Search Results (10,798)

Background/Objectives: Parotid ultrasound requires integration of sonographic morphology with clinical context under uncertainty, but conventional agreement and performance metrics provide limited insight into examiner-dependent classification patterns. Building on previously derived examiner-specific surrogate models, we applied a behavioral decision-science framework to examine observable classification patterns and case-level ambiguity. Methods: In this exploratory retrospective single-center secondary analysis, six examiners rated predefined ultrasound image sets from 149 histopathologically verified lesions. Surrogate-tree structure, feature–reference-class associations, signal detection metrics, and case-level ambiguity were analyzed. Internal robustness was assessed using cross-validation and sensitivity analyses. Results: Pruned surrogate trees identified a context-based classification pattern, a morphology-based classification pattern, and a hierarchical morphology-context pattern. Tumor history and lesion boundary were the only retained upper-level classification cues and showed the strongest overall categorical and sonographic associations with the histopathological reference class, respectively. Across 30 cross-validation trees, boundary was the root split in 22 and tumor history in eight; no other root feature occurred. Examiners differed in diagnostic discrimination and estimated decision criterion, with Examiner 3 showing the highest discrimination. Boundary remained the sonographic feature most strongly associated with the histopathological reference class across sensitivity analyses. Descriptor disagreement was associated with decision disagreement and error burden, and four cases showed unanimous but incorrect classifications. Conclusions: In this exploratory retrospective single-center cohort of histopathologically verified lesions, examiner-dependent classification was characterized by observable, model-derived cue structure, feature-use/reference-association alignment, estimated decision-criterion patterns, and case-level ambiguity. These cohort-specific findings do not directly measure examiner cognition and should not be generalized to unselected parotid-ultrasound populations; however, the complementary analyses provide an empirically grounded framework for characterizing observable examiner-dependent classification and identifying testable targets for prospective studies of examiner feedback, descriptor standardization, and decision support. Full article

Background: Endobronchial ultrasound (EBUS) is widely used for the diagnosis of pulmonary lesions. When combined with rapid on-site cytologic evaluation (ROSE), it can improve diagnostic accuracy and facilitate early identification of malignancy origin. However, differentiating primary lung cancer from metastatic tumors (e.g., breast or colorectal origin) during ROSE remains challenging due to limited cytopathology support and morphological similarities between tumor cells. This study aimed to develop a computer-aided diagnostic (CAD) system for classifying malignancy types from limited cytological samples to facilitate clinical decision-making. Methods: We utilized a retrospective dataset of cytological images obtained during EBUS procedures between November 2018 and June 2024. The study focused on classifying three malignancies: pulmonary adenocarcinoma, metastatic breast cancer, and metastatic colorectal cancer. A deep learning-based model (PLFCH) was developed, integrating few-shot learning, parameter-efficient fine-tuning, and a hybrid CNN–Transformer architecture to address limited annotated data. Results: A total of 41 patients with 346 cytological images were included. Under a 3-way 5-shot setting, the proposed model achieved an accuracy of 49.26%, outperforming existing few-shot learning methods, with precision, recall, and F1-score of 0.477, 0.493, and 0.480, respectively. Increasing the number of reference images to 20 per class further improved accuracy to 55.48%. Conclusions: The proposed framework demonstrated improved performance for cytological classification under limited data conditions. These findings provide an early proof of concept for applying few-shot learning to cytological assessment during EBUS procedures. Further improvements in model performance and validation in prospective, real-time clinical settings are required before its potential role in assisting diagnostic decision-making can be established. Full article

Background and Objectives: Multiparametric magnetic resonance imaging (mpMRI) is widely used in prostate cancer diagnosis, but biopsy findings may still underestimate tumor aggressiveness. This study evaluated the association of Prostate Imaging Reporting and Data System (PI-RADS) assessment with clinically significant prostate cancer (csPCa) and histopathological upgrading after radical prostatectomy. Methods: The retrospective analysis comprised 564 patients who underwent mpMRI–transrectal ultrasound fusion-guided biopsy followed by radical prostatectomy between 2021 and 2025. All included patients subsequently underwent radical prostatectomy, so the cohort represents a surgically selected population. Clinical variables, PI-RADS score, biopsy ISUP Grade Group, and final prostatectomy pathology were assessed. Clinically significant disease was defined as ISUP Grade Group ≥ 2. Histopathological upgrading was defined as an increase of at least one ISUP Grade Group between biopsy and final prostatectomy pathology. Results: csPCa was found in 385 patients (68.3%). Patients with csPCa had higher prostate-specific antigen density (PSAD) values than those without csPCa. PI-RADS score was significantly associated with csPCa and remained independently associated with csPCa in multivariable analysis. Histopathological upgrading occurred in 164 patients (29.1%), and PI-RADS score was also independently associated with upgrading. Model discrimination was limited. Conclusions: Preoperative mpMRI with PI-RADS assessment was associated with both csPCa and biopsy underestimation. Although PI-RADS was independently associated with both outcomes, its modest discriminatory performance indicates that it should be interpreted together with other clinical and pathological parameters rather than as a standalone predictive tool. Full article

Background/Objectives: Medicinal and aromatic plants are important sources of phenolic compounds with antioxidant properties. This study evaluated the total phenolic content (TPC) and antioxidant activity of 19 commercially available medicinal herb and spice products of reported Mount Athos provenance and investigated the influence of extraction solvent on these properties. Methods: Extracts were prepared by ultrasound-assisted extraction using water, 50% aqueous methanol, or 50% aqueous acetone. TPC was determined using the Folin–Ciocalteu assay, while antioxidant activity was evaluated using DPPH, ABTS, FRAP, and a qualitative supercoiled plasmid DNA relaxation assay. Solvent effects were assessed using Friedman and post hoc Wilcoxon signed-rank tests, and associations between TPC and antioxidant activity were examined using correlation and regression analyses. Results: TPC and antioxidant activity varied considerably among botanical products and extraction conditions, with Origanum spp. generally exhibiting among the highest TPC values and strong antioxidant responses. Aqueous acetone yielded significantly higher TPC than aqueous methanol and water. Both aqueous organic solvents produced greater DPPH inhibition than water, whereas aqueous methanol produced greater ABTS activity than water; no significant solvent effect was observed for FRAP. TPC was positively associated with antioxidant activity, particularly ABTS and FRAP, explaining up to 78% of its variability. Several extracts also preserved the supercoiled plasmid DNA form under hydroxyl radical-generating conditions, although this observation requires quantitative confirmation. Conclusions: Medicinal herbs and spices of Athonite provenance exhibit considerable phytochemical and antioxidant variability. Extraction solvent influences phenolic recovery and antioxidant activity in an assay-dependent manner, with no single solvent being uniformly superior. These findings provide baseline data supporting further phytochemical characterization and quantitative evaluation of the antioxidant and DNA-protective properties of these botanical materials. Full article

Buckwheat husk is the major by-product produced during buckwheat processing. However, despite its high nutritional and functional value, it remains underutilized as an ingredient in functional foods. This review summarizes current knowledge on the botanical origin, chemical composition, extraction approaches, and bioactive properties of buckwheat husk. Particular emphasis is placed on its high content of insoluble dietary fiber and phenolic compounds, especially rutin, which contribute to antioxidant, anti-inflammatory, and antimicrobial activities. Advances in conventional and green extraction techniques used to obtain buckwheat husk concentrates, including ultrasound- and microwave-assisted methods, are discussed. The techno-functional properties of buckwheat husk, such as water- and oil-holding capacity, emulsifying potential, and texture modification, are evaluated in relation to food applications. Reported uses in bakery products, pasta, dairy foods, beverages, and meat systems are critically reviewed. Safety aspects, allergenicity, and antinutritional factors are also considered. Overall, buckwheat husk is positioned as an underutilized resource with significant potential for sustainable functional food development. Full article

Background/Objectives: Perirolandic brain metastases are challenging to resect because small deviations from the surgical corridor may cause sensorimotor deficits. This study evaluated the stage-specific value and limitations of general-purpose, non-navigated B-mode intraoperative ultrasonography (iUS) with MRI-based frameless neuronavigation in a consecutive surgical cohort of perirolandic metastases. Methods: In this single-center, single-surgeon retrospective case series, 15 consecutive adults underwent microsurgical resection of perirolandic brain metastases using MRI-based frameless neuronavigation and a general-purpose B-mode ultrasound system, without functional mapping or neurophysiological monitoring. Extent of resection was assessed on contrast-enhanced MRI obtained 24 to 36 h after surgery, and post-resection cavity iUS findings were compared descriptively with early postoperative MRI. Results: Gross-total resection was achieved in 13 patients (86.7%). iUS modified intraoperative targeting in 6 of 15 patients: the entry point was repositioned after findings consistent with intraoperative brain shift in 4, and the lesion was localized in interhemispheric corridors in 2. Post-resection iUS suspected residual tissue in 7 of 14 patients, but only 1 corresponded to residual tumor on MRI; a thin remnant on the motor cortex was not identified as suspicious for residual tumor on iUS. A new or worsened motor deficit occurred in 2 patients (13.3%); at follow-up, this was persistent at 20 months in 1 and partially improved in the other. No patient required reoperation, and there was no 30-day mortality. Conclusions: General-purpose B-mode iUS aided exposure confirmation and trajectory refinement but had limited value for excluding thin residual tumor. When functional mapping or neurophysiological monitoring is unavailable, it may provide accessible real-time anatomical guidance; however, because it lacks functional information, it should not be considered an alternative to these functional adjuncts. Full article

Rotator cuff tear (RCT) is a leading cause of shoulder pain encountered by general practitioners. Population-based screening shows that nearly half of full-thickness tears are asymptomatic, allowing many lesions to progress undetected. This narrative review summarises 105 clinical, imaging, biomechanical and rehabilitation studies published in recent years. The review follows the disorder from early tendinopathy to full-thickness tear and discusses crucial risk factors (age, diabetes, hypercholesterolaemia, overhead work). It aims to guide early primary-care management of RCT. We examine the diagnostic accuracy of classic bedside tests, including the supraspinatus weakness and external rotation lag cluster. Furthermore, we explain when ultrasound or MRI adds value and what the classic findings are. An informative overview of patient-reported outcome tools (e.g., SPADI, WOSI, Constant–Murley, ASES) could help physicians select one for follow-up. The article objectively evaluates the evidence for conservative measures—structured exercise protocols, manual therapy, oral analgesics, and corticosteroid or platelet-rich plasma injections. Moreover, we propose an evidence-based postoperative rehabilitation timeline with milestones that incorporate targeted immobilisation and progressive loading. The article presents selected clinical situations, such as the impact of type 2 diabetes on tendon biology. We explore the viability of experimental adjuncts such as extracorporeal shock-wave therapy, low-intensity pulsed ultrasound and electrical stimulation. Finally, we compare recommendations from the American Academy of Orthopaedic Surgeons and the European Society for Surgery of the Shoulder and Elbow. We highlight similarities between the recommendations (e.g., overlapping clinical examination tests), thereby facilitating their clinical application and providing a pragmatic guide for general practitioners. Our synthesis draws on orthopaedic, radiographic and rehabilitation data to reduce diagnostic delay, optimise non-specialist resource use, and improve pain and functional outcomes for the growing population affected by rotator cuff tears. Full article

Background/Objectives: The mortality rate for acute high-risk and intermediate–high-risk pulmonary embolism (PE) was high despite treatment with heparin anticoagulation alone. Although adjunctive systemic thrombolysis can significantly reduce mortality, it still increases the incidence of major bleeding. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has been shown to reduce the incidence of major bleeding; however, the optimal treatment duration remains uncertain. Methods: This retrospective cohort study included 155 hospitalized patients with acute PE who underwent USCDT between January 2017 and June 2025 in the intensive care unit at China Medical University Hospital, Taichung, Taiwan. Patients were categorized into four groups based on average usage time: <20, 20–29, 30–39, and ≥40 h. The primary endpoints were 30-day all-cause mortality rate and major bleeding. Covariates associated with 30-day all-cause mortality were estimated and adjusted using logistic regression modeling. Results: Across all treatment groups, USCDT significantly reduced systolic pulmonary artery (PA) pressure (26.9%), mean PA pressure (21.0%), fibrinogen levels (25.2%), and right ventricle-to-left ventricle diameter ratio (21.5%) (all p < 0.001). Compared with the group with a USCDT ≥ 40 h, the group with a USCDT < 20 h had a lower odds ratio for 30-day all-cause mortality (OR: 0.36, 95% CI: 0.07–1.81). A similar benefit was observed for a USCDT 20–29 h. Conclusions: USCDT < 20 or 20–29 h (mean 15–20 mg alteplase) may provide an optimal balance between efficacy and safety by reducing 30-day all-cause mortality and major bleeding in patients with acute PE. Full article

Pomegranate peel is an agro-industrial byproduct rich in phenolic compounds with recognized functional properties. Its incorporation into stable food ingredients represents an attractive strategy for byproduct valorization. This study evaluated spray-dried vinegar powders enriched with pomegranate peel extract obtained by ultrasound-assisted extraction (UAE) using vinegar and α-cyclodextrin (αCD). Non-buffered and buffered formulations were compared with two commercial buffered powders during 6 months of storage at 22 °C. Morphological (particle size distribution and scanning electron microscopy images), physicochemical (pH, titratable acidity, moisture content, water activity and color), antioxidant (total phenolic content and DPPH radical scavenging activity), antimicrobial and sensory properties were evaluated. The powders maintained stable physicochemical properties, with moisture content remaining ≤1.2%, whereas commercial powders reached 3.0–3.9% after storage. Pomegranate-enriched powders showed total phenolic contents of 5.3–27.9 mg GAE/g_powder and antioxidant activity of 37.1–279.3 µmol TE/g_powder, compared with 0.1–0.3 mg GAE/g_powder and 2.3–4.1 µmol TE/g_powder in the non-enriched formulations, while remaining stable throughout storage. Buffered enriched powders maintained in vitro antimicrobial activity against Listeria monocytogenes, whereas only non-buffered formulations inhibited Salmonella enterica. The powders were incorporated into a béchamel croquette formulation and showed preliminary sensory acceptability. These results support spray drying with αCD as an effective strategy for obtaining stable powdered ingredients from pomegranate peel byproducts under the evaluated conditions. Full article

Background/Objectives: Defecatory straining requires coordinated abdominal-wall and lumbopelvic muscle activity to generate propulsive pressure. This study investigated whether sitting posture alters ultrasound-derived transversus abdominis (TrA) contractile behavior and trunk surface electromyographic (EMG) activity during simulated defecatory straining. Methods: Twenty healthy young adults (10 females and 10 males) performed quiet sitting and a maximal Valsalva maneuver in four standardized postures: neutral posture (NP), anterior trunk lean with anterior pelvic tilt (AT), posterior trunk lean/posterior pelvic tilt (PT), and collapsed posture (CO). TrA thickness was measured with B-mode ultrasonography, and the TrA contraction ratio was calculated as Valsalva thickness divided by resting thickness. Surface EMG root mean square amplitudes of the superficial multifidus (sMF), erector spinae (ES), external oblique (EO), and internal oblique (IO) were analyzed at rest, during Valsalva, and as an activation ratio (Valsalva/rest). Repeated-measures, one-way ANOVA with Bonferroni-adjusted comparisons was used. Results: Ultrasonographic measurements demonstrated excellent intra-rater reliability (ICC = 0.984–0.999). Resting TrA thickness did not differ among postures. During Valsalva, AT showed greater absolute and relative TrA thickness change than NP. EMG analyses showed higher absolute sMF and ES activity in AT both at rest and during Valsalva, whereas EO and IO activity during Valsalva did not differ among postures. The ES activation ratio was highest in NP among postures. Conclusions: Anterior trunk lean with anterior pelvic tilt was characterized by a distinct pattern of TrA behavior and posterior trunk muscle activity during a Valsalva-based simulated straining task. However, whether this posture-dependent muscle response increases intra-abdominal or rectal propulsive pressure or improves defecatory function remains unknown. The accompanying EMG pattern suggests that this advantage is associated with greater resting postural activation of the posterior trunk wall rather than generalized abdominal effort. Full article

Background/Objectives: Fibrosing interstitial lung disease (F-ILD) is associated with progressive respiratory impairment and substantial symptom burden. Diaphragmatic ultrasound (DUS) is a non-invasive method for assessing diaphragmatic structure and function, but its clinical role in F-ILD remains uncertain. This systematic review evaluated the available evidence on DUS in adults with F-ILD. Methods: This systematic review was conducted and reported according to the PRISMA guidelines. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched and observational studies evaluating DUS in adults with F-ILD were included. Risk of bias was assessed using the QUADAS-2, and outcome-level certainty of evidence was evaluated by GRADE framework. Results: Six cross-sectional observational studies involving 232 participants were included. Diaphragmatic excursion (DE) was assessed in all six studies, while diaphragm thickness (DT) and thickening fraction (TF) were evaluated in four. Some studies reported abnormalities in DUS parameters during deep breathing and cross-sectional associations with pulmonary function, exercise capacity, dyspnoea, or radiological severity. Substantial heterogeneity in study populations, ultrasound protocols, and outcome reporting precluded meta-analysis. The certainty of evidence was very low. Conclusions: Current evidence suggests that DUS may detect diaphragmatic abnormalities in patients with F-ILD and may have future complementary value alongside established clinical assessments. However, the evidence is limited, heterogeneous, and of very low certainty and does not establish diagnostic accuracy, prognostic value, or usefulness for longitudinal monitoring. Accordingly, DUS cannot currently be recommended for routine clinical implementation in F-ILD, and prospective longitudinal validation is required. Full article

Background: Urinary tract infections (UTIs) are a leading cause of morbidity in patients with chronic spinal cord injury (SCI). This study examined the incidence of first and recurrent symptomatic UTIs in patients with chronic SCI and explored clinical factors associated with infection risk, with particular attention to bladder management methods and structural urinary tract abnormalities. Methods: We conducted a longitudinal observational study including 297 patients with chronic SCI (≥5 years post-injury; 215 males, 82 females with a mean age of 49.1 ± 13.8 years). Participants underwent regular evaluations, including kidney ultrasounds, videourodynamic studies (VUDS), and effective renal plasma flow (ERPF) measurements. Symptomatic UTIs were strictly defined using clinical–microbiological criteria to exclude asymptomatic bacteriuria (ASB). Clinical outcomes were evaluated over a minimum 5-year follow-up period. Results: Average annual symptomatic UTI rates were 0.31 ± 0.37 (major), 0.46 ± 0.47 (minor), and 0.77 ± 0.64 (total) episodes per patient-year. Bladder management method significantly influenced UTI rates (p < 0.001), with the highest rates observed in patients with indwelling urethral catheters (IUC) (1.19 ± 0.71), followed by suprapubic cystostomy (SPC) (0.91 ± 0.54), clean intermittent catheterization (CIC; 0.59 ± 0.47), and reflex voiding (0.31 ± 0.36). Recurrence (≥2 episodes) occurred in 23.9% of patients with indwelling catheters, 26.9% with suprapubic cystostomy, 13.0% with CIC, and 7.5% with reflex voiding. Patients with indwelling urethral catheters had higher total UTI rates and a higher recurrence rate than those with suprapubic cystostomy (1.19 vs. 0.91 episodes per patient-year; recurrence 38.8% vs. 26.9%). Hydronephrosis (Adjusted OR = 4.78, 95% CI: 2.45–9.32, and p < 0.001), bladder wall trabeculation (Adjusted OR = 3.65, 95% CI: 1.92–6.94, and p < 0.001), and indwelling catheter use (IUC + SPC) (Adjusted OR = 3.41, 95% CI: 1.85–6.29, and p < 0.001) were independently associated with increased UTI risk. Conclusions: Indwelling catheter use and specific structural upper and lower urinary tract abnormalities were independently associated with an increased risk of symptomatic UTIs in chronic SCI. Prioritizing CIC, routine monitoring with imaging and urodynamics, and implementing targeted preventive strategies may help reduce infection burden and preserve renal function. Full article

Background: Low-intensity ultrasound (LIUS) has been proposed as a non-invasive approach to modulate cerebrospinal fluid movement, glymphatic–lymphatic clearance, and amyloid-beta (Aβ) handling in Alzheimer’s disease (AD). However, clinical comparisons in amyloid biomarker-confirmed patients receiving standard pharmacotherapy remain limited, and the short-term cognitive domains most likely to change after LIUS remain uncertain. Objective: The objective of this study was to compare 4-week changes in cognitive function, executive function, quality of life, and neuropsychiatric symptoms between amyloid PET-positive patients receiving add-on LIUS with donepezil-based standard treatment and those receiving donepezil-based standard treatment alone. Methods: This retrospective exploratory comparative cohort study included amyloid PET-positive patients with mild cognitive impairment or early AD who received donepezil-based standard treatment. The treatment cohort received 4 weeks of add-on LIUS at Dongtan or Bundang centers, whereas the comparator cohort received donepezil-based standard treatment alone at Soonchunhyang. Outcomes were changes from baseline to 4 weeks in Trail Making Test A (TMT-A), Trail Making Test B (TMT-B), Mini-Mental State Examination, Second Edition (MMSE-II), Quality of Life in Alzheimer’s Disease (QoL-AD), and Neuropsychiatric Inventory (NPI). Group differences were examined using unadjusted change-score comparisons and stabilized inverse probability of treatment weighting (IPTW). Results: The full analysis set included 51 amyloid PET-positive participants receiving donepezil-based standard treatment: 20 who additionally received LIUS and 31 who received standard treatment alone. Compared with controls, the add-on LIUS group showed greater improvement in TMT-A completion time in unadjusted analysis (−20.0 ± 31.3 s vs. −0.1 ± 5.6 s; p = 0.011), and this association remained significant after IPTW adjustment. TMT-B showed a favorable but less robust pattern, with borderline findings in the primary Fail-excluded analyses and a significant result in the Fail = 300 sensitivity analysis. MMSE-II change did not differ between groups. NPI improved more in the add-on LIUS group in unadjusted analysis, although this finding was exploratory. Conclusions: In amyloid PET-positive patients receiving donepezil-based standard treatment, 4 weeks of add-on LIUS was associated with short-term improvement in TMT-A performance compared with standard treatment alone, while MMSE-II remained unchanged. The findings suggest a preliminary signal for processing-speed or visual-search improvement and support prospective randomized sham-controlled studies with harmonized cognitive testing and biomarker endpoints. Full article

Background/Objectives: Preeclampsia is associated with endothelial dysfunction and neurological morbidity. Non-invasive ocular imaging may offer insight into subclinical ocular changes associated with neurological involvement. This prospective single-center pilot study evaluated retinal nerve fiber layer (RNFL) thickness, optic nerve sheath diameter (ONSD), and angiogenic biomarkers in women with and without preeclampsia across the peripartum period. Methods: Pregnant women with preeclampsia and normotensive controls were enrolled at a tertiary center. RNFL thickness was assessed by optical coherence tomography and ONSD by transbulbar ultrasound at three predefined visits: antepartum, early postpartum, and late postpartum. The soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio was determined at the antepartum visit. Group comparisons, longitudinal changes, and exploratory correlations were analyzed, with paired-eye dependence addressed using generalized estimating equations (GEE). Results: Thirty-eight women were included; after reclassification of three controls who developed preeclampsia, 15 women were analyzed in the preeclampsia group and 23 in the control group. RNFL thickness was numerically higher in women with preeclampsia across visits; GEE analyses accounting for paired-eye measurements showed exploratory between-group differences at the early postpartum visit. ONSD did not differ significantly between groups, and no participant had a bilateral mean ONSD > 5.8 mm. No significant between-group differences in longitudinal change from early to late postpartum were observed. Exploratory analyses did not demonstrate a consistent association between the sFlt-1/PlGF ratio and the imaging parameters. Conclusions: RNFL thickness was numerically higher in women with preeclampsia, whereas ONSD showed no clear separation between groups. The findings remain exploratory and do not establish a diagnostic or prognostic role for either imaging parameter. Larger prospective studies are needed to determine the clinical relevance of non-invasive ocular imaging in preeclampsia. Full article

Background: Non-invasive energy-based technologies, including high-intensity focused ultrasound (HIFU) and fractional radiofrequency microneedling (RF-MN), are increasingly used for facial rejuvenation due to their ability to induce dermal remodeling and neocollagenesis, although evidence on combined protocols remains limited. Objective: To evaluate the clinical outcomes and safety of a combined treatment protocol using HIFU and RF-MN delivered via the Focus Dual^® device for facial skin rejuvenation in patients with moderate-to-severe photo- and chrono-aging. Methods: This observational case series included 37 patients (52–85 years) treated with a combined regimen of HIFU and RF-MN over a 6-month period, consisting of two HIFU sessions and six RF-MN sessions; clinical outcomes were assessed using the Wrinkle Assessment Scale (WAS) across 11 facial anatomical regions and the Global Aesthetic Improvement Scale (GAIS), with evaluations performed on standardized photographs by two blinded independent assessors and safety monitored throughout. Statistical analysis was primarily descriptive and exploratory, including calculation of mean WAS scores, absolute and relative changes, inter-rater reliability assessment, and Pearson’s correlation analysis. Results: The combined treatment was associated with a measurable improvement in wrinkle severity, with median global WAS decreasing from 4.53 at baseline to 3.98 post-treatment, corresponding to a 12.1% overall improvement; the greatest improvements were observed in anatomically lax regions such as the cheeks (25.36%), periorbital lines (25.14%), nasolabial folds (23.92%), neck (23.77%), and marionette lines (21.36%) and corner of mouth lines (20.98%), while dynamic regions such as the glabellar and frontal areas showed a more limited response; a positive correlation between baseline severity and treatment response was observed (r = 0.73), with excellent inter-rater reliability (κ = 0.93–0.95) and no serious adverse events reported. Conclusions: The combined use of HIFU and RF-MN via the Focus Dual^® device appears to be a safe and well-tolerated non-invasive approach for facial rejuvenation associated with clinical improvements in wrinkle severity with a region- and severity-dependent response profile; the interaction between deep structural tightening (HIFU) and superficial dermal remodeling (RF-MN) suggests a complementary mechanism of action, although further controlled studies are warranted to confirm these findings and evaluate long-term outcomes. Full article