Search Results (11,274)

Background: RET fusion is an actionable tumor-agnostic biomarker, but its observed frequency in routine comprehensive genomic profiling (CGP) may vary across testing platforms and clinical contexts. We conducted a nationwide descriptive analysis to benchmark observed RET fusion frequency in Japanese routine practice. Methods: This retrospective descriptive study used anonymized aggregated data from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT), including CGP-tested cases through 31 March 2025. Observed RET fusion frequency was summarized overall, across five standardized CGP platforms, across 12 prespecified organ groups, and in pooled tissue-based versus liquid-based comparisons. Exact binomial 95% confidence intervals were calculated to provide descriptive precision for low-frequency estimates. Results: Among 97,343 cases, 257 were RET-positive, corresponding to an overall observed RET fusion frequency of 0.26%. Platform-specific frequencies were 0.29% (192/66,992) for FoundationOne CDx, 0.28% (42/14,878) for FoundationOne Liquid CDx, 0.14% (6/4235) for GenMineTOP, 0.16% (15/9196) for NCC oncopanel, and 0.10% (2/2042) for Guardant360. Thoracic tumors showed the highest observed frequency (1.39%, 94/6740), followed by head and neck/thyroid tumors (1.04%, 42/4030). In a crude pooled comparison not adjusted for organ mix or clinical context, tissue-based and liquid-based CGP yielded numerically similar crude pooled frequencies of 0.265% (213/80,423) and 0.260% (44/16,920), respectively. Conclusions: This nationwide analysis benchmarks how RET-positive findings are surfaced to clinicians across heterogeneous routine CGP implementations in Japan. The data support platform-aware interpretation of RET results in practice, but should not be construed as biologic prevalence estimates or comparative assay performance. Full article

Despite recent advances in healthcare robotics, most existing systems remain limited to single-purpose functions and lack the flexibility to collaborate dynamically with clinicians and facility systems. To address these limitations, this study presents an LLM-orchestrated framework for a multifunctional Robotic Health Attendant (RHA) that enables robot actions and environment interactions to be coordinated in healthcare environments. Within this framework, the RHA functions as a multifunctional nursing assistant capable of performing physical, communicative, and informational tasks through natural-language interaction. Tasks are expressed in natural language and decomposed into coordinated behaviors across three functional branches: physical, for navigation, object manipulation, and delivering medication; communicational, for dialog with patients and clinicians; and informational, for retrieving and summarizing clinical knowledge, such as patient education on complex heart transplant procedures. The framework integrates multiple Large Language Models (LLMs) and sensing nodes to combine facility data, patient information, and clinician commands, enabling robots and building systems to act in a context-aware manner through coordinated task execution across robotic and environmental components. Implemented in a simulated environment, the framework demonstrates the feasibility of executing representative tasks through LLM-based orchestration, serving as a proof-of-concept toward integrated robotic assistance in healthcare settings. Full article

Background/Objectives: Topical corticosteroids (TCS) are a cornerstone of dermatological treatment for inflammatory skin conditions; however, irrational fear of their use known as corticophobia undermines adherence and worsens clinical outcomes. This study investigated the prevalence of TCS-related concern and phobic behaviors among the general population in Saudi Arabia and identified factors associated with TCS-related concern and phobic attitudes. Methods: A cross-sectional study was conducted between October and December 2025 using an online self-administered questionnaire distributed via social media platforms among a non-probability convenience sample across multiple geographic zones of Saudi Arabia. A total of 481 participants were enrolled. Descriptive statistics summarized demographic and clinical characteristics. Chi-square and Fisher’s exact tests were used to examine differences in proportions between categorical variables and TCS concern, while independent-samples t-tests and one-way ANOVA compared mean phobia scores across subgroups. Results: Of 481 participants, 254 (52.8%, 95% CI 48.3–57.2) expressed concern about TCS use. The predominant reason for refusing prescribed TCS was fear of side effects (93.5%). Phobic behaviors included fear of long-term use (54.2%) and fear of application to sensitive skin areas (63.0%). On the Likert phobia-scale item, 237 (49.8%) totally agreed they would use TCS if prescribed; a separate dichotomous behavioral-intention item, administered only to non-current users (n = 308), showed that 201 (65.3%) would accept TCS if prescribed and 107 (34.7%) would refuse. Concern was significantly more prevalent among females (58.1%, BH-adj p = 0.005), married participants (61.7%, BH-adj p = 0.010), and those refusing prescribed TCS (77.6%, BH-adj p < 0.001). Mean phobia scores (theoretical range 7–28) were significantly higher among females (20.43 ± 4.06 vs. males 18.84 ± 4.68, p < 0.001), participants with Diploma-level education (21.64 ± 3.12, p < 0.001 across education strata), widowed/divorced individuals (21.82 ± 3.57, p = 0.008), and residents of the Southern (20.47 ± 3.99) and Northern (21.40 ± 3.34) regions (p = 0.002 across regions). Conclusions: TCS-related concern was expressed by over half the participants in this social media-recruited sample, posing a substantial barrier to effective dermatological care. Side-effect concern was the most frequently reported reason for refusing prescribed TCS. In adjusted analyses, female sex was the most consistent independent correlate of TCS-related concern and higher phobia score; married status was independently associated with greater concern. These associations should be replicated in probability-based samples before subgroup-targeted interventions are designed. Conclusions: TCS-related concern was prevalent (52.8%) among adults in Saudi Arabia and represented a substantial barrier to dermatological care. Female sex and married status were independently associated with greater concern. Clinicians should proactively address TCS misconceptions during dermatological consultations to improve treatment adherence. Full article

Background/Objectives: This review considered meibomian gland functional assays, reported in recent dry eye treatment trials, that have potential as a clinical/physiological measure in a Core Outcome Set in dry eye clinical trials. The focus was on clinical methods that can be applied globally by trained clinicians. Methods: An electronic search of the MEDLINE database (via PubMed) was conducted to identify randomized controlled trials published in English between 1 January 1995 and 11 December 2025. The search strategy used the terms (meibomian OR meibography) AND treatment. Studies were included if they reported outcomes related to meibum secretion and/or meibomian gland expressibility in human participants. Moreover, a retrospective chart review was undertaken from previously unpublished meibum grading data to determine whether opacity and viscosity grades for meibum are correlated. Results: 98 studies were included for analysis The grading systems of Bron and co-workers, combined with that of the similar MGD Workshop report, were the most prevalent (n = 48), followed by Lane and co-workers (n = 23) and Shimazaki and co-workers (n = 10). Expressibility grading systems were most prevalent for Pflugfelder et al. (n = 33), followed by Blackie-Korb (n = 19) and Author defined (n = 17). The retrospective analysis of 69 charts suggests high correlation between meibum opacity and viscosity (Pearson’s r = 0.904, p < 0.001. 95% CI 0.849–0.940). Conclusions: Grading meibum quality is important in dry eye diagnosis and treatment. A modification of the MGD Workshop system appears useful as a core outcome set parameter in dry eye treatment trials. Full article

Myeloproliferative neoplasms (MPNs) are a heterogenous group of myeloid disorders including polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis (MF). All these conditions can be associated with significant morbidity including increased risk of thrombotic events as well as reduced survival. Selecting therapy is dependent on patients’ risk assessment and thus prognostication is vital in the management of these conditions. There have been significant developments in prognostic and risk stratification models for MPNs over the last few years, including incorporation of molecular markers. This narrative review article aims to summarize these prognostic models and provide practical advice on how clinicians can utilize these tools to develop personalized treatment strategies for MPN patients. Full article

Background: Local recurrence of rectal cancer is a challenging problem for patients and clinicians. Surgical resection is associated with good outcomes if R0 margins are achieved; however, it is often complex, requires suitable patient fitness, and is associated with long term physical and psychological consequences. Meanwhile, continuing technical advances in radiotherapy have enabled the delivery of highly conformal treatment, thereby enabling dose escalation or pelvic reirradiation to be safely considered—either as definitive management or in the neoadjuvant setting—for patients with locally recurrent rectal cancer. Pelvic reirradiation may refer to patients who have received primary rectal radiotherapy with the aim of neoadjuvant downstaging or reducing the risk of locoregional recurrence, versus radiotherapy for a previous unrelated non-rectal pelvic malignancy. Methods: A literature search of pelvic reirradiation for non-metastatic, locally recurrent rectal cancer was conducted for full text articles published over the last 20 years. Additional papers were identified within the references of these papers. Studies focusing on non-rectal cancers, and patients having primary radiotherapy for locally recurrent rectal cancer were excluded. Due to the heterogenicity of the data, no meta-analysis was performed. Results: A total of 15 papers were included, containing a cohort of 840 patients. Several reirradiation modalities were reported, including external beam radiotherapy, brachytherapy, stereotactic ablative radiotherapy and heavy particle therapy (carbon ion). Carbon ion radiotherapy was the most common reirradiation treatment modality utilised with a median cumulative dose of 70.4 Gray (Gy). Treatment response, defined as either complete or partial improvement in tumour size, was only reported in seven studies, and varied from 14 to 88%. Overall 3-year survival was also variable with rates reported between 18 and 85%. These observations may be due to variation in patient selection, treatment intent, and technique. Pelvic reirradiation was associated with acceptable toxicity, low rates of G3+ toxicity, and improved symptom control. Conclusions: Our review describes the multitude of approaches to pelvic reirradiation for locally recurrent rectal cancer. Reviewing the radiobiological and patient outcomes is challenging in view of the degree of heterogeneity in patient selection, treatment approach, and reported outcomes. However, there is consensus that pelvic reirradiation—either for long term control or to downstage prior to definitive surgery—is feasible with potential utility in this setting. Full article

Objective: To develop and evaluate an edge-hosted Large Language Model (LLM)-assisted system for automated Neonatal Intensive Care Unit (NICU) discharge summary generation using an evidence-grounded, field-level evaluation framework. Methods: This implementation and evaluation study was conducted in a Level III NICU in India. Longitudinal patient records were constructed from integrated bedside physiologic data (ARCHITECT) and a structured electronic medical record (EMR) platform Although an embedded audio–video module was present, it was not used in this study. Automated discharge summaries were generated by MORPHEUS, an edge-hosted orchestration pipeline running on NVIDIA Jetson AGX Orin hardware with JetPack 6.2. Local orchestration, preprocessing, and workflow execution were performed on the edge device, while language generation inference was performed using the OpenAI gpt-4o-mini API. Documentation quality was assessed with an LLM-based evaluator guided by a clinician-defined rubric comprising 72 fields organized across 14 section contexts and scored on five dimensions: clinical accuracy, completeness, actionability, coherence, and non-hallucination. Paired, field-level comparisons were performed against clinician-authored summaries. Of 549 NICU admissions screened between 1 October 2024 and 3 November 2025, 401 met the inclusion criteria for evaluation. Prompt refinement was performed iteratively using omission-derived feedback without model weight updates. Results: Across 401 evaluated admissions, MORPHEUS-generated summaries demonstrated higher rubric-based scores and lower omission burden than clinician-authored summaries within the structured evaluation framework used in this study, with mean scores of 0.93 versus 0.75 for accuracy, 0.91 versus 0.67 for completeness, 0.93 versus 0.72 for actionability, 0.94 versus 0.74 for coherence, and 0.95 versus 0.78 for non-hallucination, with the largest absolute advantage observed for completeness. Error taxonomy analysis demonstrated fewer omissions, unsupported assertions, and contradictions in AI-generated summaries than in clinician-authored summaries. Iterative prompt refinement was associated with directional improvement across quality dimensions and reduced omission burden, with omission rate per patient decreasing from 2.484 to 1.807 in the later iteration. Conclusions: An edge-hosted LLM-assisted pipeline can generate NICU discharge summaries that meet or exceed clinician-authored documentation quality under a reproducible, clinician-grounded evaluation framework. These findings support the feasibility of deploying edge-orchestrated generative AI systems for high-stakes neonatal clinical documentation using a clinician-grounded field-level evaluation framework. Full article

Background: Metabolic syndrome (MetS) affects over 30% of the global population and is closely linked to higher cardiovascular (CV) morbidity and mortality. Although MetS is recognized as a significant CV risk factor, limited studies have examined which specific combinations of MetS components are associated with long-term predicted CV risk. Furthermore, limited evidence exists using established 10-year CV risk-prediction models in Asian populations. Methods: We analyzed data from 111,695 Taiwanese adults aged 30–75 years who underwent health screenings from 2007 to 2022. Predicted CV risk was estimated using the Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator at baseline and at 5- and 10-year follow-ups. Cox regression models adjusted for clinical variables were applied to evaluate the association between different MetS patterns and progression in estimated 10-year CV risk. Results: Of the 111,695 participants, 4435 had persistent MetS with the same exact three components at both baseline and follow-up. Among the MetS combinations, the TFB pattern (elevated triglycerides, fasting glucose, and blood pressure) was consistently associated with greater progression in predicted 10-year CV risk over 5- and 10-years follow-up periods in both the FRS (HR = 1.189–1.204) and ASCVD (HR = 1.144–1.146) models (all p < 0.05). Although the effect sizes were modest, the associations were consistent across models and time points. Conclusions: The TFB pattern was consistently associated with greater progression in predicted 10-year cardiovascular risk across both the FRS and ASCVD models. These findings suggest that evaluating specific MetS patterns may provide additional value beyond the total number of components and may help clinicians prioritize high-risk individuals for targeted screening and early intervention. Full article

As the population ages, the incidence and prevalence of musculoskeletal degeneration, such as osteoarthritis, increase. While the currently accepted treatment options provide symptomatic and functional improvement, they do not halt the progression of osteoarthritis. This results in the eventual need for surgery for many patients with advanced osteoarthritis. Due to the seemingly inevitable progression of OA, many clinicians and researchers have shifted their focus to regenerative therapies. Orthobiologics, a specific type of regenerative therapy designed to treat orthopedic conditions, has been gaining traction in recent years due to the utilization of autologous biological substances and synthetic peptides in healing musculoskeletal injuries and degenerative conditions. Orthobiologics can be distinguished into one of four classes: cell-based, biologic fluids-based, matrix-based, molecular-based, and based on their composition. In this review, key examples of each class, mechanism of action, and current clinical data for each agent are examined. Limitations of current orthobiologics involve a lack of standardization in the preparation and administration of each agent, as well as uniformity in assessment endpoints across different clinical studies. Lastly, we will discuss future directions of orthobiologics as a therapy for the treatment of osteoarthritis. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in dental diagnostics, treatment planning, documentation, and research. However, there is limited synthesis of how informed consent should be understood and operationalized in AI-augmented dentistry. This scoping review aimed to map the existing literature on informed consent in AI-assisted dental care and dental research, identify conceptual and practical gaps, and synthesize key domains relevant to ethically robust implementation. Methods: This review was conducted in accordance with PRISMA-ScR and the review question was developed using the Population–Concept–Context framework. Searches were performed in PubMed, Web of Science, and ClinicalKey, supplemented by Google Scholar and reference list screening. English-language sources published between January 2015 and January 2026 were considered if they addressed informed consent, patient information, autonomy, transparency, accountability, or governance in relation to AI use in dentistry or dental research. Results: Of 2624 records identified, 30 sources were included. The reviewed literature consistently emphasized the importance of disclosing AI involvement, clarifying clinician accountability, communicating uncertainty and bias, distinguishing clinical care from research-related consent, and addressing secondary data use. Most included sources were conceptual, ethical, regulatory, or narrative in nature, with limited empirical evidence on implementation or patient outcomes. Conclusions: The available literature suggests that informed consent in AI-augmented dentistry should extend beyond traditional clinician–patient models to explicitly address AI involvement, human oversight, and data governance. Based on recurring themes across the included sources, we propose the ACCOUNT-AI framework as a conceptual synthesis to support future research, policy development, and implementation efforts. Full article

Background/Objectives: Access to specialists and diagnostic resources continues to limit differential diagnosis of cognitive impairment in primary care. This pilot study examined the feasibility, usability, and clinical integration of a digitally supported Remote Cognitive Assessment (RCA) model embedded in general practice settings. Methods: A mixed-method design was used, combining structured quantitative surveys from patients (n = 10; mean age = 77.03; SD = 14.1) and neuropsychologists (10 RCAs completed by three neuropsychologists) with qualitative interviews from general practitioners (GP; n = 4). Patients were assessed remotely via a secure videoconference system operated by trained neuropsychologists. Assessments were conducted in the GP’s office, supported by local staff, to facilitate the process. Results: Patients reported high satisfaction with audio (M = 8; SD = 2.28) and video quality (M = 9.17; SD = 1.17) and expressed a strong willingness to recommend RCA (M = 8.83; SD = 1.17) on a 10-point Likert scale. Despite moderate scores for perceived simplicity (M = 5; SD = 3.41) and effectiveness (M = 5.83; SD = 2.14), overall acceptance (M = 8.33; SD = 0.82) was favorable, especially given the older age of participants. Neuropsychologists rated technical functionality positively (audio quality M = 8.17; SD = 1.18; video quality M = 8; SD = 1.67) but raised concerns about clinical utility and diagnostic depth (effectiveness M = 2.83; SD = 2.71). GPs highlighted the benefits of local facilitation, early screening, and improved access to specialist input while also noting space limitations, communication gaps, and the need for sustainable infrastructure. Conclusions: The RCA model was well accepted by patients and GPs, and technically feasible for neuropsychologists. However, neuropsychologists reported important reservations regarding usability and effectiveness. The results suggest an important mismatch between patient satisfaction and clinical confidence and RCA cannot yet be recommended for routine clinical implementations based on patient acceptability alone. This model holds promises for hybrid cognitive care, particularly in underserved or rural areas, but future development must prioritize diagnostic confidence and clinician workflow usability before scalable integration into rural cognitive care pathways can be established. Full article

Objective: Skeletal mandibular asymmetry (MA) is a pathological condition characterised by asymmetric mandibular growth, resulting in chin deviation and, in some cases, non-coincident dental midlines. Because it is a skeletal condition, some clinicians choose to treat it with functional appliances. The present study therefore evaluated whether functional appliances with asymmetric activation can promote more symmetrical growth of the mandibular condyles and rami. Methods: Eighty-five patients with MA were retrospectively selected based on cervical skeletal maturation stage 2 or 3, the presence of skeletal and dental Class II malocclusion, and the availability of good-quality orthopantomograms taken before and after treatment. Among the enrolled patients, 40 were treated with functional appliances to protrude and re-centre the mandible (study group), while 45 were treated only with a rapid maxillary expander (positive and treated control group). This control group was chosen because it has no direct effects on the mandible and avoided the ethical concerns associated with postponing time-sensitive treatment to recruit a negative control group. Ramus and condyle asymmetry were evaluated pre- and post-treatment using Habets’ method. The Mann–Whitney U-test was used to compare pre- and post-treatment asymmetry indices between the two groups. Results: Although both groups showed a post-treatment symmetry improvement, no statistically significant between-group differences were observed (p = 0.712, effect size r = 0.14 for ramal symmetry; p = 0.663, effect size r = −0.01 for condylar symmetry). Conclusions: Within the limitations of this study, functional appliances did not demonstrate greater skeletal effects than the positive control treatment. Full article

Background: This study investigated the clinical timeline, patient monitoring behaviors, and cumulative bilateral treatment burden in patients with bilateral neovascular age-related macular degeneration. Methods: We retrospectively analyzed follow-up patterns and treatment intensity from first-eye (FE) diagnosis to second-eye (SE) conversion. Results: SE conversion occurred within a mean of 2.0 years in the FE-active group (62.5%) while the FE remained exudative, contrasting with 6.2 years in the FE-inactive group (37.5%). Upon SE conversion, the total annual intravitreal injection burden escalated 3.4-fold (p = 0.002). Notably, the FE-inactive group exhibited numerically lower annual outpatient visit counts (4.40 ± 2.71 vs. 10.29 ± 5.02; p = 0.116), which potentially widened the monitoring window. Additionally, baseline SE retinal pigment epithelium (RPE) abnormalities independently predicted progression (aOR: 19.04; p = 0.032). Conclusions: While previous literature focuses on individual eyes, our findings highlight a vigilance gap in SE detection based on FE status. Clinicians must maintain proactive surveillance for patients with baseline SE RPE abnormalities, particularly when FE stability or next-generation long-acting therapies extend clinic intervals. Due to the limited sample size, these preliminary findings warrant validation in larger prospective cohorts. Full article

Background: Acute compartment syndrome (ACS) is a limb-threatening surgical emergency most commonly associated with fractures or high-energy trauma. Non-fracture-related ACS in athletes is uncommon and may lead to delayed diagnosis. Repetitive blunt trauma during combat sports has rarely been described as a potential mechanism. Case Methods: The case concerns a 21-year-old elite-level kickboxing athlete who developed acute compartment syndrome of the left lower leg following repeated calf kicks sustained during sparring. The patient presented with rapidly progressive calf pain, swelling, compartment firmness, paresthesias and weight bearing difficulties. CT angiography demonstrated diffuse edema of the posterior compartments associated with a large intramuscular soleus hematoma without active arterial bleeding. Results: In view of the severity of the symptoms and the characteristic clinical presentation, an emergency fasciotomy was performed in operating room. Progressive closure was achieved using the vessel loop shoelace technique, allowing gradual tension-free closure. Wound healing progressed without infection, and physiotherapy was introduced with joint mobilization. The patient achieved full functional recovery after 6 months. Conclusions: This case illustrates an atypical etiology of ACS—repetitive targeted calf strikes—and underscores the importance of early recognition even in the absence of fracture or major trauma. Clinical vigilance remains paramount, and prompt surgical intervention is critical to prevent irreversible muscle and nerve damage. Awareness of such mechanisms is particularly relevant for clinicians managing athletes in combat sports. To our knowledge, this is the first documented case of ACS secondary to repeated calf kicks in kickboxing. Full article

Automated clinical documentation based on clinician-patient conversations is an emerging application of deep learning, driven by advances in medical speech recognition and natural language processing. Despite technological progress, real-world adoption remains limited. This review analyzes deep learning–based medical speech-to-text systems, focusing on methodologies, evaluation strategies, and barriers to clinical implementation. A systematic review of 31 studies was conducted, covering automatic speech recognition, clinical dialogue processing, and large language model-based documentation pipelines. Speech recognition accuracy varies considerably in noisy, multi-speaker, and spontaneous clinical environments. Downstream tasks such as entity extraction and summarization are highly sensitive to transcription errors and constrained by limited real-world datasets. Most systems lack external clinical validation and are tested in controlled settings. Key challenges include speaker diarization, domain adaptation, privacy protection, and the need for standardized evaluation frameworks. Although LLMs demonstrate strong potential, concerns remain regarding hallucinations and factual reliability, necessitating improved robustness and clinician oversight. Full article