Search Results (226)

Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index—the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles—including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip–knee–ankle angle (aHKA°)—were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°, p < 0.001). FNPR was significantly higher in CPAK III and VI (+1.9° vs. −0.3°, p < 0.001), indicating a tendency toward internally rotated limb positioning during imaging. The PPR–FNPR mismatch peaked in CPAK III (4.1°, p < 0.001), suggesting patellar-based centering may mask rotational malprojection. Projection artifacts from anterior osteophytes contributed to outlier measurements but were correctable. Valgus morphotypes with oblique joint lines (CPAK III) were especially prone to projection error. FNPR more accurately reflected rotational malposition than PPR in morphotypes prone to patellar subluxation. A 3D method (e.g., CT) or repeated imaging may be considered in CPAK III to improve surgical planning. Full article

This commentary evaluates contemporary equestrian sport governance through the lens of equine welfare science. Drawing on evidence from the FEI Sport Forum 2025 debates, the IFHA Racing Integrity Handbook, media coverage of horse sport, recent scientific presentations, regulatory texts, and published research, we identify systemic shortcomings in how horse welfare is assessed, prioritised, and protected. Key issues include reliance on performance as a proxy for welfare, inadequate “fit-to-compete” protocols, neglect of horses’ mental states, coercive tack and equipment practices (e.g., double bridles, tight nosebands, ear hoods), pharmacological and surgical interventions that mask pain, euphemistic regulatory language (e.g., whip “encouragement”), and inconsistent implementation of welfare rules. Through a series of case studies, from dressage and show jumping forums to racing integrity handbooks, we illustrate euphemistic language, defensive group dynamics, dismissive rhetoric towards evidence-based criticism, and a troubling “stable blindness” that sidelines the horse’s perspective. We conclude that meaningful reform requires (1) embedding validated behavioural and physical welfare indicators into all competition and pre-competition protocols, (2) transparent, evidence-inclusive rule-making under a precautionary principle, (3) genuine engagement with independent equine welfare experts, and (4) establishment of empowered, impartial oversight bodies to ensure that stated codes of conduct translate into consistent, enforceable practice. Only by catering to the horse’s subjective experiences and applying modern ethological and bioethical standards can equestrian sport retain its social licence and ensure integrity in all areas of competition management. Full article

Meningiomas are the most common primary intracranial tumors in adults. For most cases, surgical resection is effective in mitigating recurrence risk. Accurate visualization of meningiomas helps radiologists assess the distribution and volume of the tumor within the brain while assisting neurosurgeons in preoperative planning. This paper introduces an innovative realistic 3D medical visualization system, namely SegR3D. It incorporates a 3D medical image segmentation pipeline, which preprocesses the data via semi-supervised learning-based multi-target segmentation to generate masks of the lesion areas. Subsequently, both the original medical images and segmentation masks are utilized as non-scalar volume data inputs into the realistic rendering pipeline. We propose a novel importance transfer function, assigning varying degrees of importance to different mask values to emphasize the areas of interest. Our rendering pipeline integrates physically based rendering with advanced illumination techniques to enhance the depiction of the structural characteristics and shapes of lesion areas. We conducted a user study involving medical practitioners to evaluate the effectiveness of SegR3D. Our experimental results indicate that SegR3D demonstrates superior efficacy in the visual analysis of meningiomas compared to conventional visualization methods. Full article

According to the World Health Organization, malocclusion type III is third, most important oral health problem. It may be the least prevalent malocclusion, but it is the most noticeable and challenging for orthodontic therapy. With this narrative review, we wanted to give a summation of the most current knowledge about diagnostics, different therapy options, limitations, and additional factors that can influence the therapy of class III malocclusion to help clinicians and researchers focus on the specific approaches. Therapy options were divided into the following groups: orthopedic, orthodontic, and surgical. The SNA, SNB, and ANB angles (cephalometric values) are the best ones to examine improvements in different skeletal improvements, while dentoalveolar improvements were also described, emphasizing the limitation of orthopedic therapy to change the skeletal discrepancy. Eruption-guided appliances and chin cups are more effective in early childhood, mixed dentition, during permanent teeth eruption, with no significant skeletal discrepancy. If a discrepancy exists, a face mask is the first therapy choice. The therapy of an underdeveloped maxilla can be solved with different palate expanders. Bulkiness, lack of long-term results, and duration of therapy make fixed orthodontic appliances with braces and elastic traction favorable nowadays. If the skeletal discrepancy is major, a surgical approach should be considered. One of the main limitations in articles is the combination of different therapy approaches, ages, and dentition preferred for device application, duration of therapy, and lack of information about long-term outcomes. On the other hand, the lack of original articles is noticeable, so further research should be done. Full article

Background: Respirators are essential for protecting healthcare personnel (HCPs) from airborne infections, and were particularly valuable during the COVID-19 pandemic. However, knowledge gaps, attitudes, and perceived usability issues may hinder their proper use, especially in settings lacking formal respiratory protection programs. Objective: The aim of this study was to assess the knowledge, attitudes, practices (KAP), and perceived usability of respirators among Thai healthcare personnel at a university hospital in Northern Thailand and identify differences across job roles. Methods: A cross-sectional survey was conducted among HCPs at a university hospital in Northern Thailand. Participants completed a validated questionnaire covering demographic data, KAP, and perceived usability of respirators. Descriptive and inferential statistics were used to analyze group differences. Results: A total of 479 valid responses were analyzed from physicians (31.7%), nurses (37.6%), and other HCPs (30.7%). Only around 12% of all participants correctly identified that surgical masks are not respirators, although over 90% correctly identified the nature of N95/KN95-type filtering facepiece respirators. Nurses demonstrated higher knowledge of respirator standards and proper use. Confidence and willingness to use industrial or reprocessed sterile respirators varied significantly by role (p < 0.05). Only 30.5% had received fit-testing. Perceived usability concerns included discomfort, heat, and breathability, reported across all groups. Conclusions: Knowledge, attitudes, and practices related to respirator use varied by professional role, with notable gaps in fit-testing and perceived usability. Findings highlight the need for targeted training, consistent fit-testing protocols, and improved respirator design for comfort to ensure effective respiratory protection in healthcare settings. Full article

Background: Laparoscopic surgery for endometriosis presents unique challenges due to the complexity of and variability in lesion appearances within the abdominal cavity. This study investigates the application of deep learning models for object detection in laparoscopic videos, aiming to assist surgeons in accurately identifying and localizing endometriosis lesions and related anatomical structures. A custom dataset was curated, comprising of 199 video sequences and 205,725 frames. Of these, 17,560 frames were meticulously annotated by medical professionals. The dataset includes object detection annotations for 10 object classes relevant to endometriosis, alongside segmentation masks for some classes. Methods: To address the object detection task, we evaluated the performance of two deep learning models—FasterRCNN and YOLOv9—under both stratified and non-stratified training scenarios. Results: The experimental results demonstrated that stratified training significantly reduced the risk of data leakage and improved model generalization. The best-performing FasterRCNN object detection model achieved a high average test precision of 0.9811 ± 0.0084, recall of 0.7083 ± 0.0807, and mAP50 (mean average precision at 50% overlap) of 0.8185 ± 0.0562 across all presented classes. Despite these successes, the study also highlights the challenges posed by the weak annotations and class imbalances in the dataset, which impacted overall model performances. Conclusions: In conclusion, this study provides valuable insights into the application of deep learning for enhancing laparoscopic surgical precision in endometriosis treatment. The findings underscore the importance of robust dataset curation and advanced training strategies in developing reliable AI-assisted tools for surgical interventions. The latter could potentially improve the guidance of surgical interventions and prevent blind spots occurring in difficult to reach abdominal regions. Future work will focus on refining the dataset and exploring more sophisticated model architectures to further improve detection accuracy. Full article

Artificial intelligence (AI) has shown its potential to advance applications in various medical fields. One such area involves developing integrated AI-based systems to assist in laparoscopic surgery. Surgical tool detection and phase recognition are key components to develop such systems, and therefore, they have been extensively studied in recent years. Despite significant advancements in this field, previous image-based methods still face many challenges that limit their performance due to complex surgical scenes and limited annotated data. This study proposes a novel deep learning approach for classifying and localizing surgical tools in laparoscopic surgeries. The proposed approach uses a self-supervised learning algorithm for surgical tool classification followed by a weakly supervised algorithm for surgical tool localization, eliminating the need for explicit localization annotation. In particular, we leverage the Bidirectional Encoder Representation from Image Transformers (BEiT) model for tool classification and then utilize the heat maps generated from the multi-headed attention layers in the BEiT model for the localizing of these tools. Furthermore, the model incorporates class weights to address the class imbalance issue resulting from different usage frequencies of surgical tools in surgeries. Evaluated on the Cholec80 benchmark dataset, the proposed approach demonstrated high performance in surgical tool classification, surpassing previous works that utilize both spatial and temporal information. Additionally, the proposed weakly supervised learning approach achieved state-of-the-art results for the localization task. Full article

The exponential increase in medical waste production has increased the difficulty of waste management, resulting in higher medical waste dispersion into the environment. By employing a circular economy approach, it is possible to develop new materials by waste valorization. The employment of biodegradable and renewable agro-food, waste-derived materials may reduce the environmental impact caused by the dispersion of medical waste. In this work, tomato peel recovered cutin was blended with poly(L-lactide-co-ε-caprolactone) (PLAPCL) to develop new textiles for medical application through electrospinning. The textile fabrication process was studied by varying Cut content in the starting suspensions and by optimizing fabrication parameters. Devices with dense and porous structures were developed, and their morphological, thermal, and physical–chemical properties were evaluated through scanning electron microscopy, differential scanning calorimetry, thermogravimetric analysis, and Fourier transformed infrared spectroscopy. Textile material stability to γ-irradiation was evaluated through gel permeation chromatography, while its wettability, mechanical properties, and biocompatibility were analyzed through contact angle measurement, tensile test, and MTT assay, respectively. The LCA methodology was used to evaluate the environmental impact of textile production, with a specific focus on greenhouse gas (GHG) emissions. The main results demonstrated the suitability of PLAPCL–cutin blends to be processed through electrospinning and the obtained textile’s suitability to be used to develop surgical face masks or patches for wound healing. Full article

The zygomatic bone area experiences frequent mechanical damage in the middle craniofacial region, including the orbital floor. The orbital floor bone is very thin, ranging from 0.74 mm to 1.5 mm. Enhancing digitization, reconstruction, and CAD modeling procedures is essential to improving the visualization of this structure. Achieving a homogeneous surface with high manufacturing accuracy is crucial for developing precise surgical models and tools for creating titanium mesh implants to reconstruct the orbital floor geometry. This article improved the accuracy of reconstruction and CAD modeling using the example of the development of a prototype implant to replace the zygomatic bone and a tool to form the geometry of the titanium mesh within the geometry of the orbital floor. The masked stereolithography (mSLA) method was used in the model manufacturing process because it is low-cost and highly accurate. Two manufacturing modes (standard and ultra-light) were tested on an Anycubic Photon M3 Premium 3D printer to determine which mode produced a more accurate representation of the geometry. To verify the geometric accuracy of the manufactured models, a GOM Scan1 structured light scanner was used. In the process of evaluating the accuracy of the model preparation, the maximum deviation, mean deviation, range and standard deviation were determined. The maximum deviations for anatomical structures created using the normal mode ranged from ±0.6 mm to ±0.7 mm. In contrast, models produced with the ultra-light mode showed deviations of ±0.5 mm to ±0.6 mm. Furthermore, the results indicate that the ultra-light mode offers better surface accuracy for die and stamp models. More than 70% of the surface of the models is within the deviation range of ±0.3 mm, which is sufficient for planning surgical procedures. However, the guidelines developed in the presented publication need to optimize the CAD process and select 3D-printing parameters to minimize deviations, especially at the edges of manufactured models. Full article

Background/Objectives: Effective communication in critical care is crucial, particularly with the constraints of Personal Protective Equipment (PPE). This study aimed to evaluate speech intelligibility under varying conditions of distance, ambient noise, and PPE types in a simulated ICU. Methodology: A quasi-experimental design was used with 23 participants in 24 scenarios, combining three distances (1, 2, and 5 m), two noise levels (quiet and ICU-like), and four PPE types (no mask, surgical mask, N95, and PAPR). Speech intelligibility was assessed by positioning the subjects at varying distances while playing phonetically balanced words through a playback device equipped with the different PPE being tested. The evaluation was conducted under two sound conditions (25 dB(A) and 45 dB(A)). The percentage of correct responses by the subjects to the perceived sounds was determined as a measure of intelligibility. The relation between variables was analyzed using the Wilcoxon Test and the Friedman Test. Results: Significant differences in word recognition were observed across conditions. Ambient noise reduced intelligibility, with recognition percentages significantly lowering in noisy environments. PPE type also influenced comprehension, with PAPR posing the greatest challenge. Friedman’s test showed that increasing distance significantly decreased recognition accuracy. Distances beyond two meters negatively impacted intelligibility across all devices tested. Conclusions: In noisy conditions (>45 dB(A)), a combination of distances greater than two meters and PPE use reduced intelligibility by over 40%, potentially compromising patient safety. The use of communication aids, such as visual cues or alternative speech devices, is recommended, particularly with PAPRs, to enhance comprehension and ensure effective communication between healthcare providers and patients. Full article

Objectives: We aimed to evaluate management strategies for female urinary incontinence, specifically stress urinary incontinence (SUI), and anterior vaginal prolapse (pelvic organ prolapse, POP), emphasizing diagnostic methods, treatment options, and factors influencing surgical outcomes. Methods: We conducted a thorough literature review examining diagnostic tools, including physical examinations, urodynamic testing, and pessary evaluations, alongside treatment options for SUI and POP. Both surgical interventions, such as mid-urethral sling placement and anterior colporrhaphy, and non-surgical methods, including pelvic floor exercises, were analyzed. This review assesses these approaches’ efficacy, complications, and outcomes, incorporating current clinical guidelines and evidence-based practices. Results: Evidence indicates that SUI frequently coexists with POP, with a notable proportion of cases being occult until a prolapse is reduced. Diagnostic methods such as pessary testing and urodynamic evaluations are essential in identifying masked SUI, though their predictive accuracy varies. Surgical techniques such as using mid-urethral slings are highly effective but pose risks, including voiding dysfunction and lower urinary tract injury. Long-term data emphasize the need for personalized treatment strategies, with combined procedures showing superior outcomes for the concurrent management of POP and SUI in select cases. Conclusions: Effective management of SUI and POP requires a personalized approach, factoring in the severity of a prolapse and the likelihood of postoperative incontinence. While conservative treatments are practical initial options, surgical solutions, such as mid-urethral slings and apical suspension procedures, offer robust, lasting results for advanced cases. Preoperative diagnostics, collaborative decision-making, and tailored treatment plans are essential to optimize success and minimize complications. Future research should prioritize enhancing diagnostic precision and refining surgical methods to further advance patient care. Full article

Introduction: Difficult airway management is a critical challenge in anesthesia, often necessitating advanced techniques to ensure patient safety. A patient presented with a malignant lesion on the epiglottis, significantly altering the airway anatomy. Flexible rhinolaryngoscopy revealed a laryngeal carcinoma affecting the entire epiglottis, causing thickening and displacement, which suggested the potential for difficult intubation. Methods: Given the expected feasibility of bag-mask ventilation and front-of-neck access, an asleep intubation technique was selected. The combined use of a McGrath video laryngoscope and C-MAC video stylet allowed for fast and easy atraumatic intubation on the first attempt. The anesthetic and surgical course was uneventful. Discussion: This case report highlights the successful use of a combined approach involving a video laryngoscope and video stylet for intubation in a patient with known difficulties in airway management, providing insights into the benefits of enhanced visualization and maneuverability. The rigid design and steerable tip of the C-MAC video stylet provide advantages over traditional flexible optics, offering better maneuverability and reducing the need for a second operator. Although this technique was successful in this case, its use in patients with complex airway pathologies warrants careful preoperative assessment and collaboration with an experienced airway management team. Full article

Historically, the use of a face mask has been associated with personal protection during epidemics. However, the type of mask used and the way it is used can affect the level of protection it provides. To analyze the practices of using face masks in the population in the Northeast of Brazil, a cross-sectional study was carried out, from December 2021 to February 2022, through interviews with 308 people at bus stops (simple random sample). Pearson’s Chi-square test was calculated to verify the association between exposure and outcome variables. The prevalence of clinical manifestations of COVID-19 was 21.4%. The most used type of mask was made of one- and two-layer fabric when compared to N-95 and a three-layer surgical mask and its use were associated with people in the age group of 18–39 years, an income less than four minimum wage and education level equivalent to elementary/secondary school. An association was found between the infrequent use of a mask in a public environment, removing or lowering the mask when coughing and not washing hands before removing the mask and the occurrence of clinical manifestations suggestive of COVID-19. This study showed that socioeconomic factors are associated with the type of face mask used by the population and that the hygiene behavior of face-mask users was also associated with the occurrence of clinical manifestations of COVID-19. This highlights the need for guidelines and educational strategies that address these aspects to better protect the population against possible respiratory epidemics, especially in countries with important risk factors related to the use of face masks, and highlights the need for clear and objective guidelines and educational strategies to better protect the population against possible epidemics. Full article

Background: When speaking while wearing a face mask, sound transmission is attenuated, and visual cues are lost due to the covered facial movements of the speaker. In this study, we investigated the extent to which different face masks alter speech intelligibility in individuals with different degrees of hearing impairment. Methods: A total of fifty participants were divided into four hearing status groups according to the degree of hearing loss: normal levels (16), mild (13), moderate (11), and severe (10). A modified version of the Audiovisual German Matrix Sentence Test (AV-OLSA) was used to assess speech perception in noise in five conditions (audiovisual, audio-only, visual-only, surgical mask, and FFP2 mask). Results: Our results show that acoustic attenuations of face masks cause a small but similar decrease in speech reception thresholds (SRTs) in listeners of different hearing statuses. The effect of visual cues (visual benefit) on SRTs was stronger than the effect of acoustic attenuation but also did not differ significantly between the different hearing status groups, with a median difference of 1.5 dB for mild hearing loss, 2.9 dB for moderate hearing loss, and 2.7 dB for severe hearing loss. The best-aided hearing status did not correlate with visual benefit. Conclusions: Our research confirms the importance of providing visual cues for speech reception in noisy environments, especially for individuals with impaired hearing, regardless of their degree of hearing loss. Full article

Face masks are essential pieces of personal protective equipment for preventing inhalation of airborne pathogens and aerosols. Various face masks are used to prevent the spread of virus contamination, including blue surgical and N95 filtering masks intended for single use. Traditional face masks with self-sanitisation features have an average filtration efficiency of 50% against airborne viruses. Incorporating nanomaterials in face masks can enhance their filtration efficiency; however, using nanomaterials combined with thermal heaters can offer up to 99% efficiency. Bacterial contamination is reduced through a self-sterilisation method that employs nanomaterials with antimicrobial properties and thermoregulation as a sanitisation process. By combining functional nanomaterials with conductive and functional polymeric materials, smart textiles can sense and act on airborne viruses. This research evaluates the evidence behind the effectiveness of nanomaterials and thermoregulation-based smart textiles used in self-sanitising face masks, as well as their potential, as they overcome the shortcomings of conventional face masks. It also highlights the challenges associated with embedding textiles within nanomaterials. Finally, it makes recommendations regarding safety, reusability, and enhancing the protection of the wearer from the environment and underscores the benefits of reusable masks, which would otherwise pollute the environment. These self-sanitising face masks are environmentally sustainable and ideal for healthcare, the food industry, packaging, and manufacturing. Full article