Search Results (11,054)

Background/Objectives: The trigeminal (CN V) and facial (CN VII) nerves are conventionally taught as separate pathways, yet extensive peripheral anastomoses form sensorimotor plexuses throughout the face. These communications provide the anatomical substrate for proprioception in facial muscles that paradoxically lack muscle spindles and Golgi tendon organs. This review aims to synthesise the anatomical, histological, and clinical evidence on these interconnections and to evaluate their implications across surgery, radiology, neurology, and dentistry. Methods: PubMed/MEDLINE, Scopus, and Google Scholar were searched for cadaveric dissection studies, Sihler whole-mount staining investigations, immunohistochemical analyses, quantitative axonal mapping studies, and clinical case series addressing trigeminal–facial communications and their diagnostic significance. Results: Twenty peripheral anastomoses were systematically identified and mapped, with prevalence ranging from reported-constant in multiple cadaveric series (auriculotemporal–facial trunk; mental–marginal mandibular) to variable (29–86%, depending on trigeminal division and method; V2 by cadaveric dissection, V1 by Sihler staining). Immunohistochemical evidence supports sensorimotor fibre interchange, and recent axonal mapping has revealed that the extracranial facial nerve is a mixed nerve containing motor, sympathetic, and afferent components. Clinically, these anastomoses are implicated in spontaneous facial recovery, trigeminal motor branch transfers, perineural tumour spread, local anaesthesia effects, synkinesis, and Ramsay Hunt syndrome. Conclusions: Available anatomical and histological evidence is consistent with the view that the trigeminal and facial nerves form a functionally integrated unit, though the functional significance of specific communications remains method-dependent. Recognition of these communications is relevant for surgeons, radiologists, neurologists, and dental practitioners managing facial conditions. Full article

Background/Objectives: Serum neuron-specific enolase (NSE) is a biomarker of neuronal injury, but its prognostic role in pediatric convulsive status epilepticus (CSE) remains uncertain. We evaluated the association between serum NSE levels and short-term neurological outcome, assessed model calibration with internal bootstrap validation, and examined whether NSE provides incremental discrimination beyond established clinical severity scores. Methods: This was a single-center retrospective cohort study of children aged 1 month to 18 years admitted to a tertiary pediatric intensive care unit (PICU) with CSE as the primary admission diagnosis between January 2024 and November 2025. The primary outcome was poor neurological outcome at hospital discharge, defined as a worsening of ≥1 point in the Pediatric Cerebral Performance Category (PCPC) score from baseline (ΔPCPC ≥ 1) or in-hospital death. A multivariable logistic regression model adjusting for NSE, PRISM III, acute symptomatic etiology, and mechanical ventilation was developed, with bootstrap optimism-corrected internal validation (2000 resamples) and formal calibration assessment. Separate models for in-hospital mortality and for neurological deterioration among survivors were conducted as secondary analyses. Diagnostic operating characteristics were reported with 95% Wilson confidence intervals. The study followed the STROBE and TRIPOD reporting guidelines. Results: Of 132 children included (median age 26 months, 56.1% male), 60 (45.5%) had a poor neurological outcome including 18 deaths (13.6%). Serum NSE was significantly higher in the poor-outcome group (median 22.0 vs. 14.4 μg/L; p < 0.001). In the primary multivariable model, NSE (adjusted OR 1.11 per μg/L; 95% CI 1.06–1.19; p = 0.001) and PRISM III (adjusted OR 1.15; 95% CI 1.03–1.37; p = 0.013) were independently associated with poor outcome. The model showed acceptable calibration (Hosmer–Lemeshow p = 0.130) and a bootstrap optimism-corrected AUC of 0.759. NSE remained independently associated with both in-hospital mortality (aOR 1.13) and with ΔPCPC ≥ 1 in survivors (aOR 1.09). The AUC for NSE alone was 0.741 (95% CI 0.65–0.82) for poor outcome and 0.885 (0.79–0.96) for mortality. The combined PRISM III + NSE model showed a numerically higher but not statistically significant AUC compared with PRISM III alone (0.784 vs. 0.726; DeLong p = 0.103). Conclusions: Higher serum NSE is independently associated with adverse short-term neurological outcome and mortality in pediatric CSE, including in survivor-only analysis. However, the present data do not demonstrate clinically meaningful incremental prognostic value beyond PRISM III, and the proposed cutoff was derived and tested in the same cohort and is therefore optimistic. These findings are hypothesis-generating and require external validation in prospective multicenter cohorts with serial sampling and long-term neurodevelopmental follow-up before routine clinical use can be advocated. Full article

Background: Severe jaw atrophy (Cawood and Howell Class V–VI) often renders conventional endosseous implantation unfeasible due to the lack of medullary bone and vascularization. This study presents a digital workflow for customized subperiosteal implants designed to eliminate bone segmentation errors and ensure optimal passive fit. Methods: Two clinical cases of severe atrophy—a full-arch maxillary rehabilitation and a unilateral partial rehabilitation—were treated using a prosthetic-driven CAD/CAM workflow. Key innovations included densitometric mapping using Hounsfield Units (HU) to identify high-mineralization zones (+1200 to +1800 HU) for strategic screw fixation. Intraoperatively, cobalt–chrome osteoplasty guides and PMMA check-templates were utilized to validate bone segmentation accuracy in vivo and regularize the cortical base. Results: The protocol achieved high precision with a monitored alignment deviation of 0.2 mm. At the 2-year follow-up, clinical and radiographic evaluations (CBCT) confirmed the total absence of gaps at the bone–implant interface. No signs of peri-implantitis, osteolysis, or progressive bone loss were observed, and soft tissues remained stable and healthy. Discussion: Success was driven by the rigorous management of the bone–implant interface and the use of preparatory surgical devices to bridge the gap between digital planning and surgical reality. The mechanical stability achieved through divergent fixation vectors prevented stress shielding by converting shear forces into compression, stimulating basal bone density according to Wolff’s Law. Conclusions: The standardized digital workflow and the use of preparatory surgical devices in this preliminary study showed that complex rehabilitations can be performed with favorable short-term outcomes. While this approach reduces surgical time and biological stress, further prospective studies are required to confirm its clinical predictability and define next-generation subperiosteal implants as a valid alternative for the management of severely atrophic cases. Full article

The global dissemination of carbapenem resistance is predominantly facilitated by plasmid-mediated carbapenemase genes, notably blaOXA-48-like genes. A comprehensive understanding of their evolutionary relationships and structural conservation is essential for monitoring their spread and informing therapeutic strategies. This study aimed to investigate the phylogenetic relationships and structural conservation of blaOXA-48-like carbapenemase genes in multiple Gram-negative bacterial species. We analysed blaOXA-48-like carbapenemase sequences obtained from a hospital in Pakistan and compared them with globally reported variants retrieved from GenBank. Carbapenemase gene sequences (blaOXA-48-like, blaNDM, and blaVIM) were analyzed using maximum-likelihood phylogenetics (MEGA11, Tamura–Nei model, 1000 bootstrap replicates). Comparative global sequences were retrieved from GenBank. Structural modeling of blaOXA-48-like genes was performed using SWISS-MODEL Workspace with the template PDB 3HBR, followed by validation using GMQE, QMEANDisCo, and Ramachandran plot analyses. Phylogenetic analysis revealed a tight clustering of blaOXA-48-like genes across A. baumannii, K. pneumoniae, and E. meningoseptica, showing high similarity to globally distributed plasmid-associated sequences. Structural modeling demonstrated strong conservation of the enzyme, with preserved catalytic residues (Ser70, Lys73, Ser118, Trp157, and Tyr211) and minimal structural deviation (RMSD < 0.3 Å). blaOXA-48-like carbapenemases exhibit strong phylogenetic conservation and structural stability across species and regions, consistent with the horizontal dissemination of blaOXA-48-like genes across bacterial hosts. These findings indicate that blaOXA-48-like carbapenemases have high evolutionary stability. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article

Triple-negative breast cancer (TNBC) lacks effective molecular targets, leading to poor prognosis. Previous computational methods to identify targets have suffered from low druggability, high complexity, and lack of robust validation. We propose a hybrid methodology combining Boolean network modeling with semidefinite programming (SDP) to analyze a TNBC cell line network. The resulting therapeutic pair underwent a multi-level validation framework, including Boolean simulations, statistical uncertainty quantification (bootstrap), sensitivity analysis, and orthogonal computational support from AlphaGenome, a deep learning model from Google DeepMind. Our analysis identified TK1 and VIM as a computationally robust therapeutic pair. Dual inhibition achieved 99.03% similarity to the apoptotic state with a 95% confidence interval of [98.79%, 99.26%], and was statistically superior to alternative pairs ($p<0.001$). The selection remained optimal across all tested model parameters, demonstrating high robustness. Importantly, the pair has full druggability because both targets have available specific inhibitors. Orthogonal computational evidence from AlphaGenome, stratified by mammary compartment, indicated that both targets exhibit moderate baseline expression in normal mammary epithelium (TK1 = 0.159, VIM = 0.143 in normalized RNA-seq units; n = 13 tracks per gene), with VIM showing a 2.2-fold higher expression in mammary stroma than in epithelium—a gradient consistent with its established role as a mesenchymal marker. Promoter-variant proxy analysis indicated near-zero transcriptomic perturbation upon simulated inhibition of either target in normal mammary epithelium (mean $|{log}_2\mathrm{FC}|<0.001$), supporting a favorable therapeutic window. Our methodology identified TK1–VIM as a computationally robust, druggable therapeutic candidate pair with biologically plausible mechanism of action. Gene-variability analysis identified TK1 and VIM as the highest-scoring candidates, with SDP optimization providing complementary, independent confirmation of this selection. This work provides a computationally grounded candidate strategy and a rigorous methodological benchmark for computational drug target identification; experimental validation remains an essential next step before clinical translation. Full article

Intelligent sensors and Internet of Medical Things (IoMT) platforms are rapidly changing smart healthcare by enabling continuous capture of physiological, behavioral, and clinical events outside conventional hospital settings. Yet the value of connected sensing depends on more than signal acquisition alone. A practical remote-monitoring ecosystem must also convert sensor alerts, clinician-facing summaries, and historical electronic clinical records (ECRs) into ranked evidence that supports care decisions. This study reframes a large-AI clinical retrieval model as the intelligence layer of an edge–cloud IoMT architecture. The proposed framework combines Transformer-Based Sequence (TBS) encoding, BioBERT-driven representation learning, explicit retrieval, and domain-guided re-ranking to connect sensor-originated narratives, patient records, and clinician queries. The empirical evaluation is conducted on Medical Information Mart for Intensive Care III (MIMIC-III) and i2b2, two de-identified clinical text benchmarks that approximate the documentation layer of real-world remote patient monitoring. Compared with strong baselines, including DeepBio, UniT2T, Web4IR, A2A-API, CoLTiD, VLRG, ColBERT, DeepSDH, BiRex, and DL4BTM, the proposed model achieves the best overall performance, reaching F1/Pre/NDCG scores of 0.8399/0.8338/0.5235 on MIMIC-III and 0.8090/0.8100/0.5129 on i2b2. Ablation experiments confirm the importance of exploratory data adaptation, critical feature modeling, critical token learning, cross-disciplinary supervision, and data-driven regularization. Parameter sensitivity analysis shows stable behavior for beta values greater than or equal to 1, with the strongest results at beta = 5. The study concludes that large-AI retrieval can strengthen the clinical interpretation layer required for IoMT-enabled remote monitoring, while future work should validate the approach on live multimodal sensor streams and privacy-preserving deployments. Full article

While artificial intelligence is rapidly reshaping the healthcare sector, it is important to assess readiness for AI integration to properly prepare healthcare professionals, particularly in countries where clinical AI systems have not yet been implemented in primary healthcare. This qualitative study explores healthcare professionals’ perceptions of the future use of Artificial Intelligence in Greek Primary Healthcare settings. Two focus groups were conducted with 18 Primary Health Care professionals working in a health center and a local primary healthcare unit (TOMY) in Greece. Thematic analysis identified six major themes: potential uses, challenges and risks, ethical concerns, readiness and training needs, trust factors, and AI impact on professional roles and skills. Future research should focus on developing training programs, establishing ethical and regulatory frameworks, and examining the long-term impact of Artificial Intelligence on professional roles, skills, and interprofessional collaboration in Primary Healthcare. Full article

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement. Full article

Peacekeeping operations in sub-Saharan Africa continue to be impacted by malaria both in-country and among returning service members. The Royal Thai Army (RTA) deploys an engineering company to Juba and Rumbek, South Sudan to conduct peacekeeping operations as part of the UN Mission in South Sudan (UNMISS). Each deployment is approximately 12 months long. The unit is given doxycycline one week before travel before switching to the UN-provided mefloquine during deployment and for four weeks after returning. The RTA routinely conducts post-deployment screening for malaria by microscopy and PCR for units returning from UNMISS. High rates of prophylaxis failure were observed from both during-mission and post-deployment screening cases, with cumulative malaria attack rates of 11.4% (31 cases out of 271 personnel), 18.2% (49 cases out of 270 personnel), and 23.1% (63 cases out of 273 personnel) for 2023, 2024, and 2025, respectively, with 98% of cases being due to P. falciparum. Furthermore, post-deployment screening revealed high rates of sub-microscopic and sub-clinical parasitemia with 40% of all malaria cases being identified as asymptomatic during post-deployment screening, and 61% of those asymptomatic cases being detected by PCR only. While factors underlying the high prophylaxis failure rate, as well as the high rate of sub-microscopic and sub-clinical parasitemia are unclear, these findings highlight the limitations of relying on clinical symptoms or microscopy for detecting malaria in military units returning from endemic regions and underscore the importance of unit-wide post-deployment molecular screening. Full article

The objective of this study is to mitigate the bottom-out failure and improve the energy absorption of conventional helmet liners during high-energy impacts, thereby reducing the risk of head injuries. To this end, a locally reinforced Primitive-type triply periodic minimal surface (P-TPMS) energy-absorbing liner is proposed for the helmet forehead region, which facilitates progressive energy dissipation through layer-by-layer buckling deformation. A finite element model of a helmet–head coupling was created based on a previously verified high-fidelity head model and subsequently validated against the ECE 22.06 standard drop-test methodology. Three critical design parameters—outer protective layer thickness, triply periodic minimal surface (TPMS) unit cell size, and wall thickness—were optimized employing the Box–Behnken Design (BBD) response surface methodology, resulting in quadratic regression models for the head injury criteria (HIC) and peak linear acceleration (PLA) with good fit ($R^2$ > 0.97). Optimal parameter combinations were established using multi-objective optimization, with protective efficacy carefully assessed from both head dynamic response and biomechanical response perspectives. The ideal P-TPMS liner possesses an outer protective layer thickness of 14.95 mm, a TPMS unit cell size of 12.23 mm, and a wall thickness of 3.93 mm. Compared to the traditional expanded polystyrene (EPS) liner, the optimized P-TPMS liner significantly reduces HIC (by ∼16%) and PLA (by ∼14%) while extending the impact duration. More critically, it transitions both intracranial pressure and brain tissue strain below their respective clinical injury thresholds, substantially lowering the risks of skull fracture and mild traumatic brain injury (mTBI). The P-TPMS construction facilitates continuous energy dissipation during impacts via incremental layer-by-layer buckling deformation, hence extending impact duration and markedly improving helmet protective efficacy. These findings offer theoretical foundations and technical direction for the creation of localized heterogeneous liner designs in advanced high-performance helmets, although the results are limited to frontal flat-anvil impact conditions. Full article

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical public health threat because infections caused by this pathogen are associated with high morbidity, mortality, and limited effective therapeutic options. Whilst the majority of studies have concentrated on inter-patient bacterial transmission, within-host genomic analysis offers unprecedented resolution for tracking dynamic clone predominance, plasmid rearrangements, and microevolution under clinical selection pressures. Methods and Results: Whole-genome sequencing (WGS) of nine isolates recovered from oral and rectal swabs revealed an exceptional case of CRKP clonal turnover in an intensive care unit (ICU) patient. Three distinct high-risk clones were identified during the 18 days of surveillance: an initial ST101 (Clonal Group (CG) 101) strain (days 1–7) followed by concurrent colonization with ST395 (carrying bla_NDM-5) and ST512 lineages (both CG258, days 11–18). Conclusions: This study describes a rare instance of within-host heterogeneity of CRKP, involving three distinct STs spanning two CGs. Whole-genome analysis revealed potential structural rearrangements of resistance- and virulence-associated plasmids between coexisting lineages. These genomic shifts likely reflect rapid adaptation under the intense selective pressure of broad-spectrum antibiotic therapy, culminating in the persistence of a less virulent yet multidrug-resistant ST512 clone and a favorable clinical outcome with patient recovery. Full article

Background/Objectives: The Leiden University Medical Center (LUMC) and the Medical University of Vienna (MUV) both implemented video recording and review in their neonatal intensive care unit (NICU). The two centers initiated collaborative, multicenter video review sessions to facilitate international knowledge exchange. Methods: In this exploratory, descriptive study, collaborative video review sessions were organized with the interprofessional NICU staff of the LUMC and the MUV. We aimed to describe our experience with organizing these sessions and to report procedural variations, and document lessons learned that led to new perspectives on care. Results: We conducted five sessions using recordings of different patients undergoing intubation, less invasive surfactant administration, umbilical, central-catheter insertion and physiologically based cord clamping after birth. The videos were selected to ensure technical and clinical comparability. Sessions were attended by a mean of eight providers per center. A total of 19 relevant differences were described, of which seven (37%) prompted changes in practice or new insights for one or both centers. Finally, we developed a roadmap for organizing multicenter video review sessions. Conclusions: This study shows that multicenter video review may represent a feasible and innovative educational approach for identifying practice variations and fostering cross-institutional clinical refinement. Full article

Troponin T is a molecular marker of cardiomyocyte injury, whereas left ventricular ejection fraction (LVEF) and tricuspid regurgitation velocity (TRV) reflect downstream ventricular and cardiopulmonary measures. This study evaluated whether synchronized troponin T and echocardiographic data can identify mortality risk in critically ill patients with heart failure, while separating statistical association from clinically meaningful incremental discrimination. Adult intensive care unit admissions with heart failure diagnoses were identified from MIMIC-IV and MIMIC-IV-ECHO. The primary endpoint was 28-day all-cause mortality; one-year mortality was secondary. Multivariable Cox models were adjusted for demographics, comorbidity, illness severity, organ support, and laboratory covariates. Restricted cubic splines, proportional hazards diagnostics, variance inflation factors, prespecified subgroup interaction tests, complete-case analyses, and multiple imputation sensitivity analyses were performed. The final cohort included 4362 patients, and 1072 patients (24.6%) died within 28 days. In the primary complete-case Cox model (n = 2087; 659 deaths), higher log-transformed troponin T was associated with higher 28-day mortality (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.03–1.15; p = 0.003), and higher LVEF was associated with lower mortality (HR per percentage point, 0.99; 95% CI, 0.99–1.00; p = 0.004). After severity and organ-support covariates were entered, troponin T and LVEF produced statistically detectable but very small C-statistic gains. Measurable TRV was available in 1546 patients and was associated with mortality in that subset (HR, 1.28; 95% CI, 1.08–1.52; p = 0.005). Troponin T, LVEF, and TRV were associated with mortality in ICU heart failure. Their contribution was best interpreted as risk enrichment within a clinical severity framework rather than a stand-alone decision rule. Full article

Herpesvirus infections belong to major pathogens in the human population. This study aimed at evaluating diagnostic data for eight human herpesviruses, based on datasets derived from a large European tertiary care center. Specifically, we analyzed 118,692 herpesvirus submittals to the Diagnostic Division of the Virological Institute, University Hospital Erlangen (UKER), Germany, between July 2014 and June 2024. Our points of focus were the following: (i) the frequencies of herpesvirus diagnostic results with positivity rates, (ii) departments representing main sample submitters, (iii) the specific importance of intensive care units (ICUs), (iv) the COVID-19 pandemic period, and (v) distinct properties of sample types. Overall, we are stating the highest frequencies of diagnostic assessment for herpes simplex virus (HSV), human cytomegalovirus (HCMV), and Epstein–Barr virus (EBV) infections, pointing to their dominant relevance for clinical practice. Notably, HCMV submittals (46.6% of total), together with EBV (26.2%) and HSV (15.7), accounted for almost 90% of all herpesviral diagnostic samples during this period. Within these key groups, HCMV, EBV and HSV showed positivity rates of 14.5%, 35.0%, and 18.5%, respectively. Concerning a main input of sample submittals, two departments were predominant in our center, i.e., the Departments of Haematology–Oncology and Anaesthesiology. These included patients under multifold types of treatment associated with an increased risk of herpesvirus reactivation or primary infection. Furthermore, another high portion of submittals was noted for ICUs and external sources. In addition, a numerical, transient increase in herpesvirus diagnostic submittals, from various sources, was shown for the COVID-19 pandemic years (mostly 2021) as compared to other periods. Combined, these data underlined the importance of clinical monitoring of herpesvirus infections, particularly for high-risk patients, and the steady need of improvements in preventive measures, therapeutic options, and safe diagnostic tools. Full article