Carotid webs are increasingly recognized as a cause of ischemic stroke, but less is known about morphologically similar lesions in other arteries. We present the first study characterizing the clinical and radiographic features of extra-carotid arterial webs through a single-center case series and systematic review. Patients with possible extra-carotid webs were identified from 2017 to 2025 using a natural language processing search of radiology reports at our institution. Candidate cases underwent imaging review with multiplanar and 3-dimensional reconstructions to distinguish webs from fenestrations, vessel tortuosity, dissection, or atherosclerotic plaque. In parallel, we performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review (Web of Science and PubMed, inception to September 2025) to identify published cases of extra-carotid web. Data on demographics, vascular location, imaging modality, clinical presentation, treatment, and outcomes were extracted and synthesized descriptively. Four extra-carotid webs were identified at our institution (3 basilar and 1 subclavian). None were associated with stroke, and all patients remained stable on conservative management during 9 months to 4 years of follow-up. Across 16 published studies, 22 additional extra-carotid webs were identified, yielding 26 patients in aggregate (mean age, 52.7 years; 61.5% male). The vertebral artery was the most common site (53.8%), followed by the basilar (30.8%) and subclavian (15.4%) arteries. Ten patients with vertebral or basilar web presented with posterior circulation ischemic stroke, with recurrent events in 4 patients. Most patients were managed with antiplatelet therapy or observation, while 3 vertebral webs with recurrent stroke were successfully treated with stenting. Extra-carotid webs share morphological and clinical features with carotid webs and may represent a unified disease spectrum of cervical artery webs. Vertebral and basilar webs, though rare, may be an underrecognized source of posterior circulation stroke. Recognition of these lesions may broaden the differential for cryptogenic stroke though the lack of histopathologic visualization remains a critical limitation of our study.

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese Clinical Practice Guidelines for Vascular Tumors, Vascular Malformations, Lymphatic Malformations, and Lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

Study designRetrospective study.ObjectiveOsteoporotic vertebral compression fractures (OVCF) affect postmenopausal women, with 30-40% requiring surgical intervention after conservative treatment failure. This study developed a CT and MRI radiomics-based model to predict conservative treatment failure risk.MethodsWe retrospectively analyzed 154 postmenopausal women with OVCF (2016-2024), divided into successful (n = 86) and failed (n = 68) conservative treatment groups. Three-dimensional regions of interest were delineated, and quantitative features extracted using PyRadiomics. Feature selection employed Mann-Whitney U test, Spearman correlation, and LASSO regression. Clinical, radiomics, and combined models were constructed using eight machine learning algorithms with 5-fold cross-validation.ResultsAge and vertebral CT Hounsfield units were significant clinical predictors. From 3668 initial features, 16 key radiomics features were selected. LightGBM performed best for clinical models, while k-nearest neighbors excelled for radiomics models. In testing, the clinical model achieved AUC 0.684 (accuracy 0.71), radiomics model AUC 0.812 (accuracy 0.71), and combined model AUC 0.859 (accuracy 0.806). The combined model significantly outperformed individual models.ConclusionThe comprehensive CT and MRI radiomics-based model accurately predicts conservative treatment failure risk in postmenopausal women with OVCF. This tool enables early identification of high-risk patients and supports individualized treatment decisions, potentially guiding early surgical intervention for predicted high-risk cases.

Evaluation of the ultrasonography-guidance for botulinum toxin type a injection into lateral pterygoid muscle in patients with TMJ anterior disc displacement with reduction.

Study of the mechanical behaviour of a 16th century wooden painted panel: Effect of the cradle on its shape

Introduction: Finger joint dislocations, particularly involving the Proximal Interphalangeal (PIP) joint, pose common challenges in hand injuries. Despite various treatment modalities available including extension block splinting, extension block pinning, Open Reduction and Internal Fixation (ORIF), hemi-hamate arthroplasty, volar plate arthroplasty, and Dynamic External Fixator (DFS), comparative studies assessing functional outcomes are scarce. Definitive treatments for a particular type of PIP fracture-dislocation are not defined. Dynamic external fixation is a minimally invasive and cost-effective surgical treatment that allows early joint mobilisation with soft-tissue preservation. Aim: To compare the functional outcomes of conservative treatment versus DFS for PIP joint fracture-dislocation. Materials and Methods: A comparative prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from August 2022 to August 2024. Patients aged 18-50 years with PIP fracture-dislocations less than three-week-old were included. Patients were randomised to receive conservative management using buddy strapping (Group A) or DFS (Group B). Functional assessments, radiographic monitoring, and pain evaluations were conducted preoperatively and at follow-up appointments for a duration of three months. The association between categorical variables was examined using Chi-square tests, with a p-value <0.05 indicating statistical significance. Results: Group B exhibited significant improvements in Range Of Motion (ROM) (88.3±7.7) (p-value=0.001), extensor lag (1.9±1.7°) (p-value=0.013), intra-articular step-off (1.1±1.1) (p-value=0.002), grip strength (81.4±5.9) (p-value=0.001), and pain scores (0.5±0.7) (p-value=0.001) compared to Group A’s ROM (76.3±7.4), extensor lag (3±2°), intra-articular step-off (2±1.3), grip strength (70±6.2), and pain scores (2.2±1.1) at three months follow-up. Disability scores (Quick Dash) were also significantly lower in Group B (10.9±4.4) (p-value <0.001) compared to Group A (31.6±13.5) at three months. Conclusion: DFS-Suzuki frame treatment showed superior outcomes compared to conservative treatment for PIP fracturedislocations. It resulted in improved motion, strength, and pain scores, along with reduced disability

Ring pessary therapy is a widely used conservative treatment for pelvic organ prolapse (POP). In Japan, pessary self-management (SM) is recognized as a management option that may reduce adverse events; however, its adoption in routine clinical practice remains limited, and clinical data are scarce. This study aimed to identify factors associated with successful fitting and continuation of ring pessary therapy, focusing on the role of SM. We retrospectively reviewed the medical records of 90 patients with POP who initiated ring pessary therapy at our institution between 2010 and 2020. Patient characteristics, anatomical parameters, pessary management methods (SM or clinic management [CM]), and reasons for discontinuation were analyzed. Kaplan-Meier analysis, multivariate logistic regression, and Cox proportional hazards models were used to evaluate factors associated with fitting success and continuation. Among the 90 patients, 66 (73.3%) selected SM and 24 (26.7%) CM. Successful fitting was achieved in 62 patients (93.9%) in the SM group and in 8 patients (33.3%) in the CM group. SM was independently associated with successful fitting and longer continuation. Among patients with successful fitting, continuation rates were significantly higher in the SM group than in the CM group (p < 0.0001). The median pessary size among successfully fitted patients was 62 mm. In exploratory analyses, patients who discontinued therapy due to pain or discomfort tended to have shorter total vaginal length (TVL) and lower TVL/height ratios. Ring pessary therapy is a useful conservative treatment option for Japanese women with POP. SM may facilitate successful fitting and prolonged continuation when appropriate patient instruction and follow-up are provided.

• Comparison of non-invasive sampling devices for VOCs emitted by historical snuffboxes. • Coupling of GC-MS with olfactory detection to combine chemical and olfactory data. • Comparison of olfactory data obtained with sorbent tubes filled with Tenax TA® and HiSorb probes. In the recent years, several sampling devices have been used for the non-destructive collection of volatile organic compounds in heritage environments. To heritage scientists and conservators, these have become essential tools, as they enable the investigation of material composition, degradation processes, and conservation treatments, in principle without damaging the artefact. This paper investigates the performance of sorbent tubes, common sampling devices used in museums, and HiSorb probes, to analyze the volatiles emitted from two historical snuffboxes. The first one, an empty one from the National Museum of Slovenia, has undergone conservation, while the second one is an untreated historical object from the Historical Reference Material Collection of the Heritage Science Laboratory Ljubljana, still containing tobacco. Comparison of the different sampling devices showed that both sorbent tubes and HiSorb probes gave comprehensive chromatograms, detecting products related to wood degradation, such as acetic acid, formic acid, furfural, nonanal, and decanal. Furthermore, HiSorb probes detected terpenes and tobacco-derived compounds, like nicotine, and pyridine-derivatives. Noticeably, these compounds were characterized as traces in the cleaned snuffbox, while they showed high peaks in the reference one, consistently with their conservation history. The small size of the HiSorb probe, which allowed its insertion into the snuffbox, likely contributed to the higher abundance of the detected volatiles. Gas chromatography was coupled with two detectors – mass spectrometry and olfactometry – to define the olfactory profile of the two case studies and correlate each compound with the detected smell. Two sampling devices were compared: sorbent tubes and HiSorb probes. In contrast with commonly used sorbent tubes, this study represents the first application of HiSorb sampling in combination with olfactometric analysis for heritage objects, introducing a novel methodological approach. The results demonstrated that olfactory analysis following HiSorb sampling is feasible, with a number of the most intense smells comparable, or even higher, than when sampling with sorbent tubes. The outcomes confirmed the chemical analyses, highlighting “wood”, “leather”, “flower”, and “fresh” as main descriptors, with the snuffbox belonging to the reference collection presenting a richer profile including more compounds giving “wood”, “sweet”, and “powder” notes.

Calcaneus fractures: A review.

The interdental papilla plays a vital role in dental and facial aesthetics, as the loss of papilla manifests as unesthetic "black triangles". In recent years, non-surgical approaches such as hyaluronic acid injections, autologous platelet concentrates, laser therapy, and microneedling with vitamin C have emerged as alternatives to technically demanding and unpredictable surgical reconstruction. To evaluate the effectiveness, patient satisfaction, and safety of cosmetic non-surgical treatment modalities for the correction of black triangles. A comprehensive literature search was conducted using the PubMed, Cochrane Library, Scopus, and Embase databases, from January 2013 to January 2024. All case series, cohort studies, and randomized controlled trials with relevant outcomes were included. The BestBETs methodology was used, and the risk of bias was assessed using the "Quality Assessment Tool for Quantitative Studies." A total of 19 human studies met the inclusion criteria. Of these, six studies were classified as level II evidence, while the remaining 13 were categorized as level III or level IV evidence. Based on level II evidence, hyaluronic acid injections were effective and safe for correcting the black triangles and improving the smile. Evidence on non-surgical modalities such as autologous platelet concentrates, photobiomodulation therapy, and microneedling with vitamin C remains limited. Based on level II to level IV evidence, these conservative treatments are recommended as clinically effective for filling black triangle spaces, demonstrating high patient satisfaction and minimal adverse events. Non-surgical cosmetic treatments offer a promising alternative for reconstructing interdental papilla deficiencies, with benefits including reduced complications and favorable aesthetic outcomes. However, the current evidence remains limited, and findings should be interpreted with caution. Further well-designed, standardized clinical trials are required to establish the effectiveness, long-term stability, and patient-centred outcomes of these interventions.

Tendon injuries present a major clinical challenge due to the tissue's limited regenerative capacity, poor vascularization, and tendency toward fibrotic healing that compromises mechanical function. Surgical and conservative treatments often fail to restore native tendon architecture, leading to high rates of retear, adhesion, and long-term functional impairment. In recent years, tissue engineering strategies have gained increasing attention, with nanofiber-based matrices emerging as promising platforms for functional tendon regeneration. Owing to their structural similarity to native extracellular matrix (ECM), nanofiber scaffolds enable precise control over fiber alignment, porosity, and mechanical properties, which are critical for guiding tenogenic cell behavior and matrix organization.This review summarizes recent advances in nanofiber fabrication techniques, including electrospinning and hybrid nanomanufacturing approaches, and discusses strategies for tailoring scaffold properties through biophysiochemical cues, biological factor delivery, cell incorporation, and nanoparticle functionalization. Special emphasis is placed on multifunctional nanofiber systems that modulate inflammation, promote tenogenic differentiation, enhance tendon - bone interface healing, and minimize scar formation and postoperative adhesion. Finally, current challenges and future directions toward scalable manufacturing, reproducibility, and clinical translation are discussed. Collectively, nanofiber-based matrices represent a versatile and powerful approach for advancing tendon tissue engineering and achieving durable functional repair. Search: PubMed, Google Scholar, through March 2026.

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese Clinical Practice Guidelines for Vascular Tumors, Vascular Malformations, Lymphatic Malformations, and Lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.

Achilles tendon rupture (ATR) is acommon injury among middle-aged people who are physically active. Adifferentiated clinical and sonographic assessment is primarily required to select the optimal treatment. Treatment options include both conservative and surgical methods. In the case of active young patients, there may be apreference for surgical treatment of acute/subacute ATR due to its potential for less loss of strength and enhanced rehabilitation. Minimally invasive surgery (MIS) techniques have reduced the rate of general complications (wound healing disorders, wound infections) compared to open procedures, with acomparable re-rupture rate. Open surgical techniques or reconstructions are the preferred treatment in cases of chronic ATR with defects or muscle atrophy. Conservative treatment and postoperative therapy require stage-specific functional dynamic rehabilitation, which has been shown to lead to better clinical results and areduction in the re-rupture rate.

Ureteropelvic junction obstruction (UPJO) is a major cause of obstructive uropathy in pediatric patients. However, the optimal management remains controversial. We aimed to summarize the evidence comparing surgical versus conservative treatment. We searched MEDLINE/PubMed (2016 to 31 October 2024) and the Cochrane Central Register of Controlled Trials (CENTRAL) on 31 October 2024. The primary outcome was split renal function (SRF). Results were summarized in a structured table. Study quality was assessed using the ROBINS-I tool and the level of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. Our search resulted in 2.251 reports. We included two non-randomized interventional studies with 136 patients. One study reported no statistically significant difference in SRF between the study groups after 1 year of follow up, while the second study reported higher SRF in surgical group 6 months postoperatively. The studies were judged to have a serious risk of bias, and the quality of evidence was rated as very low. The paucity of eligible data precluded the performance of a meta-analysis. Our findings could not support clinical recommendations. This study highlights the lack of high-quality evidence that will come from large, prospective, well-designed trials comparing surgical intervention to updated conservative treatment options.

This systematic review synthesizes current evidence on the application of extended reality (XR) technologies, comprising virtual reality (VR), augmented reality (AR), and mixed reality (MR), in rehabilitation medicine, assessing their effects across diverse rehabilitation domains and clinical outcomes. A comprehensive search of three biomedical databases was conducted, yielding 58 randomized controlled trials that examined XR interventions in geriatric, neurological, orthopedic, and pediatric rehabilitation. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Results were qualitatively synthesized according to intervention characteristics and outcome measures. The findings indicate that XR technologies can enhance rehabilitation outcomes, including improvements in motor and cognitive function, pain management, psychological well-being, and quality of life. XR interventions were shown to improve balance, strength, and cognitive and psychological function in older adults; facilitate motor recovery and reduce neuropathic pain in neurological populations; support postoperative rehabilitation and conservative interventions in orthopedic patients; and enhance engagement and therapeutic goals attainment in pediatric patients. XR technologies present a promising and innovative approach to rehabilitation, offering personalized and engaging therapeutic experiences. Clinicians should leverage XR technologies to empower patients and optimize clinical outcomes.

The Qinghai-Tibet Plateau (QTP) is ecologically significant due to its unique biodiversity and vulnerability to climate change and rapid urbanization. Among its emerging urban habitats, wastelands with relatively low anthropogenic disturbances offer key refuges and stepping stones for spontaneous plants. However, the patterns and drivers of spontaneous plant diversity in these habitats remain poorly understood. To address this, we surveyed spontaneous plant communities across 17 cities on the QTP. We found that native species dominated urban wasteland flora (85.8%), whereas invasive species constituted over half (65.8%) of the non-native species. The results showed that land-use legacy effects and environmental filtering shape community assembly. GLMM analyses further reveal that the climatic background constitutes a key factor shaping community diversity variations across the QTP, exerting the most significant influence on species richness, particularly through precipitation and wind speed. Urbanization and habitat quality factors jointly shape the diversity structural characteristics of communities. However, non-native and invasive species exhibit heightened sensitivity to local habitat quality. Furthermore, differences between communities across all groups were due to species turnover, though the driving factors differed between groups. Native species exhibited stronger overall ecological adaptability, whereas differences between communities of non-native and invasive species were primarily driven by human disturbance and habitat conditions. These findings underscore the ecological value of urban wastelands on the QTP for biodiversity conservation and invasion management under rapid urbanization and climate change.

G-376 CKM Jumpstart: A Randomized Pilot Trial of a Communication Tool to Assist Discussions About Conservative Kidney Management

The pediatric population presents specific management challenges with pyogenic granuloma (PG), particularly when located near joints, as surgical treatment may compromise mobility. While surgical excision remains the gold standard treatment, emerging reports suggest that more conservative approaches may be suitable in select cases, offering less invasive treatment options. We report the preservation of joint function while successfully resolving pyogenic digital granuloma with topical steroid-antibiotic preparations. A healthy 7-year-old girl presented with progressive left middle and ring finger exacerbation of lesions attributable to sheep fence lacerations. Primary closure was performed; however, it resulted in recurrent serous collections, necessitating the use of a patch of granulation tissue. Examination revealed non-tender digit swelling at the volar aspect of the middle and distal phalanges with maintained flexor digitorum muscles, intact sensation, and no Kanavel signs. The child underwent staged bedside debridement under a digital block and removal of sutures lodged within the granulation tissue. Conservative treatment included daily steroid-infused dressings with fusidic acid ointment, overlapping two debridement sessions spaced 1 week apart. No lesions were noted post-treatment, along with a full range of movement and intact sensation. Skin loss traversing the flexor creases did not result in any form of flexion contraction and remained satisfactory at follow-up. This case demonstrates that dual-action corticosteroid-antibiotic therapy, combined with stepwise debridement, can achieve functional preservation of the joint in children with digital PG. In certain pediatric patients, where the lesions are located in functionally important regions, this surgical excision alternative is beneficial. It must be noted, however, that the lack of confirmation through histopathological analysis in this case represents a significant limitation that should be considered in the course of clinical reasoning.

Assessing carbon sequestration potential of Yangtze River Delta wetlands under multiple scenarios of climate change and human activities.

Forest composition and structural diversity play a key role in shaping habitat availability and biodiversity, particularly influencing the occurrence of saproxylic species associated with tree-related microhabitats (TreMs). TreMs and deadwood are essential features of forest ecosystems, offering critical habitats for saproxylic arthropods that contribute to decomposition, nutrient cycling, and overall forest resilience. Understanding the complex interactions between forest structures, TreMs, and arthropod communities is crucial for biodiversity conservation and sustainable forest management. This study examines how forest composition, deadwood characteristics, and TreMs influence saproxylic arthropods' diversity in the Black Forest, Germany. Using environmental DNA (eDNA) metabarcoding, we assessed arthropod communities across 135 forest plots with varying degrees of retention. Our findings reveal that specific TreMs, such as cavities, mosses, and insect galleries, were associated with arthropod richness patterns, particularly for Collembola, Hemiptera, and Arachnida. Canopy closure emerged as the most consistent predictor of arthropod richness, while tree-related microhabitats, lying deadwood volume, snag volume, and forest management intensity showed additional taxon-specific associations. These findings reveal that species richness is associated with multiple ecological factors, highlighting the complexity of forest ecosystems. They underscore the need for forest management strategies that preserve deadwood and TreMs, enhance structural heterogeneity, and consider broader indicators of forest naturalness to effectively support arthropod biodiversity.