To analyze the incidence, mechanisms, anatomic distribution, and clinical outcomes of combat-related spinal injuries during high-intensity modern warfare ("Swords of Iron War"). Combat-related spinal trauma has seen a rising incidence in recent conflicts, primarily driven by high-energy mechanisms such as explosive devices. These injuries often result in severe neurological deficits and present as part of complex polytrauma, yet data regarding the specific trends in recent urban warfare remain limited. A retrospective observational study was conducted in two stages using the Israel Defense Force (IDF) Trauma Registry and Electronic Medical Records between October 2023 and June 2025. Stage one analyzed 3972 urgent prehospital casualties to determine the incidence and systemic severity of spinal injuries. Stage two focused on 105 hospital-confirmed spinal injury cases to delineate specific anatomic patterns, injury mechanisms, and surgical management. The incidence of spinal injury was 2.2% among urgent casualties. Spinal trauma served as a significant marker for injury severity, with 45.0% of patients exhibiting an injury severity score (ISS) ≥25, compared with 12.0% in the nonspinal group ( P <0.001). Explosive mechanisms (including combined explosion and ballistic trauma) predominated, accounting for 47.6% of cases. While total injuries were relatively balanced across spinal regions, major fractures were disproportionately concentrated in the lower segments, with the lumbar and sacral regions accounting for 35% and 26% of all major fractures, respectively. Neurological deficits were present in 42.9% of the cohort. Spinal fixation was the most frequent surgical intervention, primarily in the lumbar region, and 66.7% of all cases were managed nonoperatively. Combat-related spinal injuries are uncommon but serve as a critical indicator of high-energy multisystem polytrauma. The distinct pattern of major fractures favoring the lower spinal segments, likely due to axial blast loading, necessitates specialized triage and care to optimize functional outcomes.

The role and significance of YKL-40 in mucopathological remodeling in eosinophilic chronic rhinosinusitis.

Streptococcus constellatus inhabits the healthy human gastrointestinal tract and oral microbiome; however, the incidence of this species becoming opportunistically pathogenic has increased in recent decades. S. constellatus has the potential to cause severe pyogenic infections requiring combination antibiotic therapy or surgical intervention. Some virulence processes in S. constellatus, such as genetic competence, are regulated through quorum sensing (QS), facilitated by its 16-mer competence stimulating peptide (CSP). Several target residues on the CSP molecule were identified that can be mutated to enhance the peptide activity and/or lead to competitive inhibition of the competence regulon QS circuitry, thereby modulating related pathogenic phenotypes. Using a rational design approach, second-generation peptide analog libraries were designed and screened, resulting in optimization of a competitive QS inhibitor, CSP-D1AI4AM6A, with an IC50 of 38.3 nM. Overall, this work provides a rational framework upon which novel QS modulators can be designed to attenuate virulence processes in this opportunistic pathogen.

Functionalized smart surfaces to control the wound healing after glaucoma's surgery.

Objective: To analyze the clinical diagnosis and treatment strategies for acquired tracheoesophageal fistula (aTEF) and bronchoesophageal fistula (aBEF) in children, and explore the value of interventional bronchoscopy in their management. Methods: A case series study analyzed the clinical data of 9 pediatric patients with aTEF and aBEF admitted to the Department of Respiratory Intervention and Department of Gastroenterology, Children's Hospital Affiliated to Shandong University, from February 2014 to July 2025. The clinical features, diagnostic and therapeutic processes, and treatment outcomes were summarized. Results: Among the 9 patients, 7 were male and 2 were female, the age of onset was 1.7 (1.0, 4.0) years. Etiologies included esophageal corrosive injury due to button battery ingestion (4 cases), and 1 case each of esophageal corrosive injury from caustic alkali ingestion, esophageal perforation by foreign body, fall from height, neck stab wound, and iatrogenic injury.Clinical manifestations: 6 cases of dyspnea, 5 cases of recurrent cough and choking during feeding. There were 6 cases of aTEF and 3 cases of aBEF. Seven patients underwent interventional therapy via bronchoscopy or gastrointestinal endoscopy: 4 cases received covered metallic stent placement via bronchoscopy for fistula occlusion, 1 case underwent titanium clip closure via gastroscopy, 1 case underwent mucosal deepithelialization combined with titanium clip closure via gastroscopy, and 1 case received combined bronchoscopic stent placement, epidermal growth factor injection, and gastroscopic titanium clip closure. Seven patients underwent surgical treatment, including aTEF or aBEF repair in 6 cases, gastric fundoplication with gastrostomy in 2 cases, and jejunostomy in 1 case. Conclusions: The management of aTEF, aBEF in children is challenging. For patients presenting with respiratory symptoms, palliative interventions such as airway-covered stent placement or gastroscopic fistula clip closure can be considered to occlude the fistula. A multidisciplinary collaborative approach is essential for managing children with aTEF, aBEF, improve nutrition and manage complications to enhance the quality of life of the pediatric patients.

To identify clinical criteria guiding surgical versus nonsurgical treatment, compare functional outcomes, assess complication rates, and evaluate the ability of each approach to enhance supination in children with cerebral palsy (CP). MEDLINE, Embase, and Cochrane Library were systematically searched to identify studies evaluating the treatment of forearm pronation deformity in pediatric patients with CP through June 2025. Inclusion criteria were clinical studies (RCTs, cohorts, case-controls) involving CP patients <21 years undergoing surgical or nonsurgical intervention for pronation deformity and reporting relevant outcomes. Studies were assessed using PRISMA guidelines. Data were extracted on demographics, intervention type, outcome measures, supination/pronation range, and complications. Twenty-eight studies met the inclusion criteria. Treatment selection is guided by deformity severity, passive and active supination, functional impairment, and prior response to nonsurgical interventions (botulinum toxin A injections and therapy). Nonsurgical treatments are used in younger children with dynamic deformities and retained motor control, and are associated with short-term improvements that typically diminish over time. Surgical procedures are reserved for patients with static or progressive deformities or failed conservative care and consistently result in greater, more durable improvements in supination and function compared with nonsurgical methods. Pronator teres-based procedures demonstrated the most reliable enhancement of supination while largely preserving residual pronation. Complication rates were low across both nonsurgical and surgical interventions. Management of forearm pronation deformity in patients under 21 years old with CP should be individualized based on deformity characteristics, functional goals, and prior response to therapy. While nonsurgical options may provide early or adjunctive benefit, surgical intervention offers more reliable and sustained improvements in supination and function, particularly when preservation of pronation is a priority. When maximal restoration of active supination is desired, and full passive supination is present, pronator teres rerouting appears to offer a modest but consistent advantage over alternative surgical techniques. Level IV: Systematic review of level I to IV studies.

The management of cartilage lesions encountered during anterior cruciate ligament reconstruction (ACLR) remains debated, with limited evidence on whether surgical treatment affects lesion progression or outcomes. This study aimed to compare structural progression and clinical outcomes of isolated cartilage lesions treated or left untreated during primary ACLR, using data from the Swedish Knee Ligament Registry (SKLR). Patients who underwent both primary and revision ACLR between 2005 and 2024 were identified in the SKLR. Inclusion required an isolated cartilage lesion documented arthroscopically at primary ACLR. Multi-compartment lesions and multi-ligament procedures were excluded. A 1:1 matched analysis compared patients who underwent surgical cartilage treatment (debridement or microfracture) with untreated patients. Structural evolution was assessed by comparing arthroscopic findings at primary and revision ACLR and classified as stable, progressed or regressed based on International Cartilage Repair Society (ICRS) grade and lesion size. Secondary analyses included 2-year revision-free survival and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, EuroQol 5-Dimension questionnaire, EuroQol Visual Analogue Scale) in patients without revision within 2 years. A matched cohort of 156 patients (78 treated and 78 untreated) was included. Baseline characteristics were comparable, except for operated side (p = 0.007). At revision ACLR, treated patients showed higher lesion stability than untreated patients (21.8% vs. 5.1%; p = 0.005). This effect was significant in low-grade lesions (ICRS I-II), with higher stability (27.1% vs. 5.1%; p = 0.002) and lower progression (15.3% vs. 32.2%; p = 0.050), while no differences were observed in high-grade lesions. Two-year revision-free survival was comparable (log-rank p = 0.53). Among patients without revision (n = 88), both groups improved in patient-reported outcome measures with no between-group differences. Surgical treatment of isolated cartilage lesions during primary ACLR was associated with greater structural stability at revision surgery, particularly in low-grade lesions, without superior short-term clinical outcomes. These findings suggest structural benefits may not translate into early improvement. Level II, prospective comparative study.

This study aimed to evaluate the impact of hospital blunt intestinal injury (BInI) trauma volume on time to surgery in patients with BInI. The diagnosis of BInI is challenging, even for trauma experts, leading to frequent delays in necessary surgical intervention. The 2017-2020 ACS-TQIP database was used to identify patients 18 years or older with full-thickness ileal, jejunal, or colonic perforation secondary to blunt trauma. Hospitals were stratified by the annual volume of BInI. Multivariable logistic regression adjusting for demographics, comorbidities, and injury characteristics/severity was used to study the impact of hospital trauma volume on delayed surgery (>24 hours) and outcomes (eg, mortality, sepsis). Sensitivity analyses were performed classifying hospitals by their volume of (1) blunt trauma and (2) all trauma admissions. Out of a total of 4,005,762 trauma patients, 3954 were included: 1397 (35.3%) in low BInI volume, 1373 (34.7%) in medium BInI volume, and 1184 (30%) in high BInI volume hospitals. The mean time to surgery was 18 ± 46 hours in low-volume compared with 15 ± 45 hours in high-volume hospitals ( P < 0.001). On multivariable analysis, high BInI volume was independently associated with early surgery [adjusted odds ratios (aOR) for delayed surgery: 0.68, 95% CI: 0.53-0.88] and a 42% lower risk of post-injury sepsis (aOR: 0.58, 95% CI: 0.37-0.91) compared with low BInI volume. High blunt trauma and all trauma hospital volumes were similarly associated with early surgery (aOR: 0.65, 95% CI: 0.51-0.84; aOR: 0.66, 95% CI: 0.51-0.85, respectively). High trauma hospital volume is independently associated with prompt surgical intervention and improved outcomes in patients with BInI. These findings highlight the importance of clinical trauma experience and available resources for trauma care in early diagnosis and management of the rare and tricky intestinal injuries.

Electronic (E)-scooters have become increasingly common in Ireland. This study provides the first Irish orthopaedic-focused analysis of paediatric E-scooter-related injuries over a six-year period. It assesses the impact of the legislation change in 2024 banning E-scooter use in those under 16 years of age. We conducted a retrospective analysis of e-scooter-related orthopaedic trauma presenting to our emergency department (ED). Ninety-eight paediatric patients were identified between January 2020 and August 2025. This period included fourteen months prior to and subsequent to the legislation change. Four primary outcomes were analysed: Injury Severity Score (ISS) > 16, surgical intervention, injuries per patient, and fractures per patient. Medical records and patient imaging were reviewed. There were 98 paediatric patients who presented to our ED with e-scooter-related orthopaedic trauma. The average age was 12 years old with a 3:1 male-to-female ratio. There was a notable rise in cases presenting in 2025. Post-legislation comparisons showed: an increase in major trauma, a 27% increase in injuries per patient, a stable fracture rate and a decline in surgical intervention. Post-legislation injury trends remain concerning. Despite legislation, injury rates rose, with widespread non-compliance. Upper limb injuries and traumatic brain injuries were common. Multidisciplinary care was often required. A national paediatric trauma database is needed to guide prevention and policy. Systemic reforms and targeted interventions are essential to mitigate this growing public health issue.

The Role of Initial Conservative Treatment for Suspected Triangular Fibrocartilage Complex Injuries in Children and Adolescents.

Burns in prisoners: A 10-year retrospective cohort study from a UK burns unit.

Ectrodactyly (cleft foot) is a rare congenital deformity characterized by central ray deficiency. Surgical intervention is considered for pain, shoe-wear difficulty, callosities, or cosmetic concerns. This multicenter study evaluates indications, surgical strategies, radiographic correction, and incorporates intra- and inter-rater reliability testing of the Blauth and Abraham classification systems. A retrospective multicenter review was conducted of patients with ectrodactyly treated operatively between 2010 and 2022. Demographic, clinical, and radiographic data were collected, including preoperative shoe-wear difficulty, pain, and cosmesis concerns. Surgical indications, operative strategies, complications, revisions, and long-term outcomes were analyzed. Radiographic outcomes included forefoot splay angle and splay index. Sixty-six patients (101 feet) underwent surgical intervention for ectrodactyly of the foot at a mean age of 5.8±4.5 years, with a mean follow-up of 3.7±3.5 years. Shoe-wear difficulty was the most common indication for surgery (79 feet, 82%), followed by pain (51 feet, 53%), calluses or skin complaints (25 feet, 26%), and/or cosmetic concerns (10 feet, 10%). Approximately 68% of procedures were performed for Blauth type II to IV deformities. Initial surgeries included 16 soft-tissue-only, 23 bony procedures, and 59 combined approaches. Common techniques included forefoot narrowing osteotomies (32%), soft-tissue cleft closure (30%), and ray excision (11%). Eight feet (8%) underwent revision due to recurrent deformity. Radiographs demonstrated significant improvements in forefoot splay angle (36.14 to 21.39 degrees, P <0.001) and splay index (1.88 to 1.69, P <0.001). Operative management of foot ectrodactyly provides favorable radiographic outcomes. Combined bony and soft-tissue strategies were most common, yielding significant radiographic correction with low revision rates. As the largest multicenter series on cleft foot reconstruction, this study highlights considerable management heterogeneity across centers and underscores the need for an indication-based classification system that integrates radiographic severity with patient-centered concerns to guide surgical decision-making and standardize care. Level III.

Robot-assisted radical prostatectomy (RARP) has become the standard procedure for treating prostate cancer. Conventionally, RARP is performed using a three-arm, two-assistant-port transperitoneal approach, which may increase costs, pose a risk of intraperitoneal complications, and be less suitable for patients with prior abdominal surgery. To address these limitations, we developed a simplified and cost-effective two-arm, one-assistant-port extraperitoneal RARP technique. This technique evolved from a conventional transperitoneal three-arm, two-assistant-port system to an extraperitoneal three-arm, one-assistant-port system, and ultimately to an extraperitoneal two-arm, one-assistant-port configuration. Following Institutional Review Board approval, consecutive patients who underwent RARP performed by a single surgeon were enrolled. Baseline characteristics, number of dissected lymph nodes, estimated blood loss, operative time, and surgery-related adverse events were compared among groups. Between September 2014 and May 2025, a total of 361 robotic prostatectomies were consecutively performed, including 28 transperitoneal and 333 extraperitoneal procedures. The extraperitoneal cases were further categorized into 175 three-arm and 158 two-arm procedures. Compared with the three-arm approach, the two-arm approach demonstrated comparable blood loss (p=0.646) and number of dissected lymph nodes (p=0.160), but significantly shorter operative time (p<0.0001). A total of 10 surgery-related adverse events required radiologic or surgical intervention, including two cases of bowel ileus, one hemorrhagic shock, one ureteral obstruction, and six infected lymphoceles. Notably, both cases of bowel ileus occurred following the transperitoneal approach. The two-arm, one-assistant-port extraperitoneal RARP technique provides a simplified, safe, and cost-effective approach to robotic prostate surgery. Furthermore, this technique may serve as a practical transitional platform for surgeons adopting single-port robotic systems.

To report the clinical outcomes of Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) as adjunctive therapy for progressive infectious keratitis (IK) in companion animals. A retrospective descriptive review was performed on 22 eyes (14 dogs, 8 cats from private owners) treated with RB-PDAT after failure of initial medical therapy between December 2024 and September 2025. A freshly prepared 0.1% Rose Bengal solution was applied using iontophoresis, followed by green-laser irradiation for two cycles of 2 min (520-525 nm; 10.8 J/cm2). The frequency of topical antibiotic treatment was tapered following RB-PDAT. Examinations were conducted until complete corneal epithelialization was confirmed. Success was defined as infection signs resolution (ulceration, stromal infiltration) without surgical intervention. All eyes achieved full epithelialization within 30 days (Dogs: median healing time 9 days-Cats: mean healing time 14 days). Sixteen cases yielded positive cultures, identifying 30 organisms, including multidrug-resistant isolates. Clinical improvement was documented in all patients. No significant adverse effects occurred. None of the eyes required additional surgery. RB-PDAT appears to be safe, well-tolerated, and associated with rapid epithelial closure in refractory IK. The treatment may reduce reliance on aggressive antibiotic protocols and lower the likelihood of surgical intervention. Larger prospective studies are needed to further define indications, safety, and comparative efficacy of RB-PDAT in veterinary patients.

In Vitro Hip Biomechanical Positioning Device Integrated with Clinical Imaging.

Antibiotic-loaded bone substitutes in the surgical management of diabetic foot osteomyelitis: Current evidence and clinical perspectives.

Corneal opacity is a leading cause of vision loss in the United States. This study examines the demographics, underlying causes, and vision outcomes of patients undergoing surgical interventions for corneal opacity. A retrospective cohort study was conducted using data from the American Academy of Ophthalmology's Intelligent Research Insight (IRIS) Registry, which includes clinical data from 79,887,324 patients who presented to participating eye clinics between January 1, 2013, and November 30, 2020. Patients diagnosed with corneal opacity who underwent surgical procedures were identified using current procedural terminology codes. Demographic variables (age, sex, race, ethnicity), underlying causes of corneal opacity, and best-corrected visual acuity (BCVA) at diagnosis and 12 months postsurgery were analyzed. Linear regression assessed risk factors associated with worse visual outcomes. A total of 44,073 patients underwent surgery, with a mean age of 67.24 ± 14.40 years; 55% were female. The leading indications for surgery were corneal dystrophy (39%), corneal edema (21%), noninfectious ulcers (6.4%), infectious keratitis (6.1%), and trauma (1.7%); 15% had multiple etiologies. The most common procedures included endothelial keratoplasty (62.81%), penetrating keratoplasty (31.32%), and lamellar keratoplasty (2.1%). In addition, ocular surface reconstruction procedures were performed in a few cases. BCVA improved significantly postsurgery (0.72 ± 0.68 vs. 0.56 ± 0.74 logarithm of the minimum angle of resolution; P < 0.0001). Worse outcomes correlated with poorer baseline BCVA ( P < 0.0001). Surgical interventions significantly improve vision outcomes in patients with corneal opacity. However, poorer preoperative BCVA predicts worse postoperative outcomes, emphasizing the importance of early intervention.

International expert consensus on definitions and management of weight recurrence and suboptimal response after metabolic and bariatric surgery: a Delphi study.

Anatomical Empty Nose in Dogs and Cats After Nasal Disease or Endoscopic Endonasal Surgery: Implications for Human Empty Nose Syndrome?

Pediatric laryngeal lymphoma: A systematic review of clinical presentation, management, and outcomes.