Objective: To evaluate the ocular surface changes and their correlation with filtering bleb morphology after phacoemulsification cataract extraction with intraocular lens implantation (PEI) combined with trabeculectomy for primary angle-closure glaucoma (PACG). Methods: A retrospective case-series study. PACG patients who underwent PEI combined with trabeculectomy between October 2021 and March 2023 were included. Preoperatively and at 3 and 6 months postoperatively, best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical complications, 5-fluorouracil subconjunctival injection, and ocular surface data, including the noninvasive first tear film breakup time (NIF-BUT) and average tear film breakup time, tear meniscus height, tear film dynamic scattering index, Schirmer Ⅰ test, corneal staining score, meibomian gland function score, and ocular surface disease index questionnaire (OSDI), were recorded. At 6 months postoperatively, filtering blebs were graded according to the Indiana Bleb Appearance Grading Scale to explore the correlation between bleb morphology and ocular surface function. Results: A total of 51 patients (51 eyes) were included, comprising 18 males (35.3%) and 33 females (64.7%), with 22 left eyes (43.1%) and 29 right eyes (56.9%). The mean age was 63.9±7.6 years, and the mean follow-up duration was 7.5±2.1 months. The BCVA values at baseline, 3 months, and 6 months postoperatively were 0.22 (0.1, 0.52), 0.15 (0.05, 0.4), and 0.15 (0.1, 0.22), respectively. At 6 months, the BCVA was significantly improved compared with baseline (P=0.004). The IOP at baseline, 3 months, and 6 months was 26.9 (18.6, 33.2) mmHg(1 mmHg=0.133kPa), 12.8 (11.0, 16.3) mmHg, and 12.9 (11.2, 14.5) mmHg, respectively, and was significantly lower at both 3 and 6 months than that at baseline (P<0.001). The complete success rates at 3 and 6 months were 98.0% and 96.1%, respectively, and the qualified success rates were both 100%. No statistically significant differences were found in the noninvasive average tear film breakup time, tear meniscus height, tear film dynamic scattering index, Schirmer Ⅰ test, or corneal staining score among preoperative and postoperative 3-month and 6-month data. The NIF-BUT values at baseline, 3 months, and 6 months were 7.46 (4.40, 11.47) s, 5.22 (3.50, 8.15) s, and 7.84 (5.93, 11.24) s, respectively; the NIF-BUT at 3 months was significantly lower than that at 6 months (P=0.004). The OSDI scores at baseline, 3 months, and 6 months were 30.56 (25.00, 38.89), 23.47 (17.56, 32.88), and 25.00 (17.62, 30.56), respectively; the score at 3 months was significantly lower than that at baseline (P=0.016). The meibomian gland scores at baseline, 3 months, and 6 months were 3 (2, 3), 3 (2, 4), and 3 (3, 4), respectively; the score at 6 months was significantly higher than that at baseline (P=0.003). At 6 months postoperatively, except for the positive correlations of the corneal staining score with bleb vascularity and the number of 5-fluorouracil injections (r=0.405, P=0.003; r=0.401, P=0.003), no significant correlations were found between the bleb grading or number of 5-fluorouracil injections and the postoperative visual acuity, IOP, other ocular surface parameters, or OSDI scores. Conclusions: The PACG patients can achieve good visual improvement and high surgical success rates after PEI with trabeculectomy. A transient decline in the objective ocular surface parameter NIF-BUT and the subjective OSDI score can be observed at 3 months postoperatively, with recovery by 6 months. The meibomian gland function gradually deteriorates over time. The corneal staining can be positively correlated with the postoperative bleb vascularity and the number of 5-fluorouracil injections.

Multimodal MRI assessment of levator ani function in women: Comparison with the Modified Oxford Scale.

Inclusion body myositis (IBM) is an inflammatory myopathy with an insidious onset, often making diagnosis challenging. Although neuroimaging has recently been included in diagnostic criteria, the role of muscle ultrasound-despite being a rapid and cost-effective tool-in IBM has been less extensively characterized. In this study, we aimed to explore whether qualitative and quantitative muscle ultrasound measures reflect the pattern of muscle involvement in IBM and are associated with magnetic resonance imaging (MRI) findings. Thirteen patients with histologically confirmed IBM underwent clinical evaluation, including the IBM Functional Rating Scale (IBM-FRS) and Medical Research Council (MRC) grading. Qualitative (Heckmatt scale, from 1 to 4) and quantitative (muscle echo-intensity and thickness z-scores) ultrasound assessments were performed on fourteen muscles bilaterally. Lower limb muscle MRI was conducted using T1-weighted (with Mercuri score) and STIR sequences. Correlations between ultrasound parameters and MRI findings were analyzed. Qualitative ultrasound assessment showed increased echogenicity, mainly in flexor digitorum profundus, vastus lateralis, rectus femoris, tibialis anterior, and medial gastrocnemius. Quantitative analysis confirmed elevated echo-intensity in these muscles, with milder involvement of tibialis anterior and lateral gastrocnemius. Both qualitative Heckmatt scores and quantitative muscle echo-intensity scores showed positive associations with MRI T1 Mercuri scores (p < 0.001). In this study, both qualitative and quantitative muscle ultrasound reflected the characteristic pattern of muscle involvement in IBM and showed associations with MRI findings, supporting their utility in describing the pattern and extent of muscle damage.

Biopsy Negative Rejection, Does Severity Merit a Grading Scale?

Conventional grading scales and static image assessments may not capture dynamic facial movement in facial paralysis. We developed a video-based, dynamic, artificial intelligence (AI) application, DynaFace, to objectively quantify facial metrics and determine which measures correspond with patient-reported appearance, function, and psychosocial outcomes, providing insight into how objective dynamics relate to subjective patient experience. DynaFace automatically extracted dynamic facial metrics (facial asymmetry index [FAI], bilateral palpebral fissure, and oral commissure excursion [OCE]) at rest and during smile, laughter, and pucker. Multivariable linear regression, controlling for paralysis duration and baseline trait emotional intelligence, assessed associations between objective metrics and patient-reported outcomes from FACE-Q subsets. Greater asymmetry (higher FAI) during smile and laugh was associated with poorer perceived facial (β = smile: -2.82/laugh: -3.01, p < 0.05), eye (β = -3.99/-3.12, p < 0.05), and smile appearance (β = -4.40/-4.80, p < 0.01), as well as lower overall facial function (β = -3.05/-3.60, p < 0.05) and self-esteem (β = -2.93/-3.12, p < 0.05). In contrast, greater ratio of OCE change (affected to unaffected hemiface)during smile predicted better perceived facial appearance (β = 0.88, p < 0.01), smile appearance (β = 0.69, p < 0.05), and higher self-esteem (β = 0.62, p < 0.05). Greater ratio of OCE change during both smile and laugh predicted improved social function (β = 0.48/0.44, p < 0.05). Palpebral fissure asymmetry was associated with only eye appearance. Dynamic AI-derived facial metrics from DynaFace align with patient perceptions, showing that greater symmetry in movement enhance satisfaction and function. These findings highlight the clinical potential of DynaFace to bridge objective and patient-reported measures in facial paralysis assessment.

Clinical relevance and reproducibility of morphological MRI findings in liver cirrhosis: Results from ACCESS-ESLD.

Today, people increasingly embrace the natural process of aging while seeking to age gracefully and elegantly. As a result, there has been growing interest in facelift and facial rejuvenation techniques. Patients tend to prefer methods that refresh the facial expression, offer natural-looking results, and leave minimal scarring. The authors describe a new technique and its tips that include short-scar facelift in addition to forehead and midface lift, especially for patients between the ages 35 and 50 with moderate skin sagging and excess. This procedure also includes intervention on the platysma muscle and all major retaining ligaments. Seventy-four patients, all female, who were operated on with the TemFa lift technique described by the author, were evaluated with midface area measurements and Brow Positioning Grading Scale (BPGS), and the preoperative and postoperative results are presented. Compared with the preoperative results, the ratio of the upper midface area (P1) to the lower midface area (P2) increased significantly in the postoperative period (p < 0.05), while the BPGS results decreased significantly (p < 0.05), resulting in a younger eyebrow height and position. After the operation, the square face appearance is replaced by a more youthful V-shaped face. TemFa lift technique can be considered as a suitable surgical technique for patients between the ages 35 and 50 who have moderate excess skin and sagging but also want some improvement in the neck and jawline area. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mini-Cog as an independent determinant of medication self-management autonomy in hospitalized patients with heart failure

Robotic exoskeletons are increasingly used in neurorehabilitation, yet evidence remains limited regarding their role as assistive locomotion devices within a compensatory rehabilitation framework, particularly in individuals with complete spinal cord injury. Multidimensional evaluations integrating safety, usability, and patient-reported experience are still scarce. To evaluate the Atalante self-balancing exoskeleton as an assistive locomotion device in individuals with complete paraplegia through a multidimensional analysis conducted in a controlled clinical environment. This prospective, monocentric, longitudinal study included adults with chronic complete thoracic spinal cord injury (American Spinal Injury Association Impairment Scale grade A, neurological level T6-T12). Participants underwent an intensive 6-week program comprising 60 supervised sessions of exoskeleton-assisted training including 40m walking per session. Outcomes were assessed across three complementary dimensions: (1) safety (medical adverse events, safety-related technical incidents, near-falls); (2) techno-functional usability (donning/doffing performance, assistance levels, cumulative walking exposure); and (3) acceptability (patient-reported comfort and perceived safety using session-based visual analogue scales). Physiological responses were evaluated using exoskeleton-assisted 6-minute walk tests. Thirteen participants were enrolled; eleven completed the full protocol. One serious adverse event occurred, a tibial plateau fracture in a participant with severe osteoporosis (hip T-score - 3.8), leading to study withdrawal. No other serious medical adverse events were observed. Across 651 sessions, four near-fall events were recorded (0.61% of sessions and 0.16% per 10m walked). Minor adverse events were transient, and no symptomatic orthostatic hypotension was reported. Oxygen consumption, walking speed, and cost of transport (p > 0.05) remained stable between mid- and end-program assessments, while perceived exertion decreased significantly (p = 0.003). Donning time decreased from 790 [475-966] s during the first session to 223 [159-259] s during the final sessions, and doffing time from 242 [152-275] s to 55 [50-69] s, with familiarization plateau points observed after 14 and 18 sessions, respectively. Harness comfort improved over time, whereas perceived safety remained globally stable, except for transient decreases following fall-prone gait events or technical disengagements. Under supervised clinical conditions, the Atalante exoskeleton demonstrated acceptable safety and feasibility as an assistive locomotion device for individuals with complete paraplegia, enabling hands-free upright indoor walking with low metabolic demand. Severe osteoporosis emerged as a critical risk factor, supporting systematic bone densitometry and cautious exclusion criteria. These findings support the integration of self-balancing exoskeletons into compensatory rehabilitation programs and justify further studies in ecological settings to assess real-world autonomy and participation outcomes. Trial registration ClinicalTrials.gov Identifier: NCT06941896 (retrospective registration).

The Parkland Grading Scale (PGS) is a practical intraoperative grading system used to assess operative difficulty during laparoscopic cholecystectomy. This study aimed to investigate the relationship between PGS scores and preoperative inflammatory indices and to evaluate whether these indices were associated with operative severity and intraoperative complexity. This retrospective cross-sectional study included 1054 patients who underwent elective laparoscopic cholecystectomy for gallstone disease between January 2018 and January 2025. Demographic characteristics, laboratory parameters, inflammatory indices, operative duration, conversion rates, and PGS scores were analyzed. Univariate and multivariate logistic regression analyses were performed to identify variables independently associated with higher PGS severity. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic performance. According to the PGS classification, 451 patients were classified as PGS 1, 146 as PGS 2, 213 as PGS 3, 164 as PGS 4, and 80 as PGS 5. Operative duration and conversion from laparoscopic to open cholecystectomy increased significantly with increasing PGS scores (p < 0.001). In multivariate logistic regression analysis, type 2 diabetes mellitus (T2DM), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and inflammatory burden index (IBI) were identified as independent predictors of higher PGS scores (all p < 0.001). ROC analysis demonstrated that IBI had the highest discriminatory performance (AUC: 0.792), followed by NLR (AUC: 0.766) and CAR (AUC: 0.764). Preoperative inflammatory indices, particularly IBI, NLR, and CAR, were significantly associated with higher PGS scores and increased operative difficulty in laparoscopic cholecystectomy. These markers may help identify patients with increased operative complexity and improve preoperative surgical planning.

Facial asymmetry, particularly rotational asymmetry, represents a significant aesthetic concern that impacts facial harmony and perceived attractiveness. Traditional approaches to facial rejuvenation often employ symmetrical interventions, which may fail to address the underlying rotational patterns. This study investigates the efficacy of asymmetrical thread lifting using JETEMA threads (Epiticon, Bi-thread, JETEMA, Korea) for correction of facial rotation. To evaluate the effectiveness of standardised unilateral thread placement in the nasolabial fold area for correction of facial rotational asymmetry and establish a consistent approach for treatment of clockwise facial rotation patterns. Forty-five patients (32 females, 13 males; mean age 41.3 years) presenting with facial rotation were treated with asymmetrical insertion of JETEMA threads. Two threads were inserted using a reverse technique on the affected side of the face (left side for clockwise rotation, right side for counter-clockwise rotation) targeting the nasolabial fold area. Assessment of facial rotation was conducted using standardised photography and a newly-developed 4-point Facial Rotation Grading Scale (FRGS) before treatment and at 6-month follow-up. Patient satisfaction and improvements in rotation grade were evaluated. Improvement in facial symmetry was observed in 89% of patients (40/45) at the 6-month follow-up based on the study-specific Facial Rotation Grading Scale (FRGS). All severe cases (Grade 3, n = 11) improved to mild rotation (Grade 1), while most moderate cases (Grade 2, n = 26) improved to Grade 1, with the exception of 5 patients. Patient satisfaction scores averaged 8.3/10. These findings should be interpreted with caution due to the use of a non-validated assessment scale and the absence of objective measurement tools. Unilateral thread lifting using a standardised reverse technique may represent a promising minimally invasive approach for correction of facial rotational asymmetry. However, given the methodological limitations, including the use of a non-validated grading system and short-term follow-up, further studies incorporating validated assessment tools and objective measurements are required. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To assess factors associated with methotrexate-induced oral mucositis and its impact on the quality of life of pediatric patients with acute lymphoblastic leukemia, considering chemotherapy dose and mucositis severity within a clinical context where photobiomodulation is routinely used as part of the institutional care protocol. A cross-sectional study was conducted with 113 pediatric patients aged 5 to 18 years undergoing methotrexate-based chemotherapy between 2020 and 2024 in a university hospital in Northeastern Brazil. Data were collected using the Children's International Mucositis Evaluation Scale (ChIMES; self-report and proxy), the Child Oral Impacts on Daily Performances (C-OIDP), the WHO Oral Mucositis Grading Scale, photobiomodulation records, and chemotherapy regimen data. Descriptive statistics, Spearman correlation, and multiple linear regression analyses were performed (α = 0.05). Among the participants, 85% reported a high impact on quality of life. The mean age was 10.8 years (SD = 3.49), and most participants were boys. Higher mucositis severity, older age, higher methotrexate doses, and longer wound healing time were associated with worse quality of life. A strong positive correlation was observed between C-OIDP and ChIMES scores (p < 0.001). In the regression analysis, mucositis severity (β = 0.304; p = 0.021) and wound healing time (β = 0.492; p < 0.001) remained significantly associated with higher impact scores. Methotrexate-induced oral mucositis was associated with a substantial negative impact on quality of life in pediatric patients with acute lymphoblastic leukemia. Greater mucositis severity and longer wound healing time were the main factors associated with worse outcomes. Although photobiomodulation was systematically applied as a preventive and therapeutic intervention, no causal inference regarding its independent effect can be established.

This study aimed to investigate whether the progression of lumbar facet joint angle (FJA) in adjacent segment degeneration (ASD) occurs more rapidly in the sagittal plane compared to a matched control group. This retrospective longitudinal study included 35 individuals from three hospitals who underwent L4-L5 posterior lumbar interbody fusion (PLIF) surgery and had preoperative lumbar magnetic resonance imaging (MRI) scans. These patients also underwent follow-up MRI scans approximately four to five years postoperatively. A control group, matched for age and gender, was included for comparative analysis. MRI data were assessed using grading scales for facet joint degeneration (FJD) and lumbar intervertebral disc degeneration (IDD). FJA measurements were derived from T2-weighted axial images. No significant progression of IDD was found in either group. Within the PLIF group, a more rapid progression of FJD was observed at the bilateral L5-S1 and right L3-L4 segments in comparison to the control group (P < 0.05). In contrast, the control group exhibited consistent lumbar FJA across all segments. Postoperative MRI scans of the PLIF group, however, demonstrated a significant reduction in FJA on both sides of the L3-L4 segment and on the left side of the L5-S1 segment (P < 0.05), with no significant changes observed at the L2-L3 segment and the right side of the L5-S1 segment. A significant negative correlation was found between the change in FJA (ΔFJA) and the change in FJD (ΔFJD) at the left L5-S1 segment in the PLIF group (ρ = -0.335, P = 0.049). Accelerated sagittal facet remodeling occurs at segments adjacent to L4-L5 PLIF and correlates with facet degeneration. These hypothesis-generating preliminary findings suggest that FJA measurement has the potential to serve as an imaging biomarker for ASD risk, though this interpretation remains to be validated in larger prospective cohorts. The findings underscore the need for long-term postoperative surveillance.

To observe the effect of refined mode of acupuncture and moxibustion for synkinesia of facial paralysis sequelae based on surface electromyography (sEMG). Sixty patients with synkinesia of facial paralysis sequelae were randomized into a special manipulation group and a basic manipulation group in a ratio of 1∶1, with 30 cases in each group. Acupoints such as Yangbai (GB14), Cuanzhu (BL2), Touwei (ST8) and Taiyang (EX-HN5) on the affected side,as well as bilateral Sibai (ST2), Quanliao (SI18) were selected in the two groups. Conventional acupuncture was applied in the basic manipulation group, while point-to-point needling with long needle, stuck needling by lifting and dragging, and balance needling on the healthy side were delivered in the special manipulation group. The needles were retained for 30 min, once every other day, 3 times a week, for 30 sessions in total in the two groups. The Sunnybrook facial grading system (SFGS) score and the facial paralysis fine graduation scale grading were observed before and after treatment in the two groups; sEMG was performed before and after treatment, and the ratios of root mean square (RMS) on the affected side to the healthy one of frontalis, orbicularis oculi, buccinator, nasalis, orbicularis oris, and the integrated electromyography (IEMG) of orbicularis oculi were calculated; the correlation analysis was conducted between the total score of SFGS and facial paralysis fine graduation scale grading, and the clinical efficacy and safety were evaluated in the two groups. After treatment, the total scores of SFGS were increased and the synkinesia scores were decreased compared with those before treatment in both groups (P<0.001); in the special manipulation group, the total score of SFGS was higher and the synkinesia score was lower than those in the basic manipulation group (P<0.01, P<0.05). After treatment, the ratios of RMS on the affected side to the healthy one of orbicularis oculi, nasalis and orbicularis oris were increased compared with those before treatment in the special manipulation group (P<0.01, P<0.001), and those of orbicularis oculi, buccinator and nasalis were increased compared with those before treatment in the basic manipulation group (P<0.05, P<0.01); in the special manipulation group,the ratio of RMS on the affected side to the healthy one of nasalis was higher than that in the basic manipulation group (P<0.05). After treatment, the IEMG of orbicularis oculi was decreased compared with that before treatment in the two groups(P<0.001), and the IEMG of orbicularis oculi in the special manipulation group was lower than that in the basic manipulation group (P<0.05). After treatment, the grading of angulus oris drooping and eyelid closure was decreased compared with that before treatment in the two groups (P<0.01, P<0.05, P<0.001), and the grading of angulus oris drooping and eyelid closure in the special manipulation group was lower than that in the basic manipulation group (P<0.01,P<0.05). The total score of SFGS was negatively correlated with the grading of angulus oris drooping and eyelid closure (P<0.001). The total effective rate was 93.3% (28/30) in the special manipulation group, which was higher than 70.0% (21/30) in the basic manipulation group (P<0.01). No adverse events occurred during the trial. Refined mode of acupuncture and moxibustion contributes to the recovery of facial muscle strength, regulates oculofacial synkinesia, corrects angulus oris deviation and promotes eyelid closure in patients with synkinesia of facial paralysis sequelae.

Extreme cephalic conformation has been theorised to be associated with compromised health in rabbits. However, recognition and assessment of such phenotypes remain largely subjective. This study aimed to develop and validate a visual, semi-quantitative system for head shape phenotype in rabbits. Images of rabbits were collected and visually analysed for comparative phenotypic patterns, with a 1-5 grading scale subsequently created. Initial validation of the system was conducted via an online pilot survey across 24 experienced individuals. Interobserver agreement across scores was calculated to assess the reliability of the system. The proposed system yielded strong, 'almost perfect' and statistically significant interobserver agreement for cephalic assessment (W = 0.908, 95% bias-corrected and accelerated [BCa] confidence interval [CI]: 0.858-0.950; α = 0.880, 95% CI: 0.875-0.885), with largely positive feedback from veterinary professionals. Further development and validation of the system are required for complete, reliable assessment of all rabbits, particularly those with longer fur. Wider participation in the validation of this method from across the profession is also necessary. This system has the potential to enhance conformational assessment in rabbits. Implementation of the system in clinical practice may help to promote awareness of potential conformation-associated health risks and catalyse discussions regarding responsible ownership. The system may also support further studies into the precise influence of conformation on disease risk.

Early Electroencephalographic Changes After Ketogenic Diet Initiation Are Associated With Clinical Response in Pediatric Drug-Resistant Epilepsy.

ObjectiveTo initiate the development of an agreed core outcome set for post-stroke facial palsy, identifying which outcome domains should be measured in research and may inform clinical practice.DesignTwo online e-Delphi rounds followed by an online consensus meeting.SettingInternational, multi-disciplinary.ParticipantsClinicians and researchers working in post-stroke facial palsy.MethodsDelphi items were developed from existing literature, qualitative interviews with stroke survivors and patient/public involvement, then aligned with ICF levels. Participants completed two e-Delphi rounds rating outcome domains on a 1 to 9 GRADE scale: 7 to 9 'critical'; 1 to 3 'least important'. All domains were discussed at the consensus meeting and included in the final list if ≥70% of participants voted 'yes' to include the domain in the core outcome set.ResultsIn total, 156 Delphi questionnaires (round one, 101 participants from 16 countries; round two, 55 from 12 countries) were completed. Fifteen participants from 6 countries attended the consensus meeting. Three outcome domains were agreed for inclusion in the initial core outcome set: (1) facial movement and sensation, (2) everyday function, and (3) living with facial palsy.ConclusionsWe report the first internationally informed consensus between clinicians and researchers on 'what' outcome domains are important to measure for post-stroke facial palsy. We share these findings to encourage their measurement and to guide next steps. Our future work includes a separate consensus study, using a more inclusive methodology, on 'what' to measure with lived-experience stakeholders, and a systematic review on 'how' to measure these outcomes. COMET Initiative registration (December 2024): https://www.comet-initiative.org/Studies/Details/3295.

Although social stress factors are common in people with chronic pain, they are often not recorded or treated. Aquestionnaire developed by us on the presence of social stress factors is to be examined for its correlation with the questions commonly used in pain questionnaires (regularly completed in advance). The available data sets were collected between November 2017 and October 2018. The primary aim of using the questionnaire was to test its practicality in everyday clinical practice and its acceptance among patients. Atotal of 122 questionnaires on the presence of social stress factors were used for the evaluation, together with the pain questionnaire. The elements of the pain questionnaire showed varying degrees of correlation with the total score for social stressors. Significant correlations with high significance were found in both univariate and multivariate regression analysis for the Chronic Pain Grading Scale according to von Korff and for the questionnaire on habitual well-being. The presence of social stress factors cannot be predicted by the parameters of the pain questionnaire alone, although clear correlations are evident in some cases. Social aspects receive too little attention both in assessment and in therapy itself in multidisciplinary pain treatment facilities, even though the role of social factors as an independent and equivalent factor in the development of chronic pain has been proven. This questionnaire serves as ascreening tool and, to our knowledge, is the first questionnaire for assessing social stress factors in patients with chronic pain in German-speaking countries.

Facial nerve dysfunction is a common complication after vestibular schwannoma (VS) resection. Traditional grading scales such as House-Brackmann (HB), Sunnybrook, and Fisch are subjective and prone to inter-rater variability. Emotrics, a computer vision-based tool, offers objective facial analysis, but its role in neurosurgical populations remains underexplored. Patients undergoing VS surgery were prospectively enrolled in this study. Standardized frontal facial photographs were taken preoperatively, at discharge, and at three-month follow-up. Emotrics quantified facial symmetry and movement across static, dynamic, and synkinesis domains. Composite scores were generated and compared with clinical grading scales and patient characteristics. Thirty-six patients (mean age 51.2 ± 12.3years) were included. Emotrics detected significant improvement in dynamic function (mean score: 0.41 at discharge vs. 0.56 at 3months, p < 0.01) and synkinesis (0.62 to 0.51, p < 0.05); static symmetry remained stable. Strongest correlations with clinical grading were found at discharge and 3months. Discharge Emotrics total scores correlated significantly with HB (r = -0.883, p < 0.001), Sunnybrook (r = 0.892, p < 0.001), and Fisch (r = 0.883, p < 0.001). At 3months, dynamic scores remained strongly associated with HB (r = -0.799), Sunnybrook and Fisch (r = 0.790; p = 0.001). Worse Emotrics outcomes were linked to older age (62.1 vs. 48.6years, p = 0.04) and larger tumor volume (8.2 vs. 4.5 cm3, p = 0.03). Emotrics offers objective assessment of facial nerve function, correlates well with clinical scales, and enhances evaluation of dynamic facial recovery. Its integration may refine postoperative monitoring and guide rehabilitation.

Intramedullary spinal cord tumor (IMSCT) resection carries a high risk of postoperative neurological deficit because of neural tract manipulation and myelotomy. Although short-term and long-term neurological recovery represent key treatment outcomes, current prognostication methods are lacking and would benefit from further complex analysis. From March 2009 to August 2025, all adult IMSCT resections at our institution were reviewed. Demographic, oncologic, and perioperative data were extracted from electronic medical records. This included preoperative and follow-up neurological examination data in the form of American Spinal Injury Association Impairment Scale (AIS) grading, Modified McCormick Scale (MMCS), and ambulatory status. Independent ambulation served as the primary outcome for 4 machine learning models. Each model was sequentially evaluated using area under the receiver operating characteristic curve (AUROC). Fifty-four patients underwent 55 surgeries for IMSCT resection. Encapsulated lesions predominated IMSCT pathology, with grade II ependymoma comprising 28 (50.9%) resections, 5 hemangioblastomas (9.1%), and 5 cavernous hemangiomas (9.1%). Gross total resection was achieved in 36 cases (65.5%), with encapsulated tumors more readily achieving gross total resection vs unencapsulated (84.6% vs 18.8%, P < .01). By 4 weeks, conversion of MMCS, but not AIS grade, significantly correlated with concurrent ambulatory conversion (P < .01 vs P = .15). At 6 months, both AIS grade conversion (P < .01) and MMCS conversion (P < .01) significantly correlated with ambulatory conversion. For predicting ambulation at latest follow-up from 4 weeks postoperatively, the comprehensive granular model achieved an AUROC of 0.833, outperforming the AIS grade (0.583), American Spinal Injury Association Motor Score (0.667), and MMCS (0.667) models. By the 6-month follow-up, the comprehensive granular model achieved strong discrimination (AUROC 1.00). Follow-up IMSCT data demonstrate a postoperative lability that stabilizes by 6 months into a reliably modeled outcome. By enhancing the granularity of recovery data, accurate independent ambulation modeling may improve counseling for patients with IMSCT.