Search Results (18,082)

Competency in musculoskeletal (MSK) ultrasound requires learners to relate probe manipulation to spatial reasoning, image projection, and the appearance of characteristic artefacts, which remains challenging during early training due to the limited spatial context provided by conventional instructional resources. This study investigates whether reconstructing real MSK ultrasound examinations in an immersive extended reality (XR) environment is perceived as useful for early familiarisation with probe handling and image interpretation. The proposed system reproduces ultrasound acquisitions using synchronised ultrasound video, six-degree-of-freedom probe tracking, and surface scans acquired from cadaveric specimens, enabling the reconstruction of spatially accurate probe trajectories with each ultrasound frame linked to a corresponding position and orientation. Within the XR environment, users can interactively explore these trajectories or observe automated playback in which the recorded probe motion is presented together with the corresponding ultrasound sequence. An exploratory evaluation with healthcare professionals was conducted to assess perceived usefulness and clarity of spatial relationships. The results indicate that participants perceived spatially coherent playback of real ultrasound examinations in XR as a potentially useful aid for understanding probe–image relationships. These findings suggest the feasibility of this approach as a complementary resource for introductory MSK ultrasound training. Full article

Background: The development of robust artificial intelligence (AI) models for diagnosing Temporomandibular Disorders (TMDs) is severely constrained by data scarcity and patient privacy regulations. Cone-beam computed tomography (CBCT), the gold standard for assessing osseous changes in the temporomandibular joint (TMJ), inherently contains sensitive biometric facial features, making de-identification difficult without losing critical anatomical information. This study aims to develop and evaluate TMJCTGenerator, a specialized latent diffusion model (LDM) framework designed to synthesize high-fidelity, diverse, and anonymous TMJ CBCT images. We hypothesize that this LDM approach can achieve superior anatomical fidelity and diversity compared to traditional generative adversarial network (GAN)- and variational autoencoder (VAE)-based methods, specifically in capturing fine osseous details within sagittal and coronal views of the mandibular condyle. Methods: A training dataset comprising 348 anonymized CBCT volumes was obtained in this retrospective comparative study to extract high-resolution sagittal and coronal regions of interest of the mandibular condyle. An independent test set of 39 anonymized CBCT volumes was further included. We developed a class-conditional LDM that integrates a pre-trained VAE for perceptual compression with a conditional U-Net for iterative denoising in the latent space. Performance was evaluated via qualitative anatomical fidelity assessment, Fréchet Inception Distance (FID), and a blinded Visual Turing test conducted by experienced clinicians to determine the distinguishability of synthetic images from real data. Results: Qualitative analysis revealed that TMJCTGenerator produced images with superior sharpness and anatomical consistency compared to baseline models, successfully reconstructing fine bone structures essential for diagnosing degenerative joint disease. TMJCTGenerator achieved lower FID scores than both VAE and GAN baselines. In the visual Turing test, clinicians were unable to reliably distinguish the generated images from real scans, and non-inferiority analysis confirmed that the synthetic data were statistically non-inferior to real data. Furthermore, TMJCTGenerator demonstrated the capability to generate diverse pathological conditions, ranging from normal anatomy to severe osteoarthritic changes. Conclusions: The proposed LDM framework effectively addresses the data scarcity and privacy bottlenecks in TMJ AI research by generating realistic, fully anonymous medical imaging data. TMJCTGenerator outperforms traditional generative methods in both visual fidelity and diversity, offering a viable solution for training downstream diagnostic algorithms. The source code and pre-trained models of TMJCTGenerator have been made open-source. Full article

The cornea of the dromedary camel is essential for maintaining ocular clarity and protecting the eye in dry, dusty, and thermally stressful environments. Aquaporins are membrane channels that facilitate water transport, and AQP1 has been widely implicated in corneal fluid homeostasis in several species. The present work investigated, for the first time, the regional distribution of AQP1 in the camel cornea. Corneas collected from twelve healthy adult camels after slaughter were divided into nine anatomical regions: central (C), middle dorsal (MD), middle ventral (MV), middle nasal (MN), middle temporal (MT), peripheral dorsal (PD), peripheral ventral (PV), peripheral nasal (PN), and peripheral temporal (PT). Histological examination and immunohistochemistry were combined with digital morphometry to assess corneal layer thickness and AQP1 localization. AQP1 labeling was identified in the corneal epithelium, stromal keratocytes, and endothelium. Epithelial staining differed among regions and was most pronounced in the peripheral nasal region, whereas stromal keratocytes and endothelial cells showed strong and relatively uniform immunoreactivity. These findings indicate that AQP1 is broadly expressed in the camel cornea and likely contributes to regional control of hydration and tissue maintenance in an arid-adapted species. Full article

The superior mesenteric artery (SMA) is the second unpaired ventral branch of the abdominal aorta. The SMA supplies the abdominal organs that develop from the midgut. This study investigated the morphological characteristics of the SMA by (i) measuring its diameter in different sexes; (ii) assessing the vertical distance between the SMA and inferior mesenteric artery (IMA) origins in males and females, and (iii) observing if the hepatic artery arose from the SMA instead of the celiac trunk. This retrospective cross-sectional study included the contrast-enhanced CT angiograms of 260 patients (n = 205 males and 55 females) who attended the Radiology department at Sultan Qaboos University Hospital from 1 January 2021 to 31 December 2023. All included patients were aged 19–50 years and had no history of vascular pathology that altered the vascular dimensions, nor had any history of major abdominal trauma or abdominal surgeries. The mean diameter of the SMA in the study population was 7.51 ± 1.11 mm. The mean diameter of the SMA was found to be wider in males (7.73 ± 1.05 mm) compared to females (6.71 ± 0.96 mm, p < 0.001). The mean distance between the SMA and IMA was 62.67 ± 10.91 mm. The average distance between SMA and IMA in males and females was found to be 63.36 ± 10.67 mm and 60.09 ± 11.48 mm (p = 0.048), respectively. Incidence of the right hepatic artery originating from SMA, accessory right hepatic artery, and common hepatic artery originating from SMA was 7.7%, 0.38%, and 2.3%, respectively. Prior anatomical knowledge of arteries is important for occlusion, bypass grafting, and endovascular surgeries involving SMA. Full article

Capsular contracture (CC) remains the most common long-term complication of implant-based breast reconstruction (IBBR), significantly impacting cosmetic outcomes, patient satisfaction, and reoperation rates. Despite substantial advances in surgical technique, implant technology, and perioperative management, the incidence of clinically significant contracture persists at approximately 3–5% at five years in non-irradiated patients and escalates dramatically—to 20–50%—in those receiving postmastectomy radiation therapy (PMRT). The etiology is multifactorial, involving subclinical biofilm formation, a dysregulated host immune and foreign-body response, and radiation-induced fibrosis. This narrative review synthesizes contemporary evidence on the pathophysiology, clinical assessment, and modifiable risk factors for CC in IBBR, with particular emphasis on implant surface characteristics (smooth, textured, and polyurethane[PU]-coated), placement plane (prepectoral versus subpectoral), the role of acellular dermal matrices (ADMs), reconstruction timing (direct-to-implant versus two-stage), and the complex interplay with radiotherapy—including radiation timing, fractionation, and emerging delivery techniques. We also address ongoing controversies, including the lack of standardized objective diagnostic criteria, the comparative effectiveness of ADM versus PU-coated implants, and the optimal sequencing of radiation relative to reconstruction. By integrating the latest evidence from very recent major meta-analyses and national registries, this review provides an updated synthesis. We further propose an evidence-based clinical decision framework for CC risk mitigation. This review aims to inform individualized surgical decision-making and identify priority areas for future investigation. Full article

The history of ancient cities is often associated with devotional sculptures that accompanied the founding process of settlements. In southern Brazil, an old city founded in 1553 has its history linked to the image of Our Lady of Grace. However, the definition of its origin presents gaps, especially regarding its historical authenticity. This study aimed to identify the botanical species associated with this sculpture using the principles of historical anatomy. The sculpture underwent X-ray and CT scan examinations. Wood samples were extracted with a Pressler borer for histology and C¹⁴ dating. The identification was based on comparative anatomy. The artifact is carved from a single wood block, exhibiting wood integrity and absence of degrading agents. The species was identified as Cedrela sp. (Meliaceae), popularly known as cedar. C¹⁴ dated the wood around 1620 AD (330 ± 30 BP), offering new parameters for reflection on the origin of the piece and its relationship with the foundation of the city, traditionally associated with the year 1553. Cedar presents physical–structural characteristics of light density, is resistant to degrading agents, and possesses a pleasant aroma and dimensional stability, favoring its cultural use by master craftsmen and highlighting the richness in the carvings of religious images. The information contained within the wood was able to elucidate historical aspects regarding the founding of the city. Full article

Background: Sjögren’s disease (SjD) is a chronic autoimmune rheumatic disorder primarily affecting exocrine glands, leading to dryness and systemic involvement. B-cell hyperactivity and autoantibody production drive its pathogenesis and contribute to increased lymphoma risk. Although several long-term studies exist, we present a review of a closely monitored cohort assessed over 40 years. Methods: Retrospective observational study at University College London Hospital included patients fulfilling the 2016 ACR/EULAR criteria for SjD between 1986–2025. Patients with associated SjD were excluded. Associations between serological markers and clinical features were analysed using chi-square or Fisher’s exact tests (p < 0.05). Differences between ethnic groups were also assessed. Results: 283 patients were included, 93.3% female, with mean age at diagnosis of 50.1 ± 15.2 years and mean follow-up of 12.5 ± 8.6 years. Common manifestations were fatigue (61.5%), parotid swelling (30.5%), arthritis (25.8%), and Raynaud’s phenomenon (27.6%). Anti-Ro and anti-La antibodies were present in 75.7% and 45.2%, respectively; rheumatoid factor in 57.3%. Lymphoma developed in 9.9% (mostly non-Hodgkin MALT) and was associated with hypergammaglobulinemia (p = 0.03; RR = 2.56) and parotid swelling (p < 0.001; RR = 5.53). Serological markers correlated with systemic features including lymphadenopathy, vasculitis, and pulmonary involvement. Caucasian patients showed higher mortality (p < 0.001; RR = 3.89) and peripheral nervous system involvement (p = 0.02; RR = 2.18), and less ANA positivity (p = 0.004; RR = 0.88), anti-Ro (p = <0.001; RR = 0.77) and RF (p = 0.04; RR = 0.81) and hypergammaglobulinemia (p = <0.001; RR = 0.63) when compared with non-Caucasian patients. Conclusions: This long-term cohort confirms the strong association between B-cell activation markers and adverse outcomes in Sjögren’s disease. Hypergammaglobulinemia and parotid swelling emerged as key predictors of lymphoma, supporting their role in risk stratification. These findings reinforce the importance of long-term monitoring and may help guide personalized clinical management and surveillance strategies. Full article

The widespread use of modern insecticide formulations underscores the need for mechanistic evaluation of their potential renal toxicity. This study investigated the nephrotoxic effects of Ampligo^® 150 ZC, a binary formulation of lambda-cyhalothrin and chlorantraniliprole, in female rabbits under subacute exposure conditions, with particular emphasis on apoptosis-related and epithelial integrity biomarkers, and evaluated the protective effects of thyme essential oil (TEO) and vitamin C. Rabbits were allocated into four groups: control, AP, AP + TEO, and AP + TEO + vitamin C. Ampligo (AP) exposure resulted in significant renal dysfunction, as evidenced by elevated biochemical biomarkers and marked histopathological lesions. At the molecular level, AP induced p53 upregulation alongside Bcl-2 and Cyclin D1 downregulation, suggesting apoptosis induction and cell cycle dysregulation. Moreover, reduced E-cadherin and β-catenin expressions indicated disruption of epithelial junction integrity and impaired renal structural homeostasis. Notably, co-administration of TEO and vitamin C markedly attenuated these alterations, improving biochemical, histopathological, and immunohistochemical parameters. Overall, these findings suggest that AP-driven nephrotoxicity may involve apoptotic and epithelial pathways under subacute exposure conditions, whereas antioxidant co-treatment may mitigate kidney injury, supporting the potential of natural antioxidants as adjuncts against pesticide-induced renal injury. Full article

Objectives: This study aimed to examine the association between the dangling choroid plexus sign and fetal structural, chromosomal, and genetic abnormalities, as well as to define the normal range of lateral ventricular width and the ratio of choroid plexus width to lateral ventricular width at 14–17 weeks of gestation. Methods: This retrospective study analyzed ultrasound images from early fetal anatomy scans performed between January 2018 and July 2025 at two tertiary fetal medicine centres. In centre A, 6063 singleton pregnancies underwent routine scans at 11–13 and 14–17 weeks. In centre B, 776 fetuses with suspected abnormalities or increased nuchal translucency at 11–13 weeks were reassessed at 14–17 weeks. Additionally, 400 fetuses without obvious abnormalities at 14–17 weeks were used to determine normal ventricular measurements. Results: In normal fetuses, the mean lateral ventricular width was 6.90 mm (95% CI 6.81–6.99) and the mean choroid plexus-to-ventricle ratio was 0.85 (95% CI 0.84–0.86). A dangling choroid plexus was identified in 38 fetuses (0.16% in routine and 3.6% in high-risk populations). Out of 38 cases of dangling choroid plexus, 37 were associated with additional structural defects, chromosomal abnormalities, or single-gene disorders. Chromosomal abnormalities were found in 11/30 tested cases, most commonly trisomy 21. The most common defects observed on initial or subsequent scans were ventriculomegaly, cardiac defects, and abnormal posterior fossa. Conclusions: A dangling choroid plexus at 14–17 weeks is a sonographic marker associated with major fetal abnormalities and should prompt detailed anatomical assessment and consideration of genetic testing. Full article

Background and Clinical Significance: Revascularization of the circumflex territory remains technically challenging because of its anatomical position and the frequent need for distal branch grafting. Case presentation: We report the case of a 76-year-old man in whom the proximal circumflex trunk was used as the target for an in situ right internal thoracic artery routed through the transverse sinus during combined coronary and ascending aortic surgery. This approach allowed antegrade perfusion of the circumflex territory while avoiding multiple distal anastomoses. In this selected anatomical setting, the technique proved feasible and was associated with excellent intraoperative flow and 1-year radiological patency. Conclusions: Direct grafting of the circumflex trunk is not a new concept, but this case revisits it using a contemporary total arterial revascularization strategy. This approach may represent a useful adjunctive option in carefully selected patients with favorable circumflex anatomy. Full article

Background: This study aimed to evaluate the prevalence, morphology, and influencing factors of the second mesiobuccal (MB2) canal in maxillary molars and the middle-mesial canal in mandibular molars using cone-beam computed tomography (CBCT). Methods: A total of 146 CBCT scans acquired between 2023 and 2025 were retrospectively analyzed at the Oral Radiology Division, King Abdulaziz University Dental Hospital. Canal prevalence, morphometric dimensions, symmetry, and Vertucci configurations were recorded and correlated with age, sex, and voxel size. Results: MB2 canals were detected in 64.4% of maxillary first molars and 29.6% of second molars, while middle-mesial canals were found in 17.8% of mandibular first molars and 6.4% of second molars. Detection rates declined with increasing voxel size and patient age (p < 0.05). Bilateral symmetry was strong for MB2 (κ = 0.78) but moderate for mandibular canals (κ = 0.29). Vertucci Type I and II were most common in maxillary roots, and Type IV predominated in mandibular mesial roots. Conclusions: These findings confirm CBCT as a reliable tool for identifying complex canal systems and emphasize the importance of voxel resolution and anatomical understanding in enhancing endodontic diagnosis and treatment success. Full article

Epiphytic and leafless orchids possess specialized root structures and host diverse associated microorganisms, which may contribute to their adaptation to limited access to water, nutrients, and photosynthetic tissues. Microscopic, anatomical, and molecular analyses of aerial and substrate roots of Chiloschista lunifera (Rchb.f.) J.J.Sm. revealed consistent phototrophic microbial biofilms on the velamen surface. These biofilms comprised filamentous and unicellular cyanobacteria, singular bacterial cells, and green algae. Morphological characterisation identified cyanobacteria belonging to five taxonomic orders, which are Chroococcales, Chroococcidiopsidales, Nostocales, Leptolyngbyales, and Synechococcales. 16S rRNA amplicon sequencing confirmed cyanobacterial dominance, with Chroococcidiopsis thermalis PCC 7203 strongly prevalent in root wash samples (up to 99.99% relative abundance), while root homogenate samples harboured a more diverse assemblage including Phormidiaceae, Leptolyngbya, Scytonema, and Calothrix. In addition, a green alga from Watanabeales (Jaagichlorella sp.) was identified based on morphological characteristics. TEM showed diverse cyanobacterial forms and unicellular green algae with well-developed photosynthetic structures. Root anatomy differed between root types. Substrate roots exhibited an inverted kidney-shaped transverse profile, whereas aerial roots were circular, with differences in velamen distribution reflecting adaptation for water retention and substrate attachment. Branched root hairs occurred on substrate roots, while aerial roots possessed unbranched root hairs, indicating functional specialization. Autofluorescence analysis revealed lignified tissues and abundant cortical chloroplasts, suggesting a photosynthetic role of the roots that may compensate for leaflessness. These findings enhance our understanding of the anatomical and ultrastructural features of epiphytic leafless orchid roots and may support future conservation and propagation efforts. Full article

Background/Objectives: Coronary artery disease (CAD) remains the leading cause of death worldwide. Traditional cardiovascular risk assessment is based on chronological age and other clinical factors, with inherent limitations and poor accuracy. Objective was to estimate the artificial intelligence (AI)-enhanced biological cardiovascular age calculation derived from coronary computed tomography angiography (CTA) reports using a large language model (LLM), in predicting major adverse cardiovascular events (MACE). Methods: Coronary CTA reports were analyzed using a LLM (ChatGPT-4.0v, OpenAI), from symptomatic patients with suspected CAD who underwent coronary CTA for clinical indications. Patients in which the LLM successfully analyzed the key metrics (1) coronary artery calcium (CAC) score and (2) coronary CTA reports (coronary stenosis severity (CAD-RADS), high-risk anatomy, non-calcified plaque, cardiac function (LVEF and others) were included. Results: 386 CTA reports were uploaded, and 346 (89.6%) included. The mean biological age (bioAGE) was 57.2 ± 10.9 and the chronological 58.5 ± 10.8 years. 137 (39.6%) were women. The intra-individual deviation in bioAGE was high (median: 8.8; IQR 9.98). BioAGE exceeded chronological age in 45.4% patient and was lower or equal in 54.6%) MACE rate was 8.7% comprising 2 deaths, 5 myocardial infarctions, and 22 late revascularizations. The accuracy for prediction of MACE was higher for bioAGE (c = 0.768; 95% CI: 0.681–0.855, p < 0.001) compared to chronological age (c = 0.590; 95% CI: 0.492–0.689, p = 0.102) Conclusions: Biological age calculation from coronary CTA reports using LLM is feasible, yet intra-individual deviations are high. The accuracy for prediction of MACE is improved by bioAGE compared to chronological. Full article

Decellularized extracellular matrix (dECM) scaffolds derived from xenogeneic tissues represent promising biomaterials for tissue engineering. In this study, dECM scaffolds were developed and characterized from four ovine tissues—skin, tunica vaginalis, fascia lata, and pericardium—using a detergent-based decellularization protocol to evaluate decellularization efficiency and extracellular matrix (ECM) preservation. Decellularization was performed using a sequential detergent-based protocol with sodium dodecyl sulfate and Triton X-100. Decellularization efficacy and matrix preservation were evaluated through gross examination, histological analysis, scanning electron microscopy (SEM), and residual DNA quantification. Gross inspection revealed increased translucency and reduced pigmentation in decellularized tissues compared with native counterparts, indicating effective cellular removal while maintaining overall tissue architecture. Histological assessment confirmed the complete absence of nuclear and cytoplasmic material, alongside preservation of collagen-rich extracellular matrix organization. SEM analysis demonstrated well-maintained ultrastructural features, including aligned collagen fibers and porous ECM architecture, with complete removal of epithelial and stromal cellular elements. Quantitative analysis revealed approximately 94% reduction in residual DNA content across all decellularized tissues compared with native controls. This study demonstrated that the employed detergent-based protocol reliably produces structurally preserved, acellular scaffolds from multiple ovine tissues. The resulting biomaterials exhibit structural characteristics that support their potential use in tissue engineering applications, pending further functional validation. Full article

Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) ≥ 30 kg/m², identification of Calot’s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time. Full article