increased use of the MBRS as a useful and adaptable instrument in various clinical contexts, including via video calls, which are an increasingly common method in rehabilitation.
Background: Walking is a dynamic activity that relies on inputs from the multisensory system, i.e., somatosensory, vision, and vestibular. These inputs are processed and integrated in the central nervous system to produce motor impulses for efficient walking balance. The Sensory Organization Test (SOT) is established as the gold standard for assessing sensory contributions to standing balance. However, no comparable assessments have been developed for the clinical evaluation of balance during gait. This study evaluated the Gait Sensory Interaction Test (GaitSIT), a novel virtual reality (VR)-based assessment for characterizing sensory-condition-specific changes in walking balance. Methods: The GaitSIT comprises a VR environment with a physical compliant foam walking surface that evaluates gait-balance by systematically manipulating and evaluating the sensory systems. Twenty-nine healthy young adults (mean age 24.9 ± 6.4 years) were instructed to complete 6 m walking trials under six standardized conditions (C): eyes open, eyes closed/dark scene, and rotating visual scenes on a firm surface, then repeated on a foam surface. Wearing an Oculus VR headset, participants were instructed to walk in a straight line at their preferred speed, as naturally as possible, in two test sessions on the same day, followed by a third test session 24 h later. Headset-derived sway measures, including position, velocity, and acceleration data, were recorded, and the continuous trajectory deviation angle (i.e., directional control) and sensory ratios were calculated. Linear mixed-effects models included trial-level walking speed as a covariate. Additionally, participants completed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) as a clinical standing-balance reference measure; its concurrent-validity findings will be reported separately. Results: Significant condition effects were observed for position, velocity, acceleration, and CTDA after adjustment for trial-level walking speed (all p<0.001), indicating that the six sensory conditions elicited distinct gait-balance responses. Significant differences relative to the baseline condition (C1) were observed across conditions C2-C6 for position, C3-C6 for velocity, and C2 and C5 for acceleration. Session effects were not significant for any primary kinematic outcome after speed adjustment. A significant condition × session interaction was observed for position (p<0.001), whereas velocity, acceleration, and CTDA demonstrated no significant interactions. Walking speed was significantly associated with position, acceleration, and CTDA, but not velocity. Sensory-ratio analyses revealed larger visual and vestibular ratios relative to somatosensory ratios, with the visual and vestibular ratios generally decreasing across sessions. Conclusions: GaitSIT successfully manipulated sensory conditions during overground walking and produced significant changes in gait-related sway, directional control, and sensory-ratio measures. These findings support the feasibility of GaitSIT as a portable, low-cost, and immersive assessment framework for characterizing sensory-condition-specific gait-balance responses after accounting for walking speed and providing indirect behavioral indices related to sensory reweighting.
To develop a measure for ego-depletion in oncology, as a foundational step for research and future interventions to reduce ego-depletion in adults coping with cancer. Helsinki Ethical approval was granted by the ethics board of the medical centre with which the first author is affiliated. A cross-sectional field test was carried out. Based on the conceptualisation and measurement of ego-depletion, health professionals from a multidisciplinary team at a cancer centre developed items according to the content of ego-depletion and its demonstration in cancer. To validate the measure, we used the Piper Fatigue in Cancer scale, the Emotional and Functional well-being scales from the General Functional Assessment of Cancer Therapy scale, and the Busing self-regulation scale. REDCap, a web-based application, was used to capture data, structure the questionnaire, and distribute it. The final sample comprised 364 respondents. Descriptive statistics and item characteristics were carried out. Item reduction was performed using partial inter-item correlations and factor analyses. A three-factor structure underlying 27 items on the Ego-Depletion in Cancer Scale (EDIC) was supported. We label the first factor 'Actively Withstanding Ego-depletion,' the second factor 'Ego-depletion Ambivalence,' and the third factor 'Ego Cognitive Exhaustion.' The EDIC significantly correlated with related measures (e.g. fatigue, self-control, and positive emotions; p < .05). A full EDIC scale, three subscales of the 27 items, is presented. Correlations demonstrated convergent validity and suggested the EDIC is distinct from existing constructs. Implications and applications are discussed. A path analysis demonstrated that the EDIC scale is valid for measuring ego depletion in adults with cancer.
Numerous cutaneous adnexal tumors have recently been characterized by specific molecular hallmarks, notably oncogenic gene fusions. Herein, we report three cases of a sweat gland tumor exhibiting a secretory morphology and harboring SFPQ::NFATC3 or NPM1::NFATC3 fusions. The cases presented in a 36-year-old woman (left thigh), a 55-year-old man (paraumbilical region), and a 65-year-old woman (scalp), and were dermal-based neoplasms. Histopathological examination revealed ill-defined tumors with an infiltrative growth pattern, predominantly centered in the dermis, with one case extending into the subcutis. Two cases were characterized by cords, small nodules, and nests of epithelioid cells with large hyperchromatic nuclei, while prominent glandular and cribriform structures were observed in the third case. Numerous round ductal structures filled with a dense eosinophilic secretory material were identified in all cases. Mitotic activity was very low (< 1/mm²). No lymphovascular or perineural invasion was observed. Immunohistochemistry demonstrated diffuse SOX10 positivity in one case and p63 expression in the remaining two. PanTRK and NUT were negative, and YAP1 expression was preserved. Molecular analysis revealed in-frame SFPQ::NFATC3 (n = 2) or NPM1::NFATC3 (n = 1) fusions with identical breakpoints within the NFATC3 gene. These three cases of sweat gland tumor harboring NFATC3 gene fusions may represent the first identified examples of a previously undescribed adnexal tumor.
Social environments profoundly impact social animals' gut microbiome. Understanding such effects is critical for evaluating population fitness and conservation. Employing 16S rRNA and metagenomic sequencing, we investigated the gut microbiome of the endangered white-headed langur (Trachypithecus leucocephalus) to clarify its potential adaptive strategies to social environmental changes. Distinct differences were observed among social groups: the all-male group was enriched in Bacillota and showed stronger cellulose degradation potential, which might be associated with greater cellulose intake and higher cortisol and T3 levels; mixed-sex group was enriched in Actinomycetota, Pseudomonadota, and non-carbohydrate metabolism genes, possibly due to more young leaves consumption and reproductive needs. Alpha male replacement also shaped gut microbiome: the third alpha male period had highest Bacteroidota and lowest metabolic genes abundance, potentially related to improved food quality during this period. These preliminary findings highlight gut microbial adaptation to social environments in the studied population, providing implications for the conservation of this endangered species.
Background: Effective treatments for patients with complex dissociative disorders (CDDs) are urgently needed. The psychoeducational programme Finding Solid Ground (FSG) has been shown to be effective as an adjunct to individual outpatient therapy.Objective: This naturalistic pilot study evaluates changes in adaptive capacities and symptoms in adults with CDDs during a 1 year follow-up period, including a 3 month inpatient FSG-based treatment followed by patients' continuation of the FSG programme in their outpatient treatment setting.Method: Thirty adult patients with CDDs were included in the study. Patients were admitted in four consecutive groups to the inpatient FSG-based programme, combining group and individual therapy. FSG has 30 topics, each consisting of a short educational video, a psychoeducational script, and written and practical exercises. Patients completed eight topics during the inpatient stay and continued with the remaining topics during their 9 month outpatient period. Changes in adaptive capacities and symptoms were explored, using mixed-model analysis and calculating reliable change.Results: Patients completed on average 19 of the 30 topics during the 1 year study period. They improved with large effect sizes on adaptive capacities, post-traumatic stress disorder (PTSD) symptoms, and self-compassion; a moderate effect size on difficulties in emotion regulation; and a small effect size on dissociation. The majority reliably improved on adaptive capacities, PTSD symptoms, difficulties in emotion regulation, and self-compassion; while almost one-third reliably improved on dissociation. Deterioration rates were small. The highest improvement rates were observed in patients who had completed the highest number of FSG topics.Conclusions: This naturalistic pilot study shows the feasibility of the FSG programme in an inpatient treatment context, followed by patients' continuation of the programme in their local treatment setting. The results also suggest that progress with FSG topics is associated with better outcomes. Further studies are needed to replicate the findings. This 1-year naturalistic pilot explored adaptive capacities and symptoms in 30 patients with dissociative disorder using the psychoeductional programme, Finding Solid Ground. in a context involving inpatient and outpatient treatment.Most patients showed clinically meaningful improvements in adaptive capacities and symptoms.Findings suggest that progress on the programme is associated with better outcomes, underlining the importance of strengthening interactions between actors at different levels of health services for patients with prolonged treatmen needs.
Background: Urolithiasis is a common condition characterized by a high risk of recurrence, although this risk varies substantially between patients. The present study aimed to quantify incidence, identify determinants, and model recurrence risk between stone composition and recurrence, and to assess the role of selected clinical and behavioral factors in a cohort of patients with confirmed stone clearance. Methods: This retrospective cohort study included adult patients with urolithiasis managed between 2017 and 2021 in a specialized referral center. Only patients with confirmed stone-free status and available follow-up were included. Stone composition was determined using morpho-spectroscopic analysis. Clinical and behavioral variables were collected from medical records. Recurrence was defined as a new stone event during follow-up. Time-to-event analysis was performed using Kaplan-Meier estimates and Cox proportional hazards models. Results: A total of 962 patients were included, with a median follow-up of over three years. During this period, recurrence occurred in approximately one-third of patients. Uric acid stones were associated with a higher risk of recurrence compared with calcium oxalate monohydrate stones, while the effect size was moderate. Previous stone history and low fluid intake were also independently associated with recurrence. Other dietary variables did not retain statistical significance after adjustment. Conclusions: Recurrence in urolithiasis appears to reflect the combined effect of compositional, clinical, and behavioral factors. While certain variables are associated with increased risk, no single determinant fully explains recurrence patterns. These findings support a more individualized approach to risk assessment and follow-up.
Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice.
Emergency physicians face considerable workflow challenges in the emergency department (ED) due to unpredictable work environments, frequent interruptions, and mounting documentation requirements, all of which contribute to substantial computer-based work. Excessive time away from direct patient care is increasingly viewed as detrimental to the quality of care, communication, and patient safety. This study aimed to quantify and visualize how emergency physicians allocate their time during ED shifts, particularly the time spent on the computer. This cross-sectional observational time-motion study was conducted in a high-volume, urban ED. We used the validated TimeCaT application to continuously track physician activities, including computer use, direct patient care, communication, and all other tasks carried out during the shift. Electronic health record event log data were queried to estimate physicians' computer use after their scheduled shift. The main outcome was the proportion of time spent on each activity. The primary measure was the total minutes of computer use (during and after the shift) per scheduled hour of clinical work. Additionally, we generated data visualizations to illustrate ED workflow-sequencing, task switching, and between-shift variability. We observed 20 emergency physicians for one 8- to 9-hour clinical shift each, generating over 150.0 hours of real-time observation data quantifying physicians' ED workflow. Physicians spent a median of 34.1% of their shift minutes using the computer (156.5, IQR 145.2-179.3 min) and 26.9% with patients (115.2, IQR 102.0-154.1 min). Other activities included 15.9% for verbal communication with staff (73.3, IQR 45.6-96.4 min), 9.5% phone use (41.4, IQR 33.4-59.2 min), 5.5% miscellaneous tasks (24.2, IQR 18.4-30.1 min), 3.9% personal time (16.8, IQR 9.9-25.4 min), 0.7% electrocardiogram review (3.8, IQR 1.4-5.0 min), and 0.4% other procedures (median 1.7, IQR 0.6-6.4 min). Electronic health record log analysis showed that physicians spent an additional median 1.3 (IQR 0.5-2.6) hours using the computer after their scheduled shifts, for a combined 29.8 (IQR 25.6-38.5) minutes on the computer per scheduled hour of their ED shift. Workflow visualizations showed frequent alternation among activity categories and noticeable variability in within-shift fragmentation across physicians. Emergency physicians spent more than one-third of their ED shift working on the computer, which was more time than they spent with patients. They also spent 1 to 2 hours using the computer after their scheduled shift. These findings demonstrate the need for strategies to reduce unnecessary computer use during and after clinical shifts to enhance workflow efficiency and improve patient care.
To evaluate the survival rate and clinical status of a glass ionomer (GI) sealant in hypomineralised permanent first molars (PFMs), as well as to assess the occurrence of post-eruptive breakdown (PEB) and measure dentin hypersensitivity in the sealed molars over a 12-month follow-up period. Fifty-two hypomineralised PFMs, with at least two-thirds of their crown erupted, exhibiting opacities on the occlusal surface, no caries or PEB, were sealed using a GI sealant (GC Fuji Triage®). Clinical evaluation was performed using the United States Public Health Service (USPHS) criteria. PEB was clinically diagnosed. In-office dentin hypersensitivity to thermal stimuli (air spray) was measured using the Wong-Baker Faces Pain Rating Scale (WBFPRS); at-home hypersensitivity to thermal (eating/drinking cold foods/beverages) and mechanical (brushing) stimuli was assessed by interviewing the patients. PFMs were evaluated at baseline, immediately after treatment and at 3-, 6-, and 12-month follow-ups. Fully retained GI sealants were effective in preventing secondary caries and reducing dentin hypersensitivity in hypomineralised PFMs; however, they did not prevent PEB.
Background and Clinical Significance: Metallic stents represent a breakthrough in the treatment of ureteric obstruction, improving patient quality of life. Despite their advantages, management of encrustation remains a difficult complication to address. This case series highlights the rare occurrence of permanent ureteral Wallstents remaining indwelling for over 20 years. It emphasizes that the function of these older devices can be successfully preserved using minimally invasive techniques. Case Presentation: This case series details three patients, two males, aged 75 and 69 years, diagnosed with colon cancer, and one female, aged 67 years, with cervical cancer, who presented with obstructive uropathy due to extrinsic malignant compression. As a therapeutic strategy, permanent ureteral Wallstents were placed in all three patients. Over time, the stents developed significant encrustation, leading to secondary obstruction. Clinical manifestations of this complication varied, ranging from asymptomatic hydronephrosis to acute symptomatic uropathy characterized by fever and localized pain. All cases were treated endoscopically with Ho:YAG laser lithotripsy, and urine flow was successfully restored. During the follow-up period, one patient experienced two recurrences that were managed with the same technique, another remained completely symptom-free, and the third was lost to long-term follow-up. Remarkably, the stents have remained functional for over 20 years post-implantation. Conclusions: This is a rare report documenting permanent ureteral Wallstents with such prolonged indwelling time. Furthermore, our findings suggest that through minimally invasive techniques, the function of these devices can be successfully preserved.