Rapid multi-parametric quantitative MRI via deep learning-based synthetic-to-real reconstruction and 3D SSFP-MOLED imaging.

Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings. Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts. 2022-2024. State and jurisdictional health departments voluntarily report clinical and screening C. auris cases to CDC using standardized case definitions of the Council of State and Territorial Epidemiologists. Clinical cases are defined as detection of C. auris from specimens collected for diagnostic purposes; screening cases are defined as detection from colonization screening swabs. Cases were reported to CDC through the Research Electronic Data Capture (REDCap) or Data Collation and Integration for Public Health Event Response (DCIPHER) platforms. Data included patient age and sex, case type, specimen type (for clinical cases), health care facility type, Antimicrobial Resistance Laboratory Network geographic region, and specimen collection date. Analyses were descriptive and limited to cases with specimens collected during 2022-2024. During 2022-2024, a total of 13,507 clinical C. auris cases were reported to CDC, increasing from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024, with smaller annual percentage increases over time (53.7% from 2022 to 2023 and 39.9% from 2023 to 2024). Most clinical cases occurred among adults aged ≥45 years (87.8%) and among males (61.0%). The most common specimen types among all clinical cases were urine (31.5%) and blood (30.2%); by year, the proportion of blood as the specimen type was 34.4% in 2022, 30.2% in 2023, and 25.6% in 2024. Most clinical cases were identified through specimens collected in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%).During the same period, a total of 27,853 screening cases were reported to CDC, increasing from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024. Screening cases most frequently occurred among adults aged ≥45 years (90.0%) and males (57.9%). Among cases with known facility type, the proportion of specimens collected in acute care hospitals increased from 24.7% in 2022 to 50.7% in 2024, whereas the proportion of specimens collected in long-term acute care hospitals decreased from 56.1% to 35.7% during the same period. The number of clinical and screening C. auris cases reported to CDC increased during 2022-2024, indicating ongoing transmission in U.S. health care settings. Although annual percentage increases in clinical cases declined over time, absolute case counts reported to CDC continued to rise. The increasing proportion of screening cases with specimens collected in acute care hospitals might reflect increased use of screening in acute care hospitals, including screening at admission. Because of increases in the number of reported C. auris cases, sustained infection prevention and control efforts in health care facilities, including adherence to transmission-based precautions, environmental disinfection with agents effective against C. auris, and communication of C. auris status during patient transfers remain essential to preventing clinical infections and colonization. Because this pathogen is frequently resistant to antifungal drugs, continued investment in laboratory capacity and surveillance, including antifungal susceptibility testing and screening of patients at high risk for C. auris infection, can support timely detection and guide prevention strategies. Ongoing public health coordination at federal, state, and local levels is critical to limit further spread and to address emerging antifungal drug resistance.

Ensuring the health of laboratory rodents is critical for ethical research and maintaining scientific integrity. Traditional daily visual observations by trained technicians, conducted during the rodents' sleep period, often fail to detect subtle but critical health indicators due to the short duration of inspections and obstructions from enrichment materials. Here we aimed to improve health checks in mice by utilizing continuous home-cage monitoring coupled with machine learning (ML) algorithms. We hypothesized that reduced locomotion in mice would indicate distress or sickness, and that continuous tracking would identify clinical cases earlier than visual checks. We retrospectively analyzed locomotion data from three institutions using the same sensor technology and applied ML/artificial intelligence (AI) models to generate digital alerts for potential clinical cases. These alerts were then compared with clinical records to verify the accuracy of the predictions. Our results demonstrated that the ML algorithm identified animals in distress -3 to -6 days before verifiable clinical signs or death were noticed, with an accuracy of 66-80% on day -3 and 80-91% on day -6. This indicates that continuous monitoring of animal locomotion is a superior predictor of animal health compared with human observation. The findings suggest that augmenting visual checks with AI modeling can greatly improve animal welfare by identifying subclinical cases, enhancing study endpoints, increasing the rigor and reproducibility of research, and improving operational efficiency. Our work underscores the potential of integrating advanced monitoring systems and AI in laboratory animal facilities, marking a substantial step forward in the field of animal welfare and research methodology.

Case report and literature review. To report 2 detailed cases of 3D printing application in lumbar revision surgery and to conduct a corresponding literature review. As lumbar fusion surgeries rise, so do revision procedures, posing significant challenges due to potential complications. This report presents 2 successful lumbar revision cases using 3D biomodel-based customized plans. Both patients had favorable outcomes, highlighting the advantages of 3D biomodel printing in enhancing lumbar revision effectiveness. A 1:1 scale lumbar spine model was created using each patient's computerized tomography (CT) scan, and personalized interbody fusion devices were 3D printed for preoperative planning, placement simulation, patient education, and intraoperative guidance. At the 3-month follow-up, both patients reported symptom relief. Specifically, Patient 1 exhibited a reduction in VAS scores from 5 (preoperative lumbar) and 5 (preoperative leg) to 2 and 1, respectively. Patient 2 showed a decrease from 6 (preoperative lumbar) and 7 (preoperative leg) to 2 and 3, respectively. X-ray radiographs confirmed no evidence of dysfunction of the interbody fusion devices. At the 3-month follow-up, both patients exhibited symptomatic improvement. Radiographic assessment demonstrated stable positioning of the interbody fusion devices with no signs of loosening, migration, or failure. This study used 3D biomodeling to customize lumbar spine prostheses and plan revision surgeries. Favorable outcomes hint at 3D printing's benefits, but more clinical cases and long-term follow-up are needed to validate its effectiveness. The findings highlight 3D printing's potential in advancing lumbar spine surgery.

Reinforcement learning for real-time adaptive radiotherapy.

Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who progress to the third-line setting face a lack of standardized treatment, despite the presence of multiple available therapies. In this context, antibody-drug conjugates represent a relatively new class of anticancer agents; among them, loncastuximab tesirine is a second-in-class agent approved for the treatment of patients with R/R DLBCL after ≥ 2 lines of systemic therapy. Because many patients with R/R DLBCL are ineligible for intensive therapies due to advanced age and comorbidities, the availability of any new agent is particularly important. We present an overview of the clinical evidence for loncastuximab tesirine and offer practical guidance on its use in R/R DLBCL. Additionally, three clinical cases are described to illustrate its efficacy in transformed DLBCL, the management of treatment and safety when used as a bridge to allogeneic stem cell transplantation, and its role in the sequencing of therapies for R/R DLBCL. Findings from our Italian experience may be informative on the clinical application of loncastuximab tesirine in other countries where it is approved and available.

Urology encompasses a diverse array of pathologies with complex clinical presentations, demanding rigorous hands-on clinical practice and high-quality pedagogical training for medical interns. To overcome the limitations of traditional teaching models, which typically combines theoretical instruction with ward observation often provide limited exposure, we developed and validated a novel clinical teaching model that is based on real-world clinical cases in individualized three-dimensional imaging and evaluated its feasibility and effectiveness in urological internship teaching through prospective experiments. To evaluate the feasibility and effectiveness of a novel clinical teaching model that integrates real-world clinical cases with individualized three-dimensional imaging in urology interns. During the 2024-2025 academic year, 128 interns in the Department of Urology were randomly assigned to two groups based on student ID numbers: the traditional teaching mode (TTM) arm and the new teaching mode (NTM) arm, with 64 interns in each group. The TTM group received the conventional approach of thematic theoretical teaching alongside clinical case observation, while the NTM arm implemented the novel approach. After a 2-week internship, the educational effects of trainees were assessed by confidential questionnaire, theoretical knowledge examination, and clinical practice assessments, followed by statistical analysis of the results. Interns in the NTM group outperformed those in the TTM group (p < 0.05). Although some specific item assessments revealed no significant differences between the two groups, the overall scores of interns in the NTM group on confidential questionnaires, theoretical knowledge examinations, and clinical practice assessments were significantly higher than those in the TTM group (p < 0.05). The weighted composite score (confidential questionnaire constituted 0.2, theoretical knowledge examination constituted 0.4, clinical practice examination constituted 0.4) of the NTM group was significantly higher (79.75 ± 3.91 vs. 85.30 ± 6.03, p < 0.001). This study indicates that the NTM is well accepted by interns and those receiving clinical teaching through the NTM show superior theoretical knowledge and clinical skills over the TTM.

Beyond Conventional Ramp: Integrating Exercise and Dobutamine Stress for Physiologic Speed Optimization in Long-Term BTT-VAD Management: Two Clinical Cases

Removable partial denture teaching in Indonesian dental schools: A cross-sectional study.

Large language models have emerged as potential tools to support hypertension care, including diagnosis, treatment decision-making, and patient education. However, evidence regarding their validity, performance, and clinical applicability remains limited. The objective is to map current applications of large language models in hypertension care, with emphasis on model optimization strategies, evaluation approaches, and reported limitations. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews-compliant scoping review of primary studies published between 2023 and 2025 evaluating large language models in hypertension. Thirty-three studies were included. Data were charted on clinical use cases, model optimization techniques, evaluation metrics, data sets, and limitations. Applications were categorized into clinical decision support systems, patient education, medical education, research support, and administrative functions. GPT-based models predominated (82%). Model optimization was limited: 89% relied exclusively on prompt engineering. Most applications focused on patient education (52%) and clinical decision support systems (24%). In clinical decision support systems, reported accuracy ranged from 65% to 100%, reaching 87% to 91% for ambulatory blood pressure monitoring interpretation. Patient education applications showed accuracy between 80% and 90%, but frequent issues included excessive language complexity and occasional unsafe outputs. Across domains, evaluation methods were heterogeneous, reproducibility was inconsistently assessed, and safety concerns, including hallucinations and outdated knowledge, were commonly reported. Current evidence suggests that large language models may support selected tasks in hypertension care; however, their clinical reliability remains uncertain. The limited methodological rigor, minimal use of advanced optimization techniques, and narrow scope of evaluated applications preclude conclusions regarding routine clinical use. Further rigorously designed studies are required before broader implementation can be considered.

To review the role of Demodex infestation in blepharitis and summarize available evidence on the efficacy and safety of topical and oral ivermectin. This narrative review was conducted through collaboration between expert ophthalmologists and infectious diseases specialists with clinical experience in the use of ivermectin. A literature search was performed in PubMed and Embase from inception to November 2025. Evidence from clinical trials, observational studies, and case series was reviewed and synthesized. Ivermectin, administered orally or topically, has been investigated as a potential treatment option for Demodex-associated blepharitis, either as monotherapy or in combination with other therapies. Across different treatment protocols and patient populations, ivermectin use was generally associated with reductions in Demodex mite density, improvement in cylindrical dandruff, ocular surface parameters, and patient-reported symptoms. Reported adverse events were infrequent and predominantly mild. Current evidence suggests that ivermectin may represent an effective and overall safe therapeutic option for Demodex-associated blepharitis. Further studies are needed to establish standardized treatment regimens and to assess long-term outcomes.

This study aimed to clarify how midwives overcome challenges in providing perinatal mental health (PMH) care in clinical settings and to inform feasible, context-sensitive educational support. We used an interpretivist-constructivist qualitative design with a sequential two-stage approach. Thirteen midwives working at five obstetric facilities in Okinawa, Japan, each with more than 2 years of PMH care experience, participated in one focus group discussion (FGD) and one in-depth interview (IDI). FGD transcripts were analyzed descriptively to clarify key challenges and concerns and to inform the development of IDI questions. IDI transcripts were analyzed using reflexive thematic analysis to explore how midwives navigated and overcame these challenges, thereby generating an interpretive account aligned with the study aim. Five themes were generated, from which we constructed a dynamic thematic map illustrating how challenges were overcome: contextual challenges triggered action; team-based support, reflective practice, and feedback from clinical cases interacted recursively; and motivational substrates underpinned these processes and were reinforced through ongoing practice, sustaining midwives' involvement in PMH care under conditions of uncertainty. Reported barriers included limited opportunities for reflective dialogue within shift-based workflows and limited visibility of post-discharge outcomes. This study clarified the contextual challenges in PMH care and the key elements for overcoming them. These findings inform educational and organizational support combining flexible access to knowledge resources with interprofessional collaborative reflection grounded in psychological safety in emotionally and time-constrained obstetric settings, enabling midwives to sustain engagement in PMH care under conditions of uncertainty.

Introduction: Aortic diseases, such as acute thoracic aortic dissection type A (ATAAD), are life-threatening conditions that require prompt diagnosis and treatment. This condition exhibits high mortality, particularly due to its unpredictable nature and clinical variability. Although it primarily affects elderly men, female patients often present with atypical symptoms, complicating diagnosis and treatment approaches. This study presents a clinical case of a female patient under 60 years of age diagnosed with ATAAD. Aim: Presentation of a case with a female patient highlighting the importance of early diagnosis, multidisciplinary care, and a holistic approach. Case Presentation: A 58-year-old woman with a medical history of rheumatoid arthritis, hypertension, and dyslipidemia presented with sharp chest pain and was urgently transferred to a University Hospital. Her clinical condition included hypoxia and severe hypotension. Investigations revealed elevated troponin levels, and the diagnosis of aortic dissection was confirmed via computed tomography and echocardiography. The patient underwent immediate surgical operation. Postoperatively, she had bleeding and she was hemodynamically unstable, which were successfully managed. Gradually, her condition stabilized, and she began a rehabilitation program. The multidisciplinary team provided psychological support to the patient and educated her about her new health condition. The patient was hospitalized for 50 days, 30 of which were in the Cardiothoracic Intensive Care Unit, and then transferred to a rehabilitation center.

Accurate heterogeneity correction in high-precision radiotherapy relies on precise computed tomography (CT) number-to-density conversion via the Hounsfield unit look-up table (HLUT). While physical properties of tissue-equivalent materials are generally assumed consistent with manufacturer specifications, an independent audit identified clinically significant density discrepancies in commercially available lung-equivalent phantom inserts. This study evaluates the physical properties of nonconforming lung inserts through mass measurements and stoichiometric analysis, and assesses the clinical dosimetric impact of the associated density discrepancies. Five lung-inhale inserts manufactured in 2010, 2015, and 2024 (10A, 10B, 15A, 15B, and 24A) were analyzed. Mass and physical dimensions were measured in triplicate using a precision balance (1mg resolution) and vernier calipers. Stoichiometric analysis was conducted using reference materials to evaluate the tissue-equivalence of the inserts and quantify deviations from the theoretical baseline. A nonconforming table and a conforming reference table (RT) were established, derived from inserts 10A and 24A, respectively. For clinical impact assessment, volumetric modulated arc therapy (VMAT) plans for three clinical cases involving centrally located lung tumors (utilizing both inspiration breath-hold (IBH) and free-breathing) were optimized for stereotactic body radiotherapy (SBRT) and recalculated with the RT using the Acuros XB algorithm. Differences in gross tumor volume (GTV) mean dose and planning target volume (PTV) D95% were evaluated to quantify the dosimetric consequences. The 2010 inserts (10A and 10B) exhibited a 17.1% mass reduction and lower CT numbers compared to the reference 24A insert. Dimensional variations were negligible (≤ 0.2mm) across all samples. Clinical recalculation revealed maximum dose reductions of 2.1% for the GTV mean dose and 3.0% for the PTV D95% in the worst-case scenario. These errors exceed the 2% clinical tolerance, propagated by HLUT interpolation across the low-density range. Substantial inter-lot density variations in commercial calibration phantoms can lead to dosimetric errors that exceed established clinical limits, particularly for centrally located tumors treated with IBH. Medical physicists must not implicitly rely on nominal manufacturer values; independent audits and initial mass screening at acceptance are highly recommended for maintaining dose calculation accuracy.

Cavernous malformations (CMs) involving cranial nerves are exceedingly rare. To date, only six cases of trochlear nerve involvement have been published in the literature. We present the case of a microsurgical resection of a CM affecting the trochlear nerve. We report the clinical case of a 32-year-old patient who developed diplopia due to a CM affecting the trochlear nerve. Magnetic resonance imaging (MRI) showed a contrast lesion measuring 9 × 5 mm affecting the trochlear nerve. Microsurgical resection of the lesion via a subtemporal approach under continuous neuromonitoring was performed. The patient underwent successful microsurgical resection. Postoperatively, the patient's diplopia remained unchanged. No new neurological deficits were observed. This case demonstrates the feasibility and safety of microsurgical resection of a trochlear nerve CM. Given the rarity of this entity, individual case reports contribute valuable insight into diagnosis and surgical management.

Enteropathy in STAT3 GOF syndrome: Insights into the role of the JAK-STAT pathway.

A portal cavernoma is a network formed by localized dilation of the hepatic portal system. This study aims to describe a case of portal cavernoma in a 69-year-old adult presenting with gastrointestinal hemorrhage. This is a 69-year-old patient with no particular medical history admitted for hematemesis associated with diffuse abdominal pain. Clinical examination revealed blood pressure of 100/60 mmHg and tenderness in the epigastric region. Upper gastrointestinal endoscopy revealed a large bulbar ulcer in flare-up. Helicobacter pylori testing in stool samples was positive. The initial diagnosis was a bulbar ulcer, and the patient was placed on treatment to eradicate H. pylori. However, an abdominal ultrasound performed later suggested heterogeneous portal vein thrombosis, which was confirmed by abdominal CT scan. Given these findings, we made a diagnosis of portal cavernoma revealed by gastrointestinal hemorrhage. Treatment consisted of 40 mg of injectable omeprazole every 12 h, 40 mg of propranolol per day, and one sachet of Gaviscon every 8 h. Anticoagulation was initiated with enoxaparin and then continued with 4 mg of acenocoumarol per day. The patient responded well to treatment, with regression of abdominal pain and gastrointestinal hemorrhage, and was discharged home after 10 days following two stable INR readings. Although most commonly described in pediatrics, this clinical case sheds light on adult forms of the disease.

Despite the introduction of the 2017 periodontal disease classification system to enhance diagnostic accuracy, several concerns persist regarding its implementation in clinical situations. The prevalence of diagnostic errors in periodontics remains relatively high, with limited data available on the impact of different training levels and institutional approaches on the diagnostic accuracy and competency of students and practitioners. This study aims to explore the patterns of diagnostic accuracy and perceived confidence and familiarity with utilizing the 2017 periodontal classification system across various levels of clinical complexity, different educational levels, and two Canadian institutions METHODS: This prospective cross-sectional study included 104 participants from two universities, including third- and fourth-year dental students, dental hygiene degree students, periodontics residents from five programs, and clinical instructors in periodontics and dental hygiene. Participants were asked to diagnose five de-identified clinical cases along the spectrum of periodontal health and disease. Gold standard diagnoses were established by board-certified periodontists. Diagnostic accuracy, error patterns, and factors influencing diagnostic decisions were analyzed using chi-square tests, t-tests, and a content analysis approach. The overall diagnostic accuracy ranged from 18.3% to 53.8%. Clinical instructors achieved the highest accuracy (58.3%), followed by residents (52.9%), fourth-year dental students (45.2%), dental hygiene degree students (36.5%), and third-year dental students (26.4%). Statistically significant institutional differences were identified in Cases 1 (χ2 = 7.62,p=0.01) and 4(χ2 = 4.04,p=0.05). Common errors included underdiagnosis (32.4%), incorrect periodontal status identification (28.7%), and wrong extent classification (21.3%). Qualitatively, participants frequently described the classification system as "ambiguous" with substantial "gray zones". Regardless of the training level, diagnostic accuracy with the 2017 classification system remains suboptimal. Institutional variations suggest that curricular approaches may significantly impact the development of diagnostic skills and their diagnostic competency. These findings highlight the need for calibration protocols, targeted teaching and learning interventions, and technology-supported learning tools to improve diagnostic skills in periodontal education.

Proteomic profiling reveals region-specific neuroimmune and apoptotic signatures induced by Bothrops jararaca venom toxins in the murine brain.

Can AI generate safe anaesthesia plans? A comparative evaluation of three large language models on 100 synthetic cases.