Deeper Tissue Layers Research Articles

"MINIMIZING THIGHPLASTY COMPLICATIONS: A COMBINED APPROACH OF J MEDIAL PATTERN AND HELIUM-PLASMA ASSISTED LIPOSCULPTURE".

Thighplasty is a widely performed body contouring procedure, utilizing various surgical techniques for thigh lifting, including medial scar positioning, vertical and horizontal procedures, and liposuction. Despite its popularity, thighplasty is associated with high complication rates and suboptimal postoperative outcomes.This article presents a novel technique: the J medial thighplasty combined with helium plasma radiofrequency technology (HPRF) to address moderate skin and soft-tissue laxity and ptosis in the inner thighs. Between 2020 and 2023, 21 patients underwent this combined procedure. The surgical approach involved selective liposuction in targeted areas, skin resection, and preservation of deep tissue layers, coupled with the application of HPRF in the lower third of the medial thigh.Results demonstrated significant reductions in thigh laxity, correction of skin overhang, and fat reduction, yielding improved functional and aesthetic outcomes in the lower thigh region. By strategically avoiding lymphatic vessels in superficial areas, the risk of secondary lymphedema was minimized. Patient satisfaction was notably high, with both patients and surgeons reporting favorable results.In conclusion, the J medial thighplasty combined with HPRF offers an effective and straightforward method for enhancing the lower thigh area with minimal complications. This innovative technique provides a promising solution for patients seeking improved thigh contouring while ensuring high levels of patient satisfaction.

Challenges of Spine Surgery in Obese Patients: A Case Report with a Review of the Literature

Introduction: Obese patients face unique challenges across all phases of spine care and surgery, including preoperative, intraoperative, and postoperative periods. Significantly higher risks are associated with spinal surgery in obese patients. This study explores the challenges of managing spinal conditions in obese patients and offers strategies to mitigate these risks. Case report: A 56-year-old female with a BMI of 42 was referred for evaluation of chronic lower back pain and radicular leg pain. Imaging results were lumbar fusion for degenerative disc disease at the L4-5 and L5-S1 levels. During surgery, the patient required a prolonged operating time due to her increased soft tissue, which made visualization more difficult. The surgical team had to use longer instruments to navigate through the deeper tissue layers. Fluoroscopy was employed to ensure accurate placement of the fusion hardware. Postoperatively, the patient developed delayed wound healing, which required close monitoring and wound care interventions. She had significant reduction in back pain and improved mobility at her 6-month follow-up. Conclusion: Obese patients present numerous challenges to spine surgeons, ie. elective and non-elective surgeries, anesthetic issues, operative challenges, post-operative issues, complications, and outcomes. To mitigate associated risks and optimize outcomes, specific precautions can be taken during the preoperative, intraoperative, and postoperative phases.

Understanding metabolic responses to forearm arterial occlusion measured with two-channel broadband near-infrared spectroscopy.

Broadband near-infrared spectroscopy (bbNIRS) is useful for the quantification of cerebral metabolism. However, its usefulness has not been explored for broad biomedical applications. We aimed to quantify the dynamic responses of oxidized cytochrome c oxidase ( ) within the mitochondria to arterial occlusion and the dynamic correlations between hemodynamic ( ) and responses during and after occlusion in forearm tissues. We recruited 14 healthy participants with two-channel bbNIRS measurements in response to a 5-min forearm arterial occlusion. The bbNIRS system consisted of one shared white-light source and two spectrometers. The modified Beer-Lambert law was applied to determine the occlusion-induced changes in and in the shallow- and deep-tissue layers. During the 5-min occlusion, dynamic responses in hemodynamics exhibited the expected changes, but remained constant, as observed in the 1- and 3-cm channels. A linear correlation between and was observed only during the recovery phase, with a stronger correlation in deeper tissues. The observation of a constant during the cuff period was consistent with two previous reports. The interpretation of this observation is based on the literature that the oxygen metabolism of the skeletal muscle during arterial occlusion remains unchanged before all oxy-hemoglobin (and oxy-myoglobin) resources are completely depleted. Because a 5-min arterial occlusion is not adequate to exhaust all oxygen supply in the vascular bed of the forearm, the local oxygen supply to the muscle mitochondria maintains redox metabolism uninterrupted by occlusion. We provide a better understanding of the mitochondrial responses to forearm arterial occlusion and demonstrate the usefulness of bbNIRS.

Diagnostics and Surgical Treatment of Deep Endometriosis-Real-World Data from a Large Endometriosis Center.

Background: Deep endometriosis (DE) is a special form of endometriosis, one of the most common benign diseases in gynecology. In the specific case of DE, ectopic endometrium can be found not only in peritoneal but also in deeper tissue layers or even as parenchymal organ infiltration. Symptoms include dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as asymptomatic hydronephrosis or other organ dysfunctions. Due to a pathogenesis of the disease that has not been conclusively clarified to date, no causal therapy exists, which is why surgical resection of DE is still the gold standard for symptomatic cases. Methods: This article retrospectively describes the challenges in diagnosis and surgical treatment of DE at a German Level III Endometriosis Center, with a focus on diagnosis and surgical treatment, as well as the analysis of perioperative and postoperative complications. Results: The surgical treatment of DE is performed in most cases by minimally invasive laparoscopy (94.1%), whereas complex procedures such as ureterolysis, adhesiolysis, or preparation of the rectovaginal septum are considered standard procedures as well. The complexity of the procedures is further underlined by a high need for interdisciplinary operations (28%). Despite high complexity, severe postoperative complications occurred in only 3.1% of surgeries, with the complication rate being significantly higher whenever bowel surgery was necessary for DE resection. Conclusions: Our results emphasize the complexity and interdisciplinary nature of the disease. Therefore, treatment should preferably take place at an endometriosis center of the highest level with experienced, well-coordinated teams.

ОЦЕНКА ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ПРИ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЯХ ПАРОДОНТА СПРЕЯ НА ОСНОВЕ МУКОПРОТЕКТОРА: РЕОЛОГИЧЕСКИЕ ХАРАКТЕРИСТИКИ СМЕШАННОЙ СЛЮНЫ

Subject. The subject of the study is a mucoprotective spray, mixed saliva. Objectives. The aim of the study was to evaluate the effectiveness of use of the mucorotective spray on periodontal inflammation by analyzing dynamic changes in the rheological properties of mixed saliva. Methodology. The study is conducted by the Department of Therapeutic Dentistry and Propaedeutics of Dental Diseases, the Department of General Chemistry, Ural State Medical University. The research objects are: 1 – the spray with mucoprotector, titanium glycerosolvate aquacomplex used as an “inorganic nanoparticle” with high delivery capabilites into deep tissue layers and activity enhancement of anti–inflammatory, antimicrobial and regenerating components of the spray; 2 – the spray without titanium glycerosolvate aquacomple (aqueous solution), placebo. The study involved 30 dental volunteer students whose average age was 20.5 ± 0.95 years (12 young men, 18 young women) with periodontal inflammation. Two groups were formed consisting of 15 people each who used the study sprays during two weeks. The dynamic changes in the rheological parameters of mixed saliva were determined by the following methods: measuring salivary flow rates, viscosity measurements, evaluation of surface tension of mixed saliva to characterize its rinsing function and cleansing properties. Conclusions. Analysis of the findings shows high effectiveness of use of the mucorotective spray on the basis of titanium glycerosolvate aquacomplex with anti-inflammatory effect, that is confirmed by the dynamic changes in the hygiene index and the PMA index (p ⩽ 0.05). The spray has got high trans-mucus penetration and good tolerability; it is easy to use and economically affordable. The analysis of changes in the rheological parameters of mixed saliva in patients from the first group during the application course of the spray on the basis of the the titanium glycerosolvate aquacomplex mucoprotector showed increased saliva flow rates and decreased viscosity of saliva. These enhance the rheological propertiies of mixed saliva, its rinsing function and cleansing properties, as well reduce the risk of tooth decay and gum swelling, and prevent dental deposits in patients with periodontal inflammation.

Accelerated Wound Healing of Tetrahedral-Framework Nucleic Acid Nanozymes with High Penetration and Antioxidant Capacity.

The wound repair process usually leads to a non-functioning mass of fibrotic tissue because of the oxidative imbalance of deep tissue layers. However, how to improve the penetration of active ingredients into deeper layers and regulate oxidative imbalances to create a regenerative microenvironment still remains a challenge. In this study, we designed a novel tetrahedral-framework nucleic acid (tFNA) nanozyme that could penetrate the skin/mucosa barrier as deep as 450 μm within 24 h. We also demonstrated the protective role of tFNAs on the mitochondrial structural and functional integrity and inhibition of reactive oxygen species production to repair oxidative imbalances through ERK1/2-Nrf2-HO-1 during repair processes. It was found that the proliferative state and the migration ability of postburn cells in vitro were accelerated, and the early closure of wounds in vivo was significantly promoted. This study therefore provides a promising strategy to efficiently regulate the oxidative imbalances in the deep layers of the skin during wound healing.

Low molecular weight 35 kDa hyaluronan fragment HA35 in the treatment of bone metastasis pain: A case report.

Late-stage cancer patients often experience severe pain due to bone metastasis, caused by structural damage and cancer-induced inflammation. Hyaluronan, known to alleviate pain by blocking the TRVP1 calcium channel, faces limitations due to its high molecular weight. However, 35 kDa low molecular weight hyaluronan fragment (HA35) have shown promise in relieving various pains, including cancer-related pain. Nonetheless, evidence regarding their efficacy in bone metastasis pain remains scarce. A 52-year-old female with a rectal malignant tumor and multiple secondary tumors in the sacrum and lungs, accompanied by bone metastasis pain. Despite undergoing radiotherapy, her pain relief was unsatisfactory. Before treatment with HA35, her numerical rating scale score was 10, severely affecting her sleep, appetite, and daily activities. The patient was diagnosed with rectal malignant tumor with multiple metastases, presenting symptoms such as sacral metastasis pain, anal pain, lower limb pain, and anterior abdominal pain. Sacral metastasis pain and lower limb pain indicated a clear diagnosis of bone metastasis pain. Treatment involved subcutaneous injection into the deep fat tissue layer of the abdomen. A subcutaneous injection of 100 mg/5 mL of HA35 was administered once into the deep fat tissue of the abdomen, with subsequent injections repeated every 3 days. Following 1 injection, the patient's pain score decreased to 6 points within 20 minutes, providing 40% pain relief. After 40 minutes, the score further dropped to 4 points, with 60% pain relief. After 50 injections, pain was consistently controlled at around 3 points. Subcutaneous injection of HA35 into the abdominal fat tissue effectively alleviates pain in cancer and bone metastasis patients resistant to conventional treatments. Additionally, it helps alleviate anxiety and fatigue, and improves diet and sleep, thereby offering crucial palliative care for advanced cancer patients.

Immunohistochemical Analysis of CD117 in the Mast Cells of Odontogenic Keratocysts.

Odontogenic lesions contain mast cells (MCs), particularly those with a cystic appearance. Because of their high recurrence rates and aggressive clinical behaviour, odontogenic keratocysts (OKCs) require special treatment. A particular kind of protein called cluster of differentiation (CD) 117/ receptor tyrosine kinase (c-KIT) is present on the surface of many cells. Most hematopoietic cells lose their expression of KIT during the differentiation process, with the exception of MCs, which continue to express KIT throughout their lifetime. Using the CD117 immunomarker, this immunohistochemical investigation sought to assess the presence and location of MCs in OKCs and examine the relationship between MC numbers in sporadic, syndromic, and recurrent OKCs. The study comprised 30 paraffin-embedded tissue specimens, and a histopathological diagnosis was made from hematoxylin and eosin-stained sections with a thickness of 4-5 µ. Out of 30 specimens, 21 were sporadic, six were recurrent OKCs, and three were syndrome-associated OKCs. CD-117/c-kit rabbit polyclonal primary antibody was used to stain the sections for observing MCs, which were then viewed under a light microscope with a digital camera and a desktop computer with MICAPS software for viewing images. To compare the number of MCs among OKCs, a one-way ANOVA test was used. Our study revealed that a statistically significant increase in MCs has been observed in the subepithelial and deep connective tissue of recurrent OKC (p < 0.05). However, a comparison of the mean MC value among three OKC subtypes did not reveal any statistically significant differences. An increased mast count was observed in the deep connective tissue layer of syndromic OKC under multiple comparisons. Our study concluded that MCs were present in increased numbers both in the superficial and deep connective tissue of recurrent OKCs, indicative of their aggressive clinical behaviour. Increased mean MC counts observed in some of the sporadic cases may be an indicator of their chances of recurrence in the future.

A closed-loop smart dressing based on microneedle and electrochemical micropump for early diagnosis and in-time therapy of chronic wound

Early diagnosis combined with in-time treatment is a promising strategy for chronic wound care, preventing wound deterioration and promoting healing. Different smart dressings have recently emerged to enable real-time wound status monitoring and offer active intervention. However, the drawbacks of existing smart dressings, including limited drug loading capacity and poor drug penetration into the deeper wound dermal and subcutaneous tissues, are yet to be addressed, resulting in unsatisfactory therapeutic effectiveness. In this study, a Microneedle-embedded closed-loop smart Dressing (MelD) is developed to simultaneously achieve chronic wound early diagnosis and in-time therapy. The simple impedance sensing electrodes are utilized to monitor wound impedance for chronic wound early diagnosis. Based on the sensing data, the drug delivery micropump in MelD is automatically activated for in-time therapy. By integrating micropump electrodes with a drug reservoir coupled-microneedle array, a practice solution for delivering enough drug fluid into deeper wound dermal/ subcutaneous tissues is developed. Compared to untreated diabetic mice, MelD, delivering sufficient growth factor to the wound and promoting drug entry into deep tissue layers, induces faster wound healing in treated mice. Meanwhile, MelD facilitates tissue formation and nascent collagen deposition. The enhanced drug storage dosage, improved drug penetration and closed-loop operation of Meld enable the first successful attempt of ensuring sufficient and efficient drug delivery by miniaturized all-in-one smart dressing, expanding the usage of closed-loop chronic wound care from laboratorial demonstration on limited kinds of superficial wounds to a wider range of wound types.

Etiology and epidemiology of digital dermatitis in Australian dairy herds

Bovine digital dermatitis (BDD) is an important cause of lameness in dairy cows worldwide. However, very little is known about this disease in Australian herds, which are predominantly managed on pasture. The primary objectives of this cross-sectional study were to describe the presence and prevalence of BDD in Australian dairy herds and to characterize the microbiota of healthy skin and M4 lesions of BDD-affected, pasture-managed cows. Cows from 71 dairy herds were examined at milking time to identify the presence of BDD lesions. True prevalence was estimated using Bayesian methods with informative priors for sensitivity and specificity. Biopsy samples (n = 60) were collected from cows with and without BDD lesions in 7 pasture-based herds. The microbiota in the superficial and deep strata of each tissue biopsy were characterized via sequencing of the V3-V4 region of the bacterial ribosomal RNA gene. Lesions were detected in 1,817 (11.5%) of 15,813 cows and in 68 of 71 (95.8%) herds. The median herd-level apparent and true prevalences of BDD were 8.5% and 18.1%, respectively, but prevalences varied considerably between farms. On farms with BDD, M4 lesions accounted for 70% to 100% of all lesions (interquartile range = 95.1%-100%, median = 100%); M2 lesions (i.e., large ulcerative lesions) were observed at low prevalence (<2.2%) in the few herds (7/71, 9.9%) where they were found. There was a significant difference in the composition of the microbiota between healthy skin and M4 lesions but not between superficial and deep tissue layers. Several gut- and effluent-associated bacterial taxa, including Lentimicrobium and Porphyromonas, which have previously been associated with BDD, were abundant in BDD lesions but not in control biopsies. Our study supports the idea that such taxa are involved in, although possibly not essential to, lesion development and persistence in pasture-managed cows in Australia. Our results also suggest that Dichelobacter may contribute to the disease process. We conclude that BDD is likely to occur in most Australian dairy farms, but that further studies are needed to identify its effect on cow welfare and productivity. Further investigation of the etiology of BDD in Australian dairy herds is also necessary to inform prevention and control strategies.

Light-Induced Liposomal Drug Delivery with an Amphiphilic Porphyrin and Its Chlorin and Bacteriochlorin Analogues.

The development of targeted drug delivery mechanisms in the human body is a matter of growing interest in medical science. The selective release of therapeutic agents at a specific target site can increase the therapeutical efficiency and at the same time reduce the side effects. Light-sensitive liposomes can release a drug by an externally controlled light trigger. Liposomes containing photosensitizers that can be activated in the longer wavelength range (650-800 nm) are particularly intriguing for medical purposes. This is because light penetration into a tissue is more efficient within this wavelength range, increasing their potential applications. For this study, liposomes with an encapsulated amphiphilic photosensitizer, the porphyrin 5,10-DiOH (5,10-di(4-hydroxyphenyl)-15,20-diphenyl-21,23H-porphyrin), its chlorin (5,10-DiOH-chlorin) and its bacteriochlorin (5,10-DiOH-bacteriochlorin) were synthesized. The porphyrin 5,10-DiOH showed previously effective cargo release after liposomal encapsulation when irradiated at a wavelength of 420 nm. The new synthesized chlorin and bacteriochlorin photosensitizers show additional absorption bands in the longer wavelength range, which would enable excitation in deeper layers of tissue. Effective cargo release with chlorin at a longer wavelength of 650 nm and bacteriochlorin at 740 nm was possible. Irradiation of chlorin allowed more than 75% of the cargo to be released and more than 60% for bacteriochlorin. The new liposomes would enable selective drug release in deeper tissue layers and expand the range of possible applications.

A Quantitative Analysis of Microcirculation During Healing of Split-Thickness Skin Grafts in Standardized Full-Thickness Wounds

Background. Full-thickness skin defects often are managed with split-thickness skin grafting. The wound healing process, including formation of new vessels during the healing of skin grafts, is complex. Objective. To evaluate the microcirculatory changes in the treated tissue after skin grafting to analyze perfusion dynamics during the wound healing process. Materials and Methods. Fourteen full-thickness skin defects were created on the back of 14 adult male Lewis rats. All wounds were treated with autologous split-thickness skin grafts. The perfusion dynamics were assessed for 84 days with an O2C device that combines a laser light to determine blood flow and white light to determine postcapillary SO2 and the rHb. Results. Blood flow increased for 50 days after grafting. SO2 decreased in superficial skin layers (depth of 2 mm) and increased in deep skin layers (depth of 8 mm) during the entire observation period. The rHb increased until day 10 in superficial layers and until day 20 in deep tissue layers. Conclusion. The microcirculatory changes reflect the different phases of wound healing. Long after the skin transplants were macroscopically healed, alterations in microcirculation were still detected. These alterations were caused by the long-lasting changes in tissue metabolism due to the formation, conversion, and degradation of the dermal matrix and vessels during wound healing and scar formation.

A case report on angioedema induced by ramipril in a patient treated in a tertiary care hospital in north India

Angioedema is non-pitting edema, or swelling, of the area beneath the deep dermis, subcutaneous, and/or mucosal layers of tissue resulting from fluid buildup, and it can be fatal if the larynx and pharynx are implicated. Drug-induced angioedema, like other cutaneous drug reactions, is most frequently elicited by non-steroidal anti-inflammatory drugs and beta-lactam antibiotics, while reliable information obtained from epidemiologic research is lacking. The latest studies have revealed that angiotensin-converting enzyme inhibitors have an increasing role in the development of life-threatening angioedema. Because of its safety and efficacy, ramipril is a commonly prescribed ACEI. This case report describes the clinical manifestations, management, and outcome of ramipril-induced facial angioedema in a 70-year-old Indian man.

Switchable LED-based laparoscopic multispectral system for rapid high-resolution perfusion imaging.

Multispectral imaging (MSI) is an approach for real-time, quantitative, and non-invasive tissue perfusion measurements. Current laparoscopic systems based on mosaic sensors or filter wheels lack high spatial resolution or acceptable frame rates. To develop a laparoscopic system for MSI-based color video and tissue perfusion imaging during gastrointestinal surgery without compromising spatial or temporal resolution. The system was built with 14 switchable light-emitting diodes in the visible and near-infrared spectral range, a 4K image sensor, and a 10mm laparoscope. Illumination patterns were created for tissue oxygenation and hemoglobin content monitoring. The system was calibrated to a clinically approved laparoscopic hyperspectral system using linear regression models and evaluated in an occlusion study with 36 volunteers. The root mean squared errors between the MSI and reference system were 0.073 for hemoglobin content, 0.039 for oxygenation in deeper tissue layers, and 0.093 for superficial oxygenation. The spatial resolution at a working distance of 45mm was . The effective frame rate was 20fps. High-resolution perfusion monitoring was successfully achieved. Hardware optimizations will increase the frame rate. Parameter optimizations through alternative illumination patterns, regression, or assumed tissue models are planned. Intraoperative measurements must confirm the suitability during surgery.

Comment on Redmayne, M.; Maisch, D.R. ICNIRP Guidelines' Exposure Assessment Method for 5G Millimetre Wave Radiation May Trigger Adverse Effects. Int. J. Environ. Res. Public Health 2023, 20, 5267.

This article discusses the contention in the commented-upon paper that Brillouin precursors generated by 5G New Radio (5G NR) and other cellular systems are a possible cause of tissue damage at deeper layers of tissue than the power penetration depth of the carrier frequency. The original theory for Brillouin precursors from pulsed radiofrequency signals (RF-EMF) and speculation about their possible health effects dates back to the 1990's and was based on studies of the propagation of very short (nanosecond) ultrawide-bandwidth RF pulses through water. This assumption is not correct for cellular telephone signals due to their narrow bandwidth. The commented-on paper provides no alternative rationale as to why Brillouin effects should cause tissue damage from RF-EMF radiation from cellular and other communications systems. Other inaccuracies in this paper concerning thermal responses of tissue to RF-EMF are also noted.

Posterior cervical congenital dermal sinus tract: case report and review of literature

Background and importanceCongenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.Clinical presentationIn this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient’s preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1–C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.ConclusionA review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.

Deep Tattoo Ink Depth Profiling in Ex Vivo Porcine Skin Using Diffuse Reflectance Spectroscopy

Human body is a complex system composed of various chemicals, and thus inserting any foreign chemicals can lead to long-lasting damage. One such process is tattooing, which is widely common among all sections of human society. Nevertheless, there is a huge demand for safe tattoo removal, intending to target only the ink particles and protect the skin components. This work discusses the development of a non-invasive technique to assess tattoo ink location in the deep tissue layers. Tattoo ink was injected systematically from 1-6 mm depth, parallel to the surface of an <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ex vivo</i> porcine skin. The adopted methodology of the crossover point-based diffuse reflectance (DR) technique could effectively and precisely detect the tattoo ink location in the depths. A good quantitative agreement between the detected ink location and injected ink depth on cross-section tattooed skins were observed. The DR technique thus opens avenues for new applications in the clinical field for a non-invasive understanding of deep tissue regimes.

Homemade Dart Attacks in Hawai'i.

Over a 4.5-year period (September 2014 to March 2019), 7 patients presented to the State's only Level I Trauma Center with penetrating injuries inflicted by homemade metallic darts. Previously described in Micronesia, these are the first domestic cases of assaults utilizing this type of weaponry. Retrospective chart review was conducted for all patients who presented to our institution with a dart injury within the study period. Details regarding demographics, imaging, and patient management were collected and described herein. All 7 patients were male with a median age of 24.6years impaled with darts that penetrated through the deep muscle and tissue layers of the neck, torso, or extremity. Three patients required operative intervention and no mortalities were observed. The depth of penetration and proximity to vital structures highlight the potential for life-threatening injuries from these homemade darts.

Identifying ADHD boys by very-low frequency prefrontal fNIRS fluctuations during a rhythmic mental arithmetic task

Objective. Computer-aided diagnosis of attention-deficit/hyperactivity disorder (ADHD) aims to provide useful adjunctive indicators to support more accurate and cost-effective clinical decisions. Deep- and machine-learning (ML) techniques are increasingly used to identify neuroimaging-based features for objective assessment of ADHD. Despite promising results in diagnostic prediction, substantial barriers still hamper the translation of the research into daily clinic. Few studies have focused on functional near-infrared spectroscopy (fNIRS) data to discriminate ADHD condition at the individual level. This work aims to develop an fNIRS-based methodological approach for effective identification of ADHD boys via technically feasible and explainable methods. Approach. fNIRS signals recorded from superficial and deep tissue layers of the forehead were collected from 15 clinically referred ADHD boys (average age 11.9 years) and 15 non-ADHD controls during the execution of a rhythmic mental arithmetic task. Synchronization measures in the time-frequency plane were computed to find frequency-specific oscillatory patterns maximally representative of the ADHD or control group. Time series distance-based features were fed into four popular ML linear models (support vector machine, logistic regression (LR), discriminant analysis and naïve Bayes) for binary classification. A ‘sequential forward floating selection’ wrapper algorithm was adapted to pick out the most discriminative features. Classifiers performance was evaluated through five-fold and leave-one-out cross-validation (CV) and statistical significance by non-parametric resampling procedures. Main results. LR and linear discriminant analysis achieved accuracy, sensitivity and specificity scores of near 100% (p <.001) for both CV schemes when trained with only three key wrapper-selected features, arising from surface and deep oscillatory components of very low frequency. Significance. We provide preliminary evidence that very-low frequency fNIRS fluctuations induced/modulated by a rhythmic mental task accurately differentiate ADHD boys from non-ADHD controls, outperforming other similar studies. The proposed approach holds promise for finding functional biomarkers reliable and interpretable enough to inform clinical practice.

The Deepest Extent of Acellular Mucin Pools in Resected Locally Advanced Rectal Cancer With Pathological Complete Response After Preoperative Chemoradiotherapy: A Hidden Killer?

For patients with locally advanced rectal cancer (LARC) with pathological complete response (pCR), the clinical significance of the distribution extent of acellular mucin pools (AMP) distribution remains unclear, so this study was conducted to address key unanswered questions. We performed a retrospective analysis of 317 patients with LARC with pCR after preoperative chemoradiotherapy and total mesorectal resection from January 2011 to June 2020. Based on AMP existence and the deepest tissue layer of distribution, patients were assigned new stages. The patient information was recorded, and the main outcome measures included 5-year disease-free survival (DFS) and 5-year overall survival (OS). A total of 83/317 (26.2%) patients exhibited AMP, and disease recurrence occurred in 46/317 (14.5%) patients. Over the 5-year median follow-up period, the patients with AMP showed 5-year DFS rates (75.9% vs. 88.9%, P =0.004) and 5-year OS rates (85.5% vs. 95.7%, P =0.002) statistically lower than those of patients without AMP. Disease recurrence was seen in 15/54 (27.8%) patients with AMP within the subserosa and/or the serosa, or adipose tissue. Univariate and multivariate analysis showed that the existence of AMP within the subserosa and/or the serosa, or adipose tissue was an independent risk factor for DFS [hazard ratio (HR): 2.344; 95% confidence interval (CI): 1.256-4.376; P =0.007] and OS [HR: 3.374; 95% CI: 1.438-7.917; P =0.005]. The new stages based on the deepest extent of AMP were related to worse DFS ( P =0.004) and OS ( P =0.003) rates among patients with pCR. In conclusion, the presence of AMP might reduce the prognosis of LARC patients with pCR after chemoradiotherapy, especially in patients with AMP in deeper tissue layers. Therefore, the influence of the deepest AMP extent might be worth considering in staging. Moreover, the revised staging of patients with pCR according to the deepest extent of AMP, which is unrelated to the clinical T stage, might facilitate postoperative management.