임상 논문

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Breast ultrasound is widely used for cancer screening, but data scarcity and annotation challenges hinder deep learning adoption. Synthetic image generation offers a promising solution to enhance training datasets while preserving patient privacy. However, problems such as inadequate quality of synthesized images and the need for large amounts of data to train the synthesis models remain significant. We propose a three-stage latent diffusion model (LDM) workflow-enhanced by Vision Transformers and fine-tuned with low-rank adaptation-that synthesizes realistic malignant and benign breast ultrasound images directly from healthy samples while simultaneously generating accurate segmentation masks. Stage division significantly reduces the task complexity of a single synthesis model. Applied to the BUSI dataset (133 healthy, 487 benign, and 210 malignant images), the method generates synthetic cases of each tumor type. A ResNet101 classifier could not reliably distinguish synthetic from real images (AUC = 0.563), indicating high visual plausibility. Quantitative metrics confirmed strong fidelity: Fréchet inception distance = 15.2 and inception score = 1.79, indicating low distributional divergence in feature space and high similarity to real data. When used for training a U-Net segmentation model, the augmented dataset improved the F 1 -score from 0.870 to 0.896, demonstrating substantial gains in diagnostic accuracy. These results show that the proposed three-stage LDM can generate high-quality, anatomically coherent breast cancer images from healthy controls, effectively alleviating data scarcity and enabling more robust training of medical AI systems without compromising clinical realism. Delayed wound healing in diabetes mellitus (DM) is closely associated with endothelial mitochondrial dysfunction and impaired mitophagy. We therefore developed a liquid dermal matrix (LDM) and investigated its therapeutic efficacy and underlying mechanisms in diabetic wound repair. The release behavior and biocompatibility of LDM were characterized. Its therapeutic effects were evaluated in a streptozotocin (STZ)-induced diabetic mouse full-thickness wound model, and mechanistic studies were conducted in high glucose (HG)-treated human umbilical vein endothelial cells (HUVECs). LDM exhibited sustained protein release over 96 h. In STZ-diabetic mice, topical application of Gel + LDM markedly accelerated wound closure; the wound closure rate at day 12 increased from 68.87 ± 3.98% in the Gel group to 94.80 ± 1.35% in the Gel + LDM group (P < 0.001). Laser speckle imaging confirmed enhanced wound perfusion at day 12, with perfusion units increasing from 489.96 ± 33.74 (Gel) to 707.21 ± 24.21 (Gel + LDM) (P < 0.001). Histological analyses revealed improved re-epithelialization and collagen remodeling, alongside increased angiogenesis as indicated by elevated CD31 and VEGFA staining. Mechanistically, in HG-treated HUVECs, LDM restored autophagic flux, evidenced by increased LC3-II and reduced P62 accumulation, and promoted PINK1/Parkin-dependent mitophagy. This was accompanied by attenuated mitochondrial fragmentation, reduced mtROS, and improved mitochondrial membrane potential (ΔΨm). Functionally, LDM improved endothelial proliferation, migration, and tube formation, while these protective effects were largely attenuated by 3-MA, MG-149, or PINK1 knockdown, supporting a mitophagy-dependent mechanism. LDM accelerates diabetic wound healing and improves wound perfusion by restoring mitophagy and mitochondrial homeostasis in endothelial cells, highlighting LDM as a promising therapeutic strategy for DM-associated chronic wounds. Yttrium-90 resin microspheres selective internal radiation therapy ( 90 $$ {}^{90} $$ Y-SIRT) has been increasingly adopted worldwide as a locoregional treatment option for appropriately selected patients with liver malignancies. The key to ensuring that the tumor receives an adequate radiation dose while minimizing the dose to normal tissues is to optimize the trade-off between tumor control and the probability of normal tissue complications. To accurately determine a patient's internal radiation dose, pre-treatment dose planning and post-treatment dose verification using dosimetric methods are recommended and increasingly considered best practice in 90 $$ {}^{90} $$ Y-SIRT, where feasible. Due to the increased demand for personalized treatment and dose accuracy in clinical practice, 90 $$ {}^{90} $$ Y-SIRT dosimetry has transitioned from organ-level to voxel-level dosimetry. This paper introduces the relevant principles and development history of 90 $$ {}^{90} $$ Y-SIRT dosimetry for resin microspheres. It also discusses the clinical performance, influencing factors and practical applications of relevant dosimetry methods. These include body surface area (BSA) method, MIRD multi-compartment model method, and partition model method; voxel-S-value (VSV); local deposition method (LDM); and Monte Carlo (MC) method. Finally, it covers the subsequent development of resin microsphere 90 $$ {}^{90} $$ Y-SIRT dosimetry. We address computed tomography (CT) metal artifacts reduction (MAR) using a generative deep-learning model in the imaging physics framework. Existing deep learning-based MAR methods, though promising, generally lack explicit physical modeling of artifact formation and rely heavily on data-driven mappings. The absence of physics priors not only limits scalability, as they often require paired or task-specific datasets, but also makes such methods prone to hallucination, anatomical distortion, and unstable artifact suppression. We propose a novel self-supervised framework for CT MAR, integrating a lightweight multi-layer perceptron (MLP)-based beam-hardening correction with a conditional latent diffusion model (LDM). By incorporating a physics-informed correction step and an artifact-reproducing simulation technique, the framework aims to enhance scalability across diverse scenarios, reduce hallucination effects, and improve structural fidelity in the reconstructed images. The proposed MLP performs physics-driven polynomial correction, serving as a simplified but efficient alternative to existing approaches. Also, the proposed MLP implicitly incorporates sinogram consistency into its optimization objective, allowing case-specific adaptation and convergence toward the desired solution. Additionally, the learned MLP parameters are reused to simulate artifact-contaminated images from artifact-free scans, generating pseudo paired data for self-supervised training without requiring real paired datasets. A conditional LDM is trained on these synthetic pairs to remove residual artifacts. By operating in a low-dimensional latent space, the LDM significantly reduces inference time while maintaining high-quality reconstructions. The proposed method is evaluated on both the SynDeepLesion dataset and real clinical data, demonstrating superior artifact removal and structural preservation compared to the existing state-of-the-art MAR techniques. We particularly highlight the robustness, generalizability, and clinical applicability of the proposed framework. We proposed a self-supervised metal artifact reduction framework that combines MLP-based beam-hardening correction with a conditional latent diffusion model in the imaging physics framework. The MLP module provides physics motivated beam-hardening corrected CT images, while the residual artifact simulation strategy enables fully self-supervised training without the need for paired data. The proposed method demonstrated superior artifact suppression and structural preservation on both synthetic and clinical datasets, outperforming existing approaches. Injury to articular cartilage remains a major clinical challenge owing to its limited se

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear. We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider-level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria. The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges-Lehmann median difference 24 s, 95% CI 6-39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13-7.89; lateral pad: OR 0.67, 95% CI 0.19-2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral). In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers. To investigate the clinical relevance of plasma plasminogen activator inhibitor-1 (PAI-1) in pediatric epilepsy, focusing on its associations with seizure severities and therapeutic outcomes. We conducted a prospective cohort study to compare the plasma PAI-1 levels quantified by ELISA across children with active epilepsy, seizure-free patients, and healthy controls. Furthermore, subgroup analyses were conducted to assess the impact of AED treatment or long-term drug response to the plasma PAI-1 levels. PAI-1 levels were 2.1-fold higher in the seizure group than in the control group (p < 0.0001), and 1.3-fold higher than in remission patients (p < 0.0001). No significant difference was observed between the anti-epileptic drug-treated and untreated subgroups (p = 0.0689). Baseline PAI-1 levels predicted 12-month pharmaco-responses, with pharmaco-resistant patients showing 12% higher PAI-1 concentrations than responders (p = 0.0234). Our findings establish plasma PAI-1 as a promising biomarker for identifying children at high risk for pharmaco-resistant epilepsy, thereby addressing a high-burden condition. The persistence of PAI-1 elevation hints at underlying inflammatory or synaptic pathologies that may be novel therapeutic targets beyond conventional AEDs. Recent evidence has demonstrated a tight relationship between neuronal activity and glioblastoma (GBM) growth, involving novel mechanisms such as neuron-glioma synapses and tumor microtube networks. Seizure activity and antiepileptic drug (AED) usage are highly prevalent among GBM patients. In this study, we investigate the impact of AEDs and their mechanism of action on overall survival (OS) in a cohort of patients treated for GBM. We performed a retrospective, single-center study of a cohort of histopathologically proven GBM patients at a tertiary center. Multivariate analyses were performed at 4 different timepoints by (1) patients who did and did not use AEDs, (2) use of individual AEDs, and (3) use of AEDs with the same mechanism of action. A total of 236 patients were included in the analysis, 178 of which were on anti-epileptics (75.4%). There was no significant impact of AEDs overall in OS-median survival was 16.2 months for patients taking AEDs and 13.8 months for patients not. Being on a voltage-gated sodium channel (VGNC) blocker seemed to confer a significant survival advantage at 24 months when compared with patients not on AEDs (hazard ratio [HR] = 0.67, P = .045). This significance was, however, lost when corrected for covariates (multivariable HR = 1.01, confidence interval [CI] = 0.67-1.54, P = .953). While patients on adjuvant treatment had a higher OS, this was only the case in patients -taking AEDs. There was no significant effect of AEDs on OS, VGNC blockers trended toward significance at 24 months. However, a link may exist between AEDs and the impact of adjuvant treatments. Epilepsy is a clinically significant neurological disorder requiring lifelong pharmacotherapy with antiepileptic drugs (AEDs). Precise quantification of these agents in pharmaceutical formulations and biological matrices is essential to ensure therapeutic efficacy and patient safety. Although high-performance liquid chromatography (HPLC) is the gold standard for AED determination, hydrophilic interaction liquid chromatography (HILIC) has emerged as a powerful alternative, especially for highly polar and hydrophilic AEDs. HILIC provides several advantages, including superior peak resolution, enhanced reproducibility, and reduced analysis time; yet, its application in AED analysis remains relatively underexplored. This review critically evaluates the literature regarding HILIC's application in this field, focusing on chromatographic parameters, detection strategies, and method validation. Emphasis is placed on analytical performance, specifically sensitivity, accuracy, precision, and speed. Collectively, the evidence underscores HILIC's potential as a robust and efficient platform for the routine monitoring and quality control of AEDs, highlighting an underutilized approach to enhancing AED determination. However, technical constraints, including prolonged column equilibration and the complexity of retention mechanisms, remain challenges for its widespread routine implementation. Immediate cardiopulmonary resuscitation and early defibrillation are key determinants of survival after out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) remains inconsistently implemented, with major gaps in automated external defibrillator (AED) availability, integration and use. This study aimed to identify and prioritise barriers and enablers to PAD implementation and to highlight emerging deployment models for future research. During the third International Community First Responder Symposium (April 2024, Hinterzarten, Germany), 46 experts from 14 countries participated in a structured RAND-UCLA Appropriateness Method consensus study. In moderated discussions, participants identified barriers and enablers to PAD, which were grouped into four thematic fields: availability and accessibility, usability and awareness, technological and systemic aspects, and financial and maintenance concerns. Nine statements were formulated and rated on a 9-point Likert scale; strong consensus was defined a priori as a median ≥ 7 with ≥ 80% of ratings in the 7-9 range. All nine statements met criteria for strong consensus. Key barriers included limited 24/7 AED access, poor coverage in residential areas, lack of centralised, real-time AED registries, insufficient public training and awareness, legal concerns for lay responders, patchy integration with emergency medical services, and device and maintenance costs. Key enablers comprised mandatory AED registration and live mapping, community training, legal protection for lay users, equipping police and fire services with AEDs within a "nearest vehicle" strategy, and improved data sharing between AEDs and hospitals. Experts also highlighted innovative deployment concepts, including use of postal and transport fleets, Vertical Take off and Landing drones, predictive positioning models and low-cost device designs. This international consensus study underscores the need for coordinated policy, robust AE

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Sclerotic bone lesions pose a significant diagnostic challenge due to their low diagnostic yield in core needle biopsy. In this technical note, we propose a novel modification to the standard biopsy technique aimed at improving the diagnostic yield of biopsies performed on sclerotic bone lesions. The modification involves use of trephine needle to acquire one bony core sample then using trucut biopsy needle to acquire samples through the tunnel created by the trephine needle. Our approach leverages optimized instrumentation to increase the likelihood of obtaining sufficient and representative tissue samples from challenging sclerotic lesions. Through a detailed description of the technique and its application in clinical practice, we demonstrate how this modification can significantly improve the diagnostic approach for sclerotic bone lesions, providing clinicians with a reliable method for accurate histopathological diagnosis. Robot-assisted, monoplane C-arm angiography systems designed for hybrid operating rooms represent an alternative approach to neuroendovascular procedures. Conversely, non-computer-assisted monoplane systems or conventional biplane systems in angiography suites are widely established. This study aims to evaluate the effectiveness, safety and efficiency of a robotic C-arm angiography system in performing neuroendovascular interventions, including cerebrovascular digital subtraction angiography (DSA), embolization of the middle meningeal artery (MMA) in subdural hematoma, and mechanical thrombectomy for vessel occlusion. All patients undergoing DSA, MMA embolization, or mechanical thrombectomy between July 2020 and December 2024 were retrospectively included. Procedures were performed using a monoplane robotic C-arm system (ARTIS pheno, Siemens Healthineers, Munich, Germany) in a hybrid operating room. Clinical data, procedural details, and imaging outcomes were analyzed. Radiation exposure was assessed by fluoroscopy time, air kerma, and dose-area product (DAP). A total of 49 procedures were analyzed, including 28 DSAs, 6 MMA embolizations, and 15 mechanical thrombectomies. DSA and MMA embolization (EMMA grade ≥2) achieved 100% procedural success, while mechanical thrombectomies achieved successful reperfusion (mTICI ≥2b) in 93.3% of cases. Median procedure durations were 34.0 (IQR 18.0-45.0) minutes for DSA, 70.0 (IQR 28.0-126.0) minutes for MMA embolization, and 84.0 (IQR 67.0-106.0) minutes for mechanical thrombectomy. Median fluoroscopy times were 5.2 (IQR 2.9-11.5) minutes (DSA), 21.3 (IQR 8.8-36.5) minutes (MMA embolization), and 21.2 (IQR 18.5-42.9) minutes (mechanical thrombectomy). Median DAPs were 7262.5 (IQR 3867.8-11570.8) µGy·m² (DSA), 16135.5 (IQR 8244.2-18216.2) µGy·m² (MMA embolization), and 9875.2 (IQR 6524.3-18455.5) µGy·m² (mechanical thrombectomy). Additional 3D-angiography or cone-beam CT (CBCT) was associated with higher radiation exposure. Basic neuroendovascular procedures can be safely and efficiently performed using a monoplane robotic C-arm in a hybrid operating room, achieving procedural success and radiation exposure levels comparable to conventional biplane systems. The purpose of this work was to commission and validate GPUMCD, a GPU-accelerated Monte Carlo dose calculation engine for c-arm Elekta linear accelerators (linac). This algorithm was recently released for clinical implementation in the Elekta One Treatment Planning System (v6.2.3, EOP). A GPUMCD beam model was generated for all photon energies of a VersaHD linac (6X, 6FFF, 10X, 10FFF, 18X). A validated version of the Monaco Commissioning Utility was used to compare calculated percent depth dose (PDD) profiles as well as lateral profiles for open fields against measurements. An adapted MPPG 5.b methodology was used to verify point-doses and 3D dose distributions in homogeneous and heterogeneous media using the ArcCheck, solid water, the CIRS ZEUS phantom, and the IROC HN and spine phantoms. The average agreement between measured and calculated PDDs and beam profiles using a local 2% dose difference (DD) in the high dose region for fields greater than 5 × 5 cm2 was 98.4% ± 2.3% for all energies. Using a 2% DD and 2 mm distance-to-agreement (DTA) gamma criteria for all fields using a 5% dose threshold yielded an agreement of 99.9% ± 0.5%. For open fields, GPUMCD reduced the calculation time by 93% as compared to X-ray voxel Monte Carlo (XVMC) using the same hardware. All MPPG 5.b. recommended testing was within the suggested tolerance limits. All plan measurements passed at the recommended gamma criteria. GPUMCD heterogeneity agreement and point dose measurements were found to agree within 3%. The GPUMCD algorithm in EOP was successfully tested and commissioned for clinical use for the VersaHD linac. Craniospinal irradiation (CSI) is a critical treatment modality for central nervous system (CNS) tumors. This study aimed to compare the dose-volume parameters and treatment efficiency between O-ring and C-arm linear accelerators (linacs) for CSI. A systematic search of English and Chinese databases was conducted from January 2005 to January 2026. Studies were evaluated using the PICOS framework. Data extraction and meta-analysis were performed using Stata 18.0 software encompassing subgroup analysis. Twelve studies involving 87 patients were included. No significant differences were found in dose to the planning target volume (PTV) between O-ring and C-arm linacs (Dmax: standardized mean difference (SMD) = -0.14, 95% confidence interval (CI): -0.61 to 0.32; Dmean: SMD = -0.53, 95% CI: -1.57 to 0.50). However, O-ring linacs, including dual-layer multi-leaf collimator linacs (DLM-linac) and helical radiotherapy (HR), delivered significantly lower maximum doses (Dmax) to the heart and liver (heart Dmax: SMD = -1.53, 95% CI: -2.53 to -0.52, p = 0.003; liver Dmax: SMD = -1.33, 95% CI: -2.29 to -0.37, p = 0.007). Subgroup analysis revealed that DLM-linac significantly reduced Dmax to the eyes and esophagus compared to C-arm linacs (eyes Dmax: SMD = -0.62, 95% CI: -1.22 to -0.01, p = 0.045; esophagus, Dmax: SMD = -0.45, 95% CI: -0.89 to -0.01, p = 0.044). Additionally, HR had the highest monitor units and the longest treatment time among all linac types. Both O-ring and C-arm linacs are effective for CSI. No significant difference in PTV dose was revealed when the doses to the lungs and thyroid are comparable. However, O-ring linacs, particularly DLM-linac, provide superior protection for critical organs such as eyes and esophagus without extending treatment time. Considering both dose advantage and treatment efficiency, DLM-linac is a suitable radiotherapy treatment modality for CSI. Non-traumatic atlantoaxial dislocation (AAD) is an uncommon condition characterized by abnormal displacement between the C1 and C2 vertebrae, resulting in upper cervical spine instability with the possibility of causing mortal injury. We report a 63-year-old woman presented with chronic mechanical occipitocervical pain and mild upper-extremity weakness lasting more than 20 years. Her vital signs and systematic examination were unremarkable. Neurological examination revealed mild weakness of upper-extremity weakness (grade 4/5), hyperreflexia, impaired fine motor control, hand numbness, and a positive dynamic Hoffmann sign. Preoperative CT-angiography demonstrated left vertebral artery hypoplasia and right high-riding vertebral artery associated with atlantoaxial dislocation. The patient underwent C1-C2 fusion using a hybrid construct: a C1 lateral mass screw and C2 translaminar screw on the HRVA side, and a transarticular screw on the contralateral side. Intraoperative neuromonitoring was unavailable; therefore, the procedure was guided carefully using real-time C-arm

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

Effective pain management is essential in veterinary needle-related procedures. Traditional methods, including infiltrative, cream, and spray formulations, have limitations such as delayed onset, inconsistent temperature control, and skin damage. This study evaluated the efficacy of a novel vapocoolant spray (VetEase®, Recensemedical, Hwaseong-si, Republic of Korea) for enhanced pain relief. Ninety cases of dogs received cryoanesthesia immediately before undergoing three types of needle-related procedures: centesis (including cystocentesis, thoracentesis, and abdominocentesis), fine-needle aspiration (FNA), and jugular venipuncture. Each procedure was divided into three groups based on cryoanesthesia spray conditions: control (no spray), group A (2 s at 2°C), and group B (5 s at 2°C). Modified pain scores and visual analog scale evaluations were recorded immediately after needle insertion to assess the reduction in pain. Pain evaluation criteria included vocalization, general movements, and other observable responses. Significant pain reduction was observed in the centesis procedure for the group treated with cryoanesthesia at 2°C for 5 s (Group B), with a mean modified pain score of 0.8 compared to 3.7 in the control group (p = 0.001). The visual analog scale also showed a significant reduction in Group B (p = 0.001). Although both cryoanesthesia groups showed reduced pain levels during FNA and jugular venipuncture procedures, the differences did not reach statistical significance. No skin complications were reported. The novel cryoanesthetic device significantly alleviated needle-related pain during centesis procedures in dogs. It provided rapid local anesthesia, eliminating the need for prolonged onset times and minimizing skin complications, thereby presenting a viable alternative to topical anesthetics. With the growing number of veterinary centers performing pacemaker implantation in small animals, a better understanding of anesthetic management of these procedures has become essential. Most available studies focus primarily on surgical techniques, with limited discussion of anesthetic safety, efficacy, and intraoperative complications. Eighteen anesthetic procedures for transvenous pacemaker implantation were retrospectively reviewed in dogs treated at a veterinary referral center in São Paulo, Brazil, between 2024 and 2025. All dogs underwent clinical and laboratory evaluation, electrocardiography and/or Holter monitoring, and echocardiography. Continuous intraoperative monitoring included heart rate, electrocardiography, respiratory rate, end-tidal CO2, oxygen saturation, temperature, and invasive or non-invasive arterial blood pressure. Collected data included age, breed, sex, anesthetic protocol, clinical conditions, intraoperative events, and outcomes. Continuous variables were expressed as mean ± SD or median (range) according to data distribution assessed by the Shapiro-Wilk test. Group comparisons were performed using Student's t-test or Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test (p < 0.05). Sixteen dogs (8 males and 8 females) underwent 18 anesthetic procedures, including two reinterventions. The main indication for pacemaker implantation was third-degree atrioventricular block (75%). Anesthetic protocols were individualized according to patient comorbidities. The most frequent anesthetic complication was hypotension (27.7%), successfully managed with fluid therapy and vasoactive support. Electrode migration occurred in 11% of procedures and required reintervention. No perioperative deaths were recorded. Transvenous pacemaker implantation in dogs was successfully performed under individualized anesthetic management despite heterogeneous clinical conditions and absence of a standardized protocol. Hypotension was the most common anesthetic complication but was effectively treated. The routine use of temporary external pacing provided an essential safety margin for maintaining perioperative hemodynamic stability. No perioperative deaths were recorded. These findings support the feasibility and safety of tailored anesthetic strategies for canine pacemaker implantation, although prospective studies with larger populations are warranted to define optimal standardized protocols. This study compared the efficacy and safety of botulinum toxin type A (BTX-A) injection and CO2 ablative fractional laser combined with intense pulsed light (CO2AFL-IPL) therapy in preventing hypertrophic scarring after thyroidectomy. In this single-center, prospective, randomized controlled trial, 105 patients undergoing open thyroidectomy were assigned to three groups: silicone dressing (control), CO2AFL-IPL therapy, or BTX-A injection. Scar outcomes were assessed over 12 months using the Patient and Observer Scar Assessment Scale (POSAS), modified Vancouver Scar Scale (mVSS), 3D imaging, colorimetry, and adverse event reports. Both BTX-A and CO2AFL-IPL groups showed significantly improved POSAS and mVSS scores compared to the control group at 6 and 12 months (p < 0.001), with no significant difference between the two treatment arms. BTX-A treatment had fewer adverse events and lower pain scores. Colorimetry and 3D imaging revealed no significant differences between groups. Both BTX-A and CO2AFL-IPL effectively prevented post-thyroidectomy scarring, each outperforming silicone dressings. While their efficacy was comparable, BTX-A offered greater convenience, safety, and patient comfort, making it a more practical option for routine clinical use, with CO2AFL-IPL serving as an effective alternative where laser therapy is available. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This study aimed to evaluate the feasibility of incorporating injectable platelet-rich fibrin (i-PRF) into electrospun chitosan-polyvinyl alcohol (PVA) nanofibers by assessing (1) swelling behavior after immersion in i-PRF, (2) potential interactions between components based on Fourier transform infrared spectroscopy (FTIR) profiles, and (3) initial in vitro cytocompatibility using human primary fibroblasts.Chitosan-PVA nanofibers were fabricated by electrospinning and trimmed into 5-mm discs. Specimens were immersed in 0.5 mL of i-PRF for six time points (5, 10, 15, 20, 25, and 30 minutes), and swelling capacity was evaluated to determine the immersion time associated with the highest absorption. FTIR was performed to compare functional group profiles before and after i-PRF immersion. For cytocompatibility testing, 5-mm diameter nanofiber discs were soaked in 0.5-mL i-PRF for 10 minutes and placed into wells seeded with human primary fibroblasts (5 × 103 cells/well). After 24, 48, and 72-hour incubation at 37°C in a CO2 incubator, methylthiazol tetrazolium (MTT) reagent was added and incubated for an additional 4 hours. Absorbance was measured using a multimode microplate reader, and cell viability was calculated as the percentage relative to the control group.The highest swelling was observed after 10 minutes of immersion (p < 0.05). FTIR spectra showed no additional peaks indicative of new chemical functional groups after immersion, suggesting that i-PRF incorporation occurred predominantly through physical interaction rather than formation of new covalent bonds. In the MTT assay, fibroblast viability in the i-PRF-immersed nanofiber group was comparable to the control (p < 0.05), indicating no detectable cytotoxic effect under the tested conditions.Chitosan-PVA nanofibers demonstrated an ability to absorb i-PRF, exhibiting comparable FTIR functional groups following immersion. This finding indicates that the pr

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes. Tracheal schwannoma is a rare benign tumor originating from Schwann cells, and it is even less common in adolescents. The clinical manifestations are usually nonspecific respiratory symptoms such as cough and sputum production, which can easily be mistaken for infectious diseases. Imaging findings often suggest an inflammatory mass, making early diagnosis challenging. A 15-year-old female was admitted with a 3-day history of cough and sputum production and was initially diagnosed with community-acquired pneumonia. High-resolution chest CT and 3D reconstruction revealed a well-defined, mildly to moderately enhanced round nodule (approximately 1.1 × 0.7 cm) in the lower trachea, accompanied by bronchopneumonia. Imaging findings suggested an inflammatory myofibroblastic tumor or inflammatory granuloma. The lesion was completely resected under painless bronchoscopy. Histopathology showed spindle cells arranged in bundles, with strong positive staining for S-100 and SOX-10 and a Ki-67 proliferation index of about 5%, confirming the diagnosis of benign tracheal schwannoma. After postoperative anti-infective therapy, the patient's symptoms rapidly resolved. Although tracheal schwannoma is benign, it may initially present as pneumonia and mimic an inflammatory tumor on imaging, leading to diagnostic confusion. For adolescent patients with recurrent respiratory symptoms and poor response to conventional therapy, early chest CT and bronchoscopy should be considered. Bronchoscopic resection combined with anti-infective therapy can achieve excellent outcomes. Neisseria gonorrhoeae (NG) causes sexually transmitted hyperacute bacterial conjunctivitis. Involvement of the lacrimal gland is exceedingly rare and has been previously reported in two case reports. This report discusses a 71-year-old male who presented with a painful red left eye. There was notable swelling of the upper eyelid, which was confirmed on CT to be due to lacrimal gland inflammation. Clinical features of dacryoadenitis associated with scleritis were found on ophthalmologic assessment. Conjunctival swabs were sent for culture and returned positive for NG, following which the patient reported a new sexual encounter previously unknown to the treating clinicians. Following IV ceftriaxone and flucloxacillin, topical steroid and chloramphenicol eye drops, the patient saw marked clinical improvement. This case demonstrates that NG may present with unusual features, and clinicians should have a low threshold for conjunctival cultures and promptly explore the sexual and social histories of patients presenting with similar symptomology. Isolated epididymal tuberculosis presenting as chronic hydrocele is exceptionally rare and poses significant diagnostic challenges. We report a healthy 35-year-old male who presented with 6-month progressive unilateral scrotal swelling clinically diagnosed as chronic hydrocele. During hydrocelectomy, intraoperative findings revealed approximately 150 mL of clear fluid with dense adhesions between testis and tunica vaginalis-an atypical finding that prompted epididymal biopsy. Histopathology demonstrated non-necrotizing granulomatous inflammation with epithelioid cells and multinucleated giant cells, suggestive of tuberculosis. Subsequent pulmonary evaluation confirmed active tuberculosis with positive sputum acid-fast bacilli (2 + on Ziehl-Neelsen stain), Mycobacterium tuberculosis detection by GeneXpert MTB/RIF, bilateral apical nodules with tree-in-bud opacities on chest CT, and 18 mm tuberculin skin test induration. The patient completed nine months of standard anti-tuberculosis therapy comprising intensive phase (rifampicin, isoniazid, pyrazinamide, ethambutol for two months) followed by continuation phase (rifampicin and isoniazid for seven months) with complete clinical and radiological resolution. This case highlights three critical diagnostic challenges: atypical presentation as isolated hydrocele without classic tuberculous features, non-necrotizing rather than typical caseating granulomas, an

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Preliminary evidence suggests an increased risk for early-onset cognitive and neurological decline in ASD. While brain development in children, adolescents, and young adults with ASD diverges from neurotypical (NT) peers, it remains unclear in older adults with ASD. Understanding age-related changes of brain function in ASD is crucial to establish best practices for cognitive and health screenings and develop interventions that might reduce the risk of accelerated decline. Decreases in blood-oxygenation-level-dependent (BOLD) signal variability (BSV) in typical aging have been shown across multiple studies and are associated with poorer cognitive performance. We hypothesized that adults with ASD would show reduced BSV compared to the NT group, with steeper negative age associations in the ASD than NT group. The study assessed BSV during resting state fMRI in adults (40-70 years), 28 with ASD and 39 age-matched NT. General linear models tested diagnostic group, age, and group-by-age interactions, controlling for motion. Significant group-by-age interactions were observed for the right insular, left temporal occipital fusiform, right frontal orbital, and right inferior lateral occipital cortex, with BSV showing strong negative associations with age in the ASD but not NT adults. These findings suggest that BSV decreases may occur earlier in adults with ASD compared to their NT peers. This would be consistent with accelerated aging; however, additional longitudinal analyses are necessary to determine if the results presented truly reflect accelerated aging or arise from lifelong persistent differences in brain function. Understanding age‐related changes of brain function during aging in ASD is crucial to establish best practices for cognitive and health screenings to detect potential accelerated decline in older adults with ASD and to develop interventions that might reduce risk. BSV is an MRI‐based measure that decreases in typical aging and is linked to cognitive decline. In this study, we found that BSV decreases may occur earlier in 40–70‐year old adults with ASD compared to their neurotypical peers, possibly indicating accelerated aging, although additional longitudinal analyses will be required to confirm this. Verbal memory tasks differ in their cognitive demands and may rely on distinct left medial temporal structures. One model holds that verbal delayed recall is hippocampal dependent, whereas verbal paired associate learning relies on adjacent rhinal cortex. We test this by examining the relationship between task performance and regional temporal lobe volumes in individuals with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Retrospective analysis of 99 surgically naïve TLE patients (12 bilateral TLE-HS, 35 left TLE-HS, 28 right TLE-HS, and 24 MRI-negative left TLE) with contemporaneous neuropsychological and T1-weighted MRI data. Delayed recall was operationalized using the Rey Auditory Verbal Learning Test, and arbitrary associative learning with the Paired Associates Learning subtest. Linear regressions assessed associations between memory performance and temporal lobe volumes. We also studied a cohort with nonlesional left TLE to better distinguish the relative impact on verbal memory of left temporal onset seizures versus the structural integrity of the left mesial temporal lobe. Patients with left-sided TLE-HS (unilateral/bilateral) performed significantly worse on both memory measures compared to right TLE-HS and MRI-negative left TLE (p < 0.001). Left hippocampal volume significantly predicted performance on both measures (both p < 0.001), whereas rhinal cortex volumes were not significantly associated with either. Secondary analyses revealed associations between left temporal pole volume and both memory measures, and between inferior temporal gyrus volume and delayed recall. Despite differing cognitive demands, both verbal arbitrary associative learning and delayed recall were primarily linked to left hippocampal volume, underscoring its central role in verbal memory impairment in TLE. Associations with the temporal pole and inferior temporal regions suggest additional contributions from extrahippocampal areas. Left hippocampal atrophy exacerbates verbal memory impairment beyond what would be expected from seizure activity alone. The results of this study show that the ability to learn semantically unrelated information and recall unstructured information after a period of delay is particularly compromised in individuals with left hippocampal atrophy. These impairments were strongly associated with reduced left hippocampal volume. In contrast, volumes of the adjacent rhinal cortex were not related to memory performance. These findings underscore the central role of the left hippocampus in supporting verbal memory in temporal lobe epilepsy. This study investigates a novel femoral ring block technique designed to enhance postoperative analgesia for knee surgeries. Due to the complex innervation of the knee and the significant postoperative pain resulting from surgical interventions, effective regional anesthesia techniques are essential. Traditional methods, such as femoral, genicular nerves, and adductor canal blocks, often require multiple injections and can lead to prolonged procedure times and patient discomfort. This research hypothesizes that a high-volume injection from the midline into the femur would result in a ring-like spread of anesthetic, effectively targeting critical nerves involved in knee innervation. Four lower extremity cadavers with no prior history of knee surgery were included in the study. To enhance visibility, two different solutions (methylene blue-acrylic green dye and saline-radio-opaque substance mixtures) were used to obtain two different colors, as determined by CT and MRI. The ring block was applied to both knees of each cadaver using the same technique and the same solution. The spread was monitored during the injections using real-time ultrasonography. CT and MRI scans were performed after the block applications. Following the imaging procedures, the cadavers were dissected. Results demonstrated that this technique could potentially improve analgesia quality by effectively blocking multiple nerves with a single injection, thereby reducing the number of required injections and shortening block application time. In cadaveric dissections, the superior medial and lateral geniculate nerves, the vastus intermedius and vastus medialis nerves, and the saphenous nerve running along the adductor canal were stained. In conclusion, results demonstrated that six vital nerves for knee analgesia can be blocked with a single needle entry. The new ring block technique showed promising results as a more efficient approach to knee analgesia. Although further clinical researches are needed, this study lays the groundwork for future innovations in regional anesthesia for knee surgery. Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running. To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times. Cohort study; Level of evidence, 2. A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meeti

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

The indole scaffold is common in natural products and bioactive compounds, including anti-cancer and anti-inflammatory medicines. In this work, a series of indole-acrylamide derivatives was synthesized, and their antiproliferative and anti-inflammatory effects were evaluated on COX enzymes and against a panel of cancer cell lines. All the final compounds were characterized via HRMS and (1H & 13C)-NMR. Anticancer and anti-inflammatory activities were evaluated using standard biomedical techniques by SRB, MTS, and COX kit assays. Additionally, the molecular docking analysis was conducted using the AutoDock Vina tool. The results demonstrated that the produced compounds displayed significant inhibitory effects on the COX-2 enzyme, with IC50 values of 128 nM to 1.04 µM. 6a demonstrated significant COX-2 selectivity with an IC50 of 128 nM and an SI of 352, highlighting its preference for COX-2 over COX-1. 6c exhibited potent COX-2 inhibition with an IC50 of 0.215 µM and an SI of 10.6. The assessed compounds exhibited substantial cytotoxic effects on cancer cells, especially against liver cancer cell lines (Huh7, HepG2, Mahlavu, and SNU475), and breast cancer (MCF-7). 6d compound was the most COX-1 selective inhibitor, which observed potent activity against hepatocellular carcinoma, with IC50 values as low as 3.5 µM, and was highly effective against MCF-7. Additionally, COX-2 selective inhibitors, 6a and 6b, exhibited strong antiproliferative effects against both breast cancer (MCF-7) and melanoma (B16F1), with IC50 values ranging from 4.75 to 15.4 µM. Furthermore, the molecular docking of 6a demonstrated a strong affinity for the COX-2 enzyme, with energy scores (S) of -8.392 kcal/mol, comparable to celecoxib's score of -10.96 kcal/mol. The findings suggest a possible correlation between COX-2 inhibition and anticancer efficacy, especially for compounds 6a and 6c, which demonstrate excellent COX-2 selectivity and notable antiproliferative effects, positioning them as prospective candidates for further advancement in cancer treatment. Melasma remains a therapeutically challenging hyperpigmentation disorder due to its high recurrence rate and the limitations of existing topical therapies. Nicotinamide adenine dinucleotide (NAD+) is a fundamental coenzyme critical for mitochondrial bioenergetics, DNA repair, and NAD+-dependent sirtuin-mediated gene regulation. Its systemic decline is implicated in cellular ageing and dysfunction. This study examines a novel procedural intervention, which involves the intradermal delivery of high-dose NAD+ utilizing a microneedling therapy system (MTS). To evaluate the efficacy and safety of a series of microneedling sessions followed by topical sterile NAD+ booster application at three-week intervals for melasma management. A prospective single-centre case series was conducted over 21 weeks involving 36 Korean female patients with mixed-type melasma. Participants received five treatment sessions consisting of MTS immediately followed by NAD+ (Sihler N, Sihler Inc., Korea). The primary outcome measure was the change in Melasma Area and Severity Index (MASI) score from baseline to week 21. Secondary outcomes included blinded photographic evaluation using a 5-point Global Aesthetic Improvement Scale (GAIS) and patient-reported satisfaction measures. All enrolled participants completed the treatment protocol. Analysis revealed a statistically significant reduction in mean MASI score from 16.8 ± 5.2 at baseline to 6.9 ± 3.1 at week 21 (p < 0.001), representing a 59.2% improvement. Independent blinded dermatological assessment rated 83.3% of patients as demonstrating clinical improvement. The procedure demonstrated an excellent safety profile with only transient erythema and oedema observed, resolving spontaneously within 48 hours. The combination of MTS with microneedling-assisted topical application of sterile NAD+ appears to be an effective and well-tolerated intervention for melasma management. The distinct mechanism of action, focused on supporting cellular function, warrants further investigation in randomized controlled designs (e.g. split-face or vehicle-controlled trials). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Ceftobiprole is a new-generation cephalosporin with activity against Staphylococcus aureus, but a comprehensive evaluation of MIC Test Strip (MTS) and disk diffusion (DD) methods using EUCAST and FDA breakpoint is lacking. Using broth microdilution (BMD) as the reference standard, we assessed the performance of MTS and DD for determining ceftobiprole susceptibility among 422 clinical S. aureus isolates. Ceftobiprole retained potent activity, with MIC₅₀/MIC₉₀ of 0.5/1 mg/L and an overall susceptibility rate of 98.8%; methicillin-resistant Staphylococcus aureus (MRSA) showed 97.6% susceptibility. MTS demonstrated high agreement with BMD, achieving 98.8% categorical agreement (CA), 1.2% major error (ME), and zero very major error (VME) under European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, meeting the acceptability limits of ISO 20776-2:2021 and CLSI M52. DD performance was breakpoint-dependent: under EUCAST criteria, the overall CA was 89.6%, with 10.6% ME and 0 VME. The 40.3% of MRSA that fell into the EUCAST-defined Area of Technical Uncertainty (ATU) zone were all shown to be susceptible by the reference BMD method. Under Food and Drug Administration (FDA) breakpoints, the CA rose to 94.1% and ME fell to 1.7%. Consequently, MTS offers a reliable routine option; DD is suitable for routine testing under FDA breakpoints, while for EUCAST users, MRSA isolates in the ATU zone should be confirmed by BMD or MTS. VME was not determined under FDA breakpoints due to the absence of resistant isolates. Ceftobiprole offers a β-lactam option for Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA); however, its susceptibility testing remains insufficiently examined across both European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Food and Drug Administration (FDA) interpretive criteria. We systematically compared MIC Test Strip (MTS) and disk diffusion (DD) with broth microdilution (BMD), demonstrating breakpoint-specific performance for methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA and providing practical recommendations that allow laboratories to report accurate results regardless of the guidelines they follow. Human rhinovirus (HRV) is a highly widespread pathogen, the most frequent cause of the common cold, and often associated with asthma exacerbation. To date, attempts to develop direct-acting antivirals (DAAs) have proved unsuccessful, also due to their tendency to select resistant variants when challenged with HRV quasispecies. 27-hydroxycholesterol (27OHC), a cholesterol-derived host-targeting antiviral (HTA), inhibits HRV replication and is less prone to selecting resistant variants than the DAAs pleconaril and rupintrivir. In the present study, we developed and evaluated a lipid nanoparticle (LNP)-based formulation for the nasal delivery of 27OHC. The antiviral efficacy of 27OHC-loaded LNPs was assessed on HeLa cells by focus reduction assays and yield reduction assays. The effect on cell viability and the cytotoxicity were determined via MTS and LDH assays to calculate the 50% cytotoxic concentration (CC50). Efficacy and biocompatibility of 27OHC were further validated in a physiologically relevant 3D model of reconstituted human nasal epithelia derived from healthy donors. Cellular uptake and internalization kinetics of LNPs were assessed on HeLa cells with the use of fluorochrome-tagged LNPs and i

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Malignant lymphoma in the breast is rare, with primary breast lymphoma and secondary breast lymphoma being the two subtypes. Primary breast lymphoma presents as a fast-growing, painless, palpable mass and is less frequent due to limited lymphoid tissue in the breast. Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution. Prostate specific membrane antigen (PSMA) is a type II transmembrane protein overexpressed in the neovasculature of some pancreatic ductal adenocarcinoma (PDAC). PET/CT can detect this expression and has now become an essential tool in this context. However, this antigen can also be expressed by other neoplasms. While this may create diagnostic uncertainty, it could also open therapeutic opportunities. Here we describe a case in which a PET/CT performed to restage a patient with prostate adenocarcinoma experiencing biochemical recurrence revealed the coexistence of a PDAC. A literature review aimed to summarize the bibliographic evidence on the use of this technique in this setting, which is relatively uncommon. Prostate-specific membrane antigen can be overexpressed in PDACs. This finding may offer potential for theranostic applications. Although histopathological evaluation of myocardium is essential for detecting both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) following heart transplantation, indeterminate results and complication risks associated with repeated endomyocardial biopsies remain serious problems. We investigated the clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect rejection. This retrospective single-center study reviewed the clinical data of heart-transplant recipients at our institution between 2008 and 2022. Patients who underwent 18F-FDG PET/CT scans post-transplant were enrolled. Scans were performed following a high-fat, low-carbohydrate diet initiated 24 hours before imaging and an 18-hour fasting period. FDG uptake was represented as cardiac metabolic volume (CMV), maximum standard uptake value (SUVmax), and total lesion glycolysis (TLG). During the study period, 132 18F-FDG PET/CT scans in 40 heart-transplant recipients were identified. Age at transplant was 53 [43-62] years old, and 29 patients (73%) were male. We found 10 scans at the time of significant ACR. No patients experienced AMR. At the time of ACR, CMV (88.2 [22.5-275.8] vs 0.0 [0.0-7.3] ml, p < 0.001), SUVmax (9.21 [6.87-16.0] vs 2.98 [2.49-4.48], p < 0.001) and TLG (365.3 [78.3-1,908.7] vs 0.0 [0.0-25.8] g, p < 0.001) were significantly higher compared to those without rejection. From baseline to the time of ACR, significant increases of CMV, SUVmax, and TLG (p < 0.001 for all) were also found. FDG uptake was significantly elevated at the time of ACR. 18F-FDG PET/CT may represent a promising non-invasive diagnostic adjunct for detecting ACR following heart transplantation. Prostate-specific membrane antigen (PSMA) PET is used to guide postprostatectomy salvage radiotherapy (SRT) and enable intensification through dose escalation and target modification. The oncologic benefit and safety profile of PSMA PET-guided intensification remain uncertain. We aimed to synthesize comparative and single-arm evidence on oncologic outcomes and toxicity of PSMA PET-guided intensification of postprostatectomy SRT. We performed a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Embase and Cochrane Library were searched from inception to 26 December 2025. Comparative and single-arm studies evaluating PSMA PET-guided intensification of postprostatectomy SRT were included. We included clinical studies using PSMA PET/CT or PET/MRI to guide radiotherapy intensification and excluded preclinical studies and non-original reports. Primary outcomes were failure-free survival (FFS) and biochemical recurrence-free survival (bRFS). Secondary outcomes included metastasis- and survival-related endpoints, treatment escalation, and toxicity. Meta-analysis was conducted only when sufficient comparative data were available. Hazard ratios were pooled in RevMan 5.4.1 using fixed- or random-effects models according to heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical significance was set at two-sided P<0.05. Fifteen studies met inclusion criteria, including five comparative and ten single-arm studies. Two studies reported FFS-type endpoints; because only two studies were available and endpoint definitions differed substantially, these findings were summarized descriptively. Four comparative studies involving 692 patients contributed to bRFS meta-analysis. PSMA PET-guided SRT showed numerically improved bRFS versus standard SRT, but the difference was not statistically significant (pooled HR 0.61, 95% CI 0.33-1.13; P = 0.12; I²=55%). Other secondary oncologic outcomes were variably reported with limited events and were synthesized descriptively. Severe genitourinary or gastrointestinal toxicity was uncommon, and some studies suggested delayed treatment escalation. PSMA PET-guided intensification of postprostatectomy SRT may improve biochemical control without an increase in severe toxicity; however, a statistically significant bRFS benefit was not demonstrated and evidence for other oncologic outcomes remains limited. https://www.crd.york.ac.uk/prospero/, identifier CRD420261277044. Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies. Catastrophic antiphospholipid syndrome is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. A 74-year-old woman presented with progressive dyspnoea and acute right-hand ischaemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischaemia and later on she suffered an ischaemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. Catastrophic antiphospholipid syndrome should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management. Metastasis-directed stereotactic body radiotherapy (MD-SBRT) has shown promise in retrospective and phase II studies for oligometastatic hormone-sensitive prostate cancer. However, prospective randomized phase III data-particularly in newly diagnosed cases and in combination with androgen deprivation therapy and next-generation androgen receptor pathw

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)-estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)-derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain. To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers. In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)-adjusted FRAX-Hip and defined high risk as FRAX-Hip ≥3%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest-yet modest-incremental improvement over a base clinical model (ΔAUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46-0.62) and negligible incremental value. The clinical model explained >93% of the variance in log-transformed FRAX-Hip. Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density-related risk factors while maintaining tight RA disease control. Over the past few decades, X-ray computed tomography (CT) has been introduced as one of the main cross-sectional imaging methods in a wide range of clinical applications in diagnostic radiology, oncology, and multimodality molecular imaging. Despite the acknowledged value of this imaging method, in some cases, the quality of CT images is affected by the presence of metallic implants. The presence of metal objects such as dental fillings, hip or knee prostheses, pacemakers, war shrapnel, and spinal cages cause and exacerbate image artifacts. These types of artifacts appear in the image as black and white lines that obscure the structures and tissues surrounding the metal implant and destroy the diagnostic value of CT images. These artifacts also affect the accuracy of radiotherapy treatment planning, which relies on CT images to characterize electron density and estimate the relative stopping power of particles. Therefore, to solve this problem, over the past 4 decades, algorithms called Metal Artifact Reduction (MAR) have been proposed. The objective of this study was to assess the five MAR algorithms using simulation and clinical studies. The algorithms include linear interpolation (LI-MAR) of degraded data in sinograms, normalization metal artifact reduction (NMAR), metal removal method (MDT), metal artifact reducer for orthopedic implants (OMAR), and a method based on iteration-based algorithms (MAP). Clinical images in different body regions, with different dimensions and types of metal implants, have been studied to evaluate the performance of MAR algorithms. To quantitatively assess the quality of images modified with MAR algorithms, the normalized root mean square error (NRMSE) criterion has been calculated and evaluated. The results of the algorithm evaluation showed that the NMAR algorithm was more efficient than other algorithms in reducing metal artifacts in most cases. Also, the algorithm processing time parameter demonstrated the clinical value of the NMAR algorithm. With the ability to achieve ideal efficacy while significantly reducing radiation damage to normal tissues, ultra-high dose rate radiotherapy (FLASH-RT) is considered one of the most innovative technologies for cancer treatment in the era of precision medicine. However, compared with conventional radiotherapy (CONV-RT), FLASH-RT has not demonstrated superior efficacy in treating tumors. We found that the tea polyphenol EGCG could observably promote FLASH-RT X-ray-induced ROS production and DNA damage compared to CONV-RT. A radiosensitizer was further designed by functionalized self-assembled EGCG nanoparticles (named BENPs), aiming to strengthen the anti-tumor effect of FLASH-RT. In vitro experiments such as CCK-8 assay and DNA damage experiment were carried to verify the sensitising effect of BENPs to 4T1 cells. It was further validated in vivo and the molecular mechanism was analyzed using immunofluorescence staining. Biosafety was evaluated by hematoxylin and eosin (H&E) staining and blood routine experiments. Flow cytometry was used to investigate the in vivo immune status of mice triggered by BENPs synergized with FLASH-RT. RNA sequencing assay was employed to estimate the immune response in the spleen of mice. This combined strategy markedly induced apoptosis and necrosis in tumor cells, which availably inhibited the malignant progression of tumors with good biosafety. More than that, BENPs-assisted FLASH-RT facilitated dendritic cell maturation and increased CD8+ Cytotoxic T cells, B lymphocytes, natural killer and memory T cells differentiation, implying the induction of "positive regulation" of the immune microenvironment, with a better immune prognosis. Meanwhile, the activation of immune regulation was confirmed by effectively upregulation of proinflammatory cytokines in the serum. Our study suggests that the potential application of BENPs as a sensitizer for FLASH-RT that brings new inspiration for the future clinical application of FLASH-RT therapy. Foreign body aspiration (FBA) in adults is rare and often overlooked, presenting with nonspecific pulmonary symptoms that may mimic recurrent infections or malignancy. Delay in diagnosis can lead to prolonged morbidity and mismanagement. We report a 55-year-old woman with a 2-month history of productive cough, intermittent hemoptysis, dyspnea, pleuritic chest pain, and recurrent pneumonia unresponsive to multiple courses of antibiotics and corticosteroids. Chest X-ray revealed right middle-lobe collapse, while computed tomography demonstrated a linear radiopaque lesion in the right middle-lobe bronchus. Flexible bronchoscopy confirmed complete bronchial obstruction by purulent debris concealing a sharp chicken bone fragment, which was retrieved successfully. The patient showed rapid clinical improvement following removal. This case underscores the importance of considering FBA in the differential diagnosis of persistent atelectasis or treatment-resistant pneumonia in adults, even in the absence of aspiration history or risk factors. Diagnostic bronchoscopy remains the gold standard, enabling both definitive diagnosis and therapeutic intervention, thereby preventing misdiagnosis as neoplasm and avoiding unnecessary procedures. Liver fibrosis is the key determinant of prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). While obesity is a major risk factor, whether regional adipose tissue distribution differentially relates to fibrosis independent of overall adiposity remains unclear. We analyzed data from 3668 U S. adults participating in NHANES 2017-2018 with available dual-energy X-ray absorptiometry and vibration-controlled transient elastography. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and thigh subcutaneous adipose tissue (tSAT) were expressed as percentages of total fat mass (VAT%, aSAT% and tSAT%). Clini

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%

Despite therapeutic advances, multiple myeloma (MM) remains incurable due to the development of drug resistance by malignant plasma cells (PCs) and a severe immunosuppressive bone marrow (BM) microenvironment. Oncolytic virotherapy offers the dual benefit of tumor cell lysis and immune activation, but the efficacy of human viruses is often hampered by pre-existing antiviral immunity. Here, we demonstrated that bovine herpesvirus type 1 (BoHV-1), a virus that is nonpathogenic to humans, efficiently infected MM cells, inducing mitochondrial apoptosis and suppressing pro-survival programs, including MYC targets, oxidative phosphorylation, and the unfolded protein response. Infected tumor cells upregulated NK-activating ligands and downregulated MHC class I, enhancing susceptibility to NK-mediated cytotoxicity. In patientderived BM mononuclear cells (BMMCs), BoHV-1 selectively reduced malignant PCs and immunosuppressive myeloid subsets, while sparing lymphoid populations and hematopoietic progenitors. The infection promoted activation of CD8⁺ T cells, NK cells, and monocytes, driving a shift toward a pro-inflammatory M1-like polarization. Monocyte depletion in BMMCs attenuated the BoHV-1 anti-MM effect, confirming their functional contribution. This pronounced immune remodeling was accompanied by an inflammatory cytokine storm dominated by type I/II interferons and key innate immune mediators. Co-treatment of BoHV-1 with either bortezomib or lenalidomide increased anti-MM cytotoxicity. Finally, BoHV-1 upregulated CD38 on both MM cells and immune effectors, thereby increasing sensitivity to the anti-CD38 daratumumab. These findings establish BoHV-1 as a promising immunovirotherapy agent, effective as a single agent and in combination strategies, by coupling direct oncolysis with broad immune remodeling of the BM microenvironment. Therapy-related acute myeloid leukemia (t-AML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor outcomes. The liposomal formulation of cytarabine and daunorubicin (CPX-351) improved complete remission (CR) and CR with incomplete hematologic recovery (CRi) rates and overall survival (OS) compared with 'standard' induction (7+3) chemotherapy in a phase-III trial for patients aged 60-75 years. However, 7+3 dosing varies among trials and in clinical practice and it remains unknown whether CPX-351 is superior to 7+3 double-induction regimens including intermediate-dose cytarabine, as the one employed in the HOVON-SAKK-Nordic clinical trials. To address this question, we conducted a post-hoc analysis on t-AML/AML-MRC patients aged ≥60 years enrolled in three HOVON-SAKK-Nordic trials and defined a subset of patients that met the eligibility criteria of the CPX-351 trial and compared their outcomes with those of the CPX-351 arm using reconstructed survival data. CR/CRi rates were higher in the higher-intensity 7+3 cohort (67.8%) compared with CPX-351 (47.7%) with similar median OS between the two cohorts (10.1 months versus 8.9 months respectively, HR = 0.99; 95% CI 0.78-1.26, p=0.95). Thirty-day mortality (4.4% for higher-intensity 7+3 versus 5.9% for CPX-351) and adverse events, including febrile neutropenia (61% for higher-intensity 7+3 versus 68% for CPX-351), were comparable. The data suggest that obligatory double-induction may achieve outcomes similar to CPX-351 in these patients and provide a strong rationale for ongoing clinical trials comparing these regimens. Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways. There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay. This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay. A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay. Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis. Level III-therapeutic study. Osteosarcoma, the most aggressive primary malignant bone tumor, has stagnant therapeutic outcomes despite decades of standard MAP chemotherapy and surgery; 5-year overall survival (OS) is <30% for metastatic/recurrent cases. Plagued by genomic heterogeneity, immunosuppressive TME, and low immunogenicity, emerging immunotherapies lack robust large-scale clinical validation. We systematically analyzed 864 interventional osteosarcoma trials from Trialtrove (as of September 2025). Results showed trial numbers peaked at 54 in 2021, with 77.3% past (completed/terminated) and over 94% in phase I/II (only 3.6% phase III-IV). Geographically, the U.S. dominated (60.9%, focusing on immunotherapy/targeted therapy), while low- and middle-income countries (LMICs) accounted for <2%