Search Results (423)

This study analyses the effectiveness of a contextualized teaching and learning sequence (TLS) based on forensic entomology (FE) to disprove the idea of spontaneous generation (SG) among students enrolled in the Higher Vocational Education and Training (VET) Cycle in Pathological Anatomy and Cytodiagnosis. Through an inquiry- and project-based learning approach, students replicate a version of Francesco Redi’s historical experiments, enabling them to engage with core scientific concepts such as the metamorphic cycle of insects and the role of entomology in forensic science. The research adopts a semiquantitative and exploratory design. It investigates: (1) whether students’ prior knowledge about FE and related biological processes is sufficient to refute SG; (2) to what extent this knowledge is influenced by their previous academic background and gender; and (3) whether a contextualized TLS can significantly enhance their conceptual understanding. The results reveal that most students begin with limited initial knowledge of FE and multiple misconceptions related to SG, irrespective of their previous study. Gender differences were observed at baseline, with women showing lower prior knowledge, but these differences disappeared after the intervention. The post-intervention data demonstrate a significant improvement in student’s ability to reject SG and explain biological processes coherently. The study highlights the importance of integrating entomology into health-related VET programs, both as a means to promote scientific literacy and correct misconceptions and as a pedagogical tool to foster critical thinking. It also highlights the potential and historically grounded methodologies to equalize learning outcomes and strengthen the scientific preparation of future healthcare professionals. Full article

Background/Objectives: Historically, echocardiographic imaging of the right heart has been challenging because its abnormal geometry is not conducive to reproducible anatomical and functional assessment. With the development of advanced echocardiographic techniques, it is now possible to complete an integrated assessment of the right heart that has fewer assumptions, resulting in increased accuracy and precision. Echocardiography continues to be the first-line imaging modality for diagnostic analysis and the management of acute and chronic right heart failure because of its portability, versatility, and affordability compared to cardiac computed tomography, magnetic resonance imaging, nuclear scintigraphy, and positron emission tomography. Virtually all echocardiographic parameters have been well-validated and have demonstrated prognostic significance. The goal of this narrative review of the echocardiographic parameters of the right heart chambers and hemodynamic alterations associated with right ventricular dysfunction is to present information that must be acquired during each examination to deliver a comprehensive assessment of the right heart and to discuss their clinical significance in right heart failure. Methods: Using a literature search in the PubMed database from 1985 to 2025 and the Cochrane database, which included but was not limited to terminology that are descriptive of right heart anatomy and function, disease states involving acute and chronic right heart failure and pulmonary hypertension, and the application of conventional and advanced echocardiographic modalities that strive to elucidate the pathophysiology of right heart failure, we reviewed randomized control trials, observational retrospective and prospective cohort studies, societal guidelines, and systematic review articles. Conclusions: In addition to the conventional 2-dimensional echocardiography and color, spectral, and tissue Doppler measurements, a contemporary echocardiographic assessment of a patient with suspected or proven right heart failure must include 3-dimensional echocardiographic-derived measurements, speckle-tracking echocardiography strain analysis, and hemodynamics parameters to not only characterize the right heart anatomy but to also determine the underlying pathophysiology of right heart failure. Complete and point-of-care echocardiography is available in virtually all clinical settings for routine care, but this imaging tool is particularly indispensable in the emergency department, intensive care units, and operating room, where it can provide an immediate assessment of right ventricular function and associated hemodynamic changes to assist with real-time management decisions. Full article

Many speech coding strategies have been developed over the years, but comparing them has been convoluted due to the difficulty in disentangling brand-specific and patient-specific factors from strategy-specific factors that contribute to speech understanding. Here, we present a comparison with a ‘virtual’ patient, by comparing two strategies from two different manufacturers, Advanced Combination Encoder (ACE) versus HiResolution Fidelity 120 (F120), running on two different implant systems in a computational model with the same anatomy and neural properties. We fitted both strategies to an expected T-level and C- or M-level based on the spike rate for each electrode contact’s allocated frequency (center electrode frequency) of the respective array. This paper highlights neural and electrical differences due to brand-specific characteristics such as pulse rate/channel, recruitment of adjacent electrodes, and presence of subthreshold pulses or interphase gaps. These differences lead to considerably different recruitment patterns of nerve fibers, while achieving the same total spike rates, i.e., loudness percepts. Also, loudness growth curves differ significantly between brands. The model is able to demonstrate considerable electrical and neural differences in the way loudness growth is achieved in CIs from different manufacturers. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

In the traditional classification system of the Lauraceae family based on morphology and anatomy, the phylogenetic position of the genus Sassafras has long been controversial. Chloroplast (cp) evolution of Sassafras has not yet been illuminated. In this study, we first sequenced and assembled the complete cp genomes of Sassafras, and conducted the comparative cp genomics, phylogenomics, and divergence time estimation of this ecological and economic important genus. The whole length of cp genomes of the 10 Sassafras ranged from 151,970 bp to 154,011 bp with typical quadripartite structure, conserved gene arrangements and contents. Variations in length of cp were observed in the inverted repeat regions (IRs) and a relatively high usage frequency of codons ending with T/A was detected. Four hypervariable intergenic regions (ccsA-ndhD, trnH-psbA, rps15-ycf1, and petA-psbJ) and 672 cp microsatellites were identified for Sassafras. Phylogenetic analysis based on 106 cp genomes from 30 genera within the Lauraceae family demonstrated that Sassafras constituted a monophyletic clade and grouped a sister branch with the Cinnamomum sect. Camphora within the tribe Cinnamomeae. Divergence time between S. albidum and its East Asian siblings was estimated at the Middle Miocene (16.98 Mya), S. tzumu diverged from S. randaiense at the Pleistocene epoch (3.63 Mya). Combined with fossil evidence, our results further revealed the crucial role of the Bering Land Bridge and glacial refugia in the speciation and differentiation of Sassafras. Overall, our study clarified the evolution pattern of Sassafras cp genomes and elucidated the phylogenetic position and divergence time framework of Sassafras. Full article

Precise medical image segmentation is crucial for advancing computer-aided diagnosis. Although deep learning-based medical image segmentation is now widely applied in this field, the complexity of human anatomy and the diversity of pathological manifestations often necessitate the use of image annotations to enhance segmentation accuracy. In this process, the scarcity of annotations and the lightweight design requirements of associated text encoders collectively present key challenges for improving segmentation model performance. To address these challenges, we propose MedLangViT, a novel language–vision multimodal model for medical image segmentation that incorporates medical descriptive information through lightweight text embedding rather than text encoders. MedLangViT innovatively leverages medical textual information to assist the segmentation process, thereby reducing reliance on extensive high-precision image annotations. Furthermore, we design an Enhanced Channel-Spatial Attention Module (ECSAM) to effectively fuse textual and visual features, strengthening textual guidance for segmentation decisions. Extensive experiments conducted on two publicly available text–image-paired medical datasets demonstrated that MedLangViT significantly outperforms existing state-of-the-art methods, validating the effectiveness of both the proposed model and the ECSAM. Full article

Background/Objectives: This case study presents the first documented use of a low-cost, simulated, patient-specific three-dimensional (3D) printed model to support presurgical planning for an infant with Apert syndrome in a resource-limited setting. The primary objectives are to (1) demonstrate the value of 3D printing as a simulation tool for preoperative planning in low-resource environments and (2) identify opportunities for future AI-enhanced simulation models in craniofacial surgical planning. Methods: High-resolution CT data were segmented using InVesalius 3, with mesh refinement performed in ANSYS SpaceClaim (version 2021). The cranial model was fabricated using fused deposition modeling (FDM) on a Creality Ender-3 printer with Acrylonitrile Butadiene Styrene (ABS) filament. Results: The resulting 3D-printed simulated model enabled the surgical team to assess cranial anatomy, simulate incision placement, and rehearse osteotomies. These steps contributed to a reduction in operative time and fewer complications during surgery. Conclusions: This case demonstrates the value of accessible 3D printing as a simulation tool in surgical planning within low-resource settings. Building on this success, the study highlights potential points for AI integration, such as automated image segmentation and model reconstruction, to increase efficiency and scalability in future 3D-printed simulation models. Full article

Accurate segmentation of cardiac MR images using deep neural networks is crucial for cardiac disease diagnosis and treatment planning, as it provides quantitative insights into heart anatomy and function. However, achieving high segmentation accuracy relies heavily on extensive, precisely annotated datasets, which are costly and time-consuming to obtain. This study addresses this challenge by proposing a novel data augmentation framework based on a condition-guided diffusion generative model, controlled by multiple cardiac labels. The framework aims to expand annotated cardiac MR datasets and significantly improve the performance of downstream cardiac segmentation tasks. The proposed generative data augmentation framework operates in two stages. First, a Label Diffusion Module is trained to unconditionally generate realistic multi-category spatial masks (encompassing regions such as the left ventricle, interventricular septum, and right ventricle) conforming to anatomical prior probabilities derived from noise. Second, cardiac MR images are generated conditioned on these semantic masks, ensuring a precise one-to-one mapping between synthetic labels and images through the integration of a spatially-adaptive normalization (SPADE) module for structural constraint during conditional model training. The effectiveness of this augmentation strategy is demonstrated using the U-Net model for segmentation on the enhanced 2D cardiac image dataset derived from the M&M Challenge. Results indicate that the proposed method effectively increases dataset sample numbers and significantly improves cardiac segmentation accuracy, achieving a 5% to 10% higher Dice Similarity Coefficient (DSC) compared to traditional data augmentation methods. Experiments further reveal a strong correlation between image generation quality and augmentation effectiveness. This framework offers a robust solution for data scarcity in cardiac image analysis, directly benefiting clinical applications. Full article

Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article

Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article

Coronary computed tomography angiography (CCTA) has emerged as the leading noninvasive imaging modality for the assessment of coronary artery disease (CAD), offering high-resolution visualization of the coronary anatomy and plaque characterization. The development of fractional flow reserve derived from CCTA (FFR-CT) has further transformed the diagnostic landscape by enabling the simultaneous evaluation of both anatomical stenosis and lesion-specific ischemia. FFR-CT has demonstrated diagnostic accuracy comparable to invasive FFR. The combined use of CCTA and FFR-CT is now pivotal in a broad range of clinical scenarios, including the evaluation of stable and acute chest pain, assessment of high-risk and complex plaque features, and preoperative planning. As evidence continues to mount, CCTA and FFR-CT are positioned to become the primary gatekeepers to the cardiac catheterization laboratory, potentially reducing the number of unnecessary invasive procedures. This review highlights the growing clinical utility of FFR-CT, its integration with advanced plaque imaging, and the future potential of these technologies in redefining the management of CAD, while also acknowledging current limitations, including image quality requirements, cost, and access. Full article

Background: The transapical off-pump NeoChord procedure is a recognized minimally invasive surgical approach for the treatment of severe degenerative mitral regurgitation. This study aims to report the initial Greek experience with the NeoChord procedure, presenting mid-term clinical and echocardiographic outcomes from a single cardiothoracic surgical center, with a median follow-up duration of 20 months. Methods: In this study, 42 symptomatic patients with moderate to severe and severe primary mitral regurgitation underwent mitral valve repair with the Neochord procedure between March 2018 and December 2024. All patients were evaluated clinically and echocardiographically by the Heart team preoperatively, after 1 month, and at the last follow-up (end of 2024). The primary endpoint was established as the presence of a major clinical event (all-cause mortality, reintervention due to deterioration of MR, and cardiac-related rehospitalization). Results: The median age of patients was 69 [61.75–79.25] years, and 69% of patients were men. The median EuroScore II was 1.79 [1.32–2.48], and the STS-PROM MV repair score was 3.18 [2.28–4.66]. Regarding the preprocedural mitral valve anatomical evaluation, 35 patients had type A (83.3%),4 had type B(9.5%), whereas only two patients had type C and 1 with type D anatomy. The median of LAI was 1.2 [1.15–1.25], whereas the CI was 4 [2.15–5]. More than two neochordae were implanted in 34 patients (81%). MR severity improved at 1-month (<moderate:92.85%) and at the last follow-up (<moderate:92.1%). NYHA class decreased within 1 month (I + II: 95.23%) after the procedure and was maintained at the last follow-up (I + II: 94.73%). The median left ventricular ejection fraction (LVEF) before the procedure was 63 [58–67]%, which significantly decreased to 57 [53–61]% at the 1-month follow-up (2-sided p < 0.001). At the final follow-up, LVEF increased to 65 [60–68]%, however, this change was not statistically significant compared to the preprocedural value. During the follow-up period, four deaths were documented—three due to non-cardiac and one attributable to a cardiac cause. Two cases proceeded to reoperation for surgical valve implantation due to recurrent mitral valve regurgitation 6 months and 8 months after the NeoChord procedure. Conclusions: Transapical off-pump NeoChord implantation offers a minimally invasive alternative to conventional surgery for symptomatic patients with moderate-to-severe or severe primary mitral regurgitation. Among patients with suitable mitral valve anatomy, the procedure has demonstrated a favorable safety profile and promising mid-term outcomes, in terms of cardiac mortality, as well as freedom from reoperation and rehospitalization. Full article

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy. Full article

Background/Objectives: This prospective intervention study examined the learning effect of using 3D-printed phantom heads with cleft lip and palate (CLP) and upper jaw models with CLP and maxillary plates during a lecture for dental students in their fourth year at J. W. Goethe Frankfurt University. The primary aim was to evaluate the impact of 3D-printed models on students’ satisfaction levels along with their understanding and knowledge in dental education. Methods: Six life-sized phantom heads with removable mandibles (three with unilateral and three with bilateral CLP) were designed using ZBrush software (Pixologic Inc., Los Angeles, CA, USA) based on MRI images and printed with an Asiga Pro 4K 3D printer (Asiga, Sydney, Australia). Two groups of students (n = 81) participated in this study: the control (CTR) group (n = 39) attended a standard lecture on cleft lip and palate, while the intervention (INT) group (n = 42) participated in a hands-on seminar with the same theoretical content, supplemented by 3D-printed models. Before and after the session, students completed self-assessment questionnaires and a multiple-choice test to evaluate knowledge improvement. Data analysis was conducted using the chi-square test for individual questions and the Wilcoxon rank test for knowledge gain, with the significance level set at 0.05. Results: The study demonstrated a significant knowledge increase in both groups following the lecture (p < 0.001). Similarly, there were significant differences in students’ self-assessments before and after the session (p < 0.001). The knowledge gain in the INT group regarding the anatomical features of unilateral cleft lip and palate was significantly higher compared to that in the CTR group (p < 0.05). Conclusions: The results of this study demonstrate the measurable added value of using 3D-printed models in dental education, particularly in enhancing students’ understanding of the anatomy of cleft lip and palate. Full article

The junctional epithelium, which lines the inner gingival surface, seals the gingival sulcus to block the infiltration of food debris and pathogens. The junctional epithelium is derived from the reduced enamel epithelium, consisting of late developmental stage ameloblasts and accessory cells. No prior studies have investigated whether defective ameloblast differentiation or enamel matrix formation affects junctional epithelium anatomy or function. Here, we examined the junctional epithelium in mice exhibiting amelogenesis imperfecta due to loss-of-function mutations in the major enamel matrix protein amelogenin (Amelx^−/−) or the critical enamel matrix protease KLK4 (Klk4^−/−). Histological analyses demonstrated altered morphology and cell layer thickness of the junctional epithelium in Amelx^−/− and Klk4^−/− mice as compared to wt. Immunohistochemistry revealed reduced ODAM, laminin 5, and integrin α6, all of which are critical for the adhesion of the junctional epithelium to the enamel in Amelx^−/− and Klk4^−/− mice. Furthermore, we observed altered cell–cell adhesion and increased permeability of Dextran-GFP through the mutants’ junctional epithelium, indicating defective barrier function. Reduced β-catenin and Ki67 at the base of the junctional epithelium in mutants suggest impaired mitotic activity and reduced capacity to replenish continuously desquamated epithelium. These findings highlight the essential role of normal amelogenesis in maintaining junctional epithelium homeostasis. Full article