Grading System Research Articles

Fat embolism: a systematic review to facilitate the development of standardised procedures in pathology.

Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non-traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up-to-date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors' descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures.

Artificial Intelligence in Prostate Cancer Diagnosis

Prostate cancer (PCa) is a cancer with a broad spectrum of biological behavior and it is a heterogeneous nature. In order to prevent overdiagnosis and overtreatment, and to detect clinically significant PCa, standardized scoring and grading systems are used in imaging and pathological examinations. However, reproducibility and agreement between readers in these diagnostic stages, which require experience, are low. Promising results have been achieved by integrating artificial intelligence (AI)-based applications into the diagnosis and management of PCa. In radiological and pathological imaging, computer-aided diagnostic tools have increased clinical efficiency and achieved diagnostic accuracy comparable to that of experienced healthcare professionals. This review provides an overview of AI applications used in radiological imaging, prostate biopsy, and histopathological examination in the diagnosis of PCa.

AI-powered assessment tools for E-learning: Enhancing feedback and grading systems

Recently, there has been increased incorporation of artificial intelligence in the education system, which has impacted the practice and use of assessment in learning. To this end, the following is a paper discussing the role of AI in grading, instant feedback, and personalized adaptive testing. The paper also covers the ability of AI to minimize bias and introduce fairness while grading, as well as the ability that comes with the mass LMS platforms. Moreover, this paper discusses the issues and guidelines regarding the ethical use of AI in education: data protection, the problem of automated prejudice in AI, and the replacement of human tutors. When these seemingly unimportant problems are solved, and institutions admit that ethical practices are critical, such opportunities for Artificial Intelligence can be harnessed to make learning more efficient and fairer. At last, integrating AI into learning benefits teachers and students: it enhances the teaching and learning processes. It creates the prospects for the future global exposition of technology with human creativity to enrich learners.

Can ischemic stroke patients with mTICI of 2b achieve similar outcomes compared to those with complete recanalization following endovascular therapy?

Endovascular therapy (EVT) has been used as a standard treatment method for patients with large vessel ischemic stroke within 24 h of the onset. The extent of recanalization after EVT can be assessed using the modified thrombolysis in cerebral infarction (mTICI) scale as an accepted angiographic grading system. In this study, we aimed to investigate whether patients with a mTICI grade of 2b achieve similar outcomes compared to those with complete recanalization (mTICI of 3) following EVT for acute ischemic stroke. A retrospective analysis was conducted on 196 consecutive patients who underwent EVT in a comprehensive stroke center. In the final study, 176 patients were included based on the inclusion criteria. The primary outcome was the 3-month modified Rankin Scale (mRS) of 0-2 considered as a favorable outcome, while excellent outcomes were defined as mRS scores of 0-1. Our data showed that 59.46% of patients in the mTICI 2b group achieved a favorable outcome, comparable to 58.99% observed in the mTICI 3 group (p = 0.959). Additionally, 54.05% (n = 37) of patients with mTICI 2b achieved an excellent outcome, compared to 51.80% (n = 139) in the mTICI 3 group (p = 0.807). The case fatality rates were also comparable between the groups, with 8.11% in the mTICI 2b group and 10.79% in the mTICI 3 group (p = 0.632). Overall, there were no statistically significant differences between the two groups in terms of 3-month favorable outcomes, excellent outcomes, or mortality. Similar 3-month outcomes can be achieved for ischemic stroke patients undergoing EVT with a mTICI grade of 2b compared to those with a mTICI grade of 3. These data can help clinicians in setting realistic expectations and making informed decisions during EVT procedures.

Association of Plasma Zinc Status with Severity of Lesions in Patients with Acne Vulgaris: A Cross-Sectional Study

Background: Zinc (Zn) is an essential trace mineral that plays a critical role in maintaining overall skin health and functionality. Zn deficiency has been linked to various dermatological conditions, including acne, eczema, and delayed wound healing, highlighting the mineral’s indispensable role in promoting skin resilience and health. Some investigators have refuted these findings. Objective: was to determine plasma Zn level and Zn status in patients with Acne vulgaris (AV) belonging to Nowshera, Khyber Pakhtunkhwa (KPK) and to find any possible relationship between Zn status & severity of the acne lesions. Methods: Hundred patients of either sex with untreated AV were randomly selected in a cross-sectional study. Based on the Global Acne Grading System (GAGS) the acne lesions were categorized as mild, moderate & severe. Blood samples were taken for determination of serum Zn. The relationship of Zn status with severity of lesions was determined with Pearson Correlations coefficient (r). Results: The study included 42 males and 58 females with male to female ratio of 1:1.4. Mean age was 21.8 years. The average plasma zinc level across the cohort was 67.4 ± 12.6 µg/dL, with males showing slightly higher zinc levels (69.1 ± 11.8 µg/dL) than females (65.8 ± 13.2 µg/dL), though this difference was not statistically significant (p = 0.092). 22% had mild acne, 46% moderate acne and 32% had severe acne. Patients with severe acne had significantly lower plasma zinc levels (60.2 ± 10.4 µg/dL) compared to those with mild acne (73.1 ± 13.1 µg/dL) (p < 0.01). Pearson’s correlation analysis revealed a significant inverse relationship between plasma zinc status and acne severity (r = -0.43, p < 0.001), indicating that lower zinc levels were associated with more severe acne. No significant gender differences were observed in the relationship between zinc levels and acne severity. Conclusion: Pasma Zn concentration is markedly decreased in patients with AV and the more severe is the lesion, the more Hypozincemia. Hence, Plasma Zn status is associated negatively with severity of AV lesions in the studied population.

Therapeutic potential of oral tofacitinib in alopecia areata: a retrospective study

Background: Alopecia areata (AA), a prevalent autoimmune disorder, poses challenges in management, particularly in severe cases. Recent advancements highlight janus kinase (JAK) inhibitors-tofacitinib demonstrating promise. However, the literature reports conflicting information on its safety profile, especially at higher doses, necessitating a comprehensive evaluation. Methods: This retrospective analysis investigates the long-term efficacy and safety of oral tofacitinib in AA patients from January 2017 to October 2022. The study included 69 patients diagnosed with patchy multifocal AA (mfAA), alopecia totalis (AT), alopecia universalis (AU) or alopecia sub-totalis (AS). Data analysis incorporated demographic details, treatment history, autoimmune comorbidities, tofacitinib dosages, prior investigations, recurrence rates, and adverse effects. Efficacy was assessed using severity of alopecia tool (SALT) scores, with a grading system for percentage of hair regrowth. Results: The study comprising of 58% males and 42% females, exhibited varied alopecia types. Treatment response analyzed through percent change in SALT score revealed 46.5% showed very good response to tofacitinib treatment, while 4.3% had excellent response (100% change in SALT score). 44.9% of patients showed no recurrence. Adverse effects were minimal, including acneiform eruptions and upper respiratory tract infections. Pearson correlations revealed age negatively correlated with hair regrowth percentage, suggesting older individuals exhibited lower regrowth responses. Conclusions: Our findings endorse tofacitinib as a promising therapeutic option for the management of AA, with no serious side effects observed even during longer treatment durations. It can be regarded as the primary choice of treatment modality for moderate to severe forms of AA.

Simple Epithelial Transplantation for Ocular Surface Reconstruction After Severe Ocular Burn Injury.

To manage ocular surface complications and recover conjunctival and corneal epithelia after unilateral severe chemical burn. We performed simple conjunctival epithelial transplantation (SCET) to obtain renewal of fornix and bulbar-tarsal conjunctiva epithelium, followed by simple limbal epithelial transplantation (SLET) to recover limbal function and epithelial corneal surface. Slit-lamp examination, fluorescein staining, in vivo confocal microscopy, Kheirkhah grading system for symblepharon severity, Wong-Baker FACES Pain Rating Scale, and best-corrected visual acuity were assessed before surgery, at 1 to 3 months after SCET and SLET, and thereafter at 6 to 12 to 36 months. Two patients with unilateral burn injuries underwent surgery. Eye mobility and fornix reconstruction were promptly achieved, and conjunctival epithelium with goblet cells was observed on the bulbar and tarsal conjunctiva 3 months after SCET. After SLET, corneal epithelium and cornea-conjunctiva transition zone were observed at 3 and 6 months, respectively. From before surgery to 6 months after SLET, symblepharon improved from grade IVa2 and IIIb2 to Ic0 and Ib0, the Wong-Baker FACES Pain Rating Scale changed from grade 6 and 4 to 0, and best-corrected visual acuity upgraded from 1.40 and 1.10 logarithm of the minimum angle of resolution to 0.5 logarithm of the minimum angle of resolution, in patient 1 and 2, respectively. After 3 years, results remained stable. SCET effectively healed the bare conjunctival area relieving subjective symptoms and discomfort. Sequential SCET and SLET showed to be feasible in restoring a normal ocular surface with long-lasting results suggesting the aim in patients with severe ocular burn is not merely corneal epithelium renewal but also the regeneration of ocular surface homeostasis.

Creation and Validation of the Facial Diplegia Scale for Assessment of Bilateral Facial Palsy.

Objectives: House-Brackmann (HB) classification and the Sunnybrook Facial Grading System (SFGS), both reference tools for the assessment of facial palsy, are not suitable for bilateral facial palsy. The aim of this study was to develop, standardize, and validate the Facial Diplegia Scale (FDS). Methods: The FDS was standardized in a healthy population (n = 111) and validated in 40 patients with diplegia. Correlations with the SFGS were sought to prove its criterion validity. The comparison between healthy subjects and patients with diplegia was used to test the construct validity. The diagnostic performance of the FDS was verified using an ROC curve based on the HB classification. Internal and external consistency were investigated. Results: The FDS and the SFGS were significantly correlated for the right hemiface [F(39) = 51.51, p < 0.0001, R2 = 0.575] as well as for the left one [F(39) = 95.10, p < 0.0001, R2 = 0.714]. A significant difference between control subjects and patients with diplegia was found [t(149) = -9.95, p < 0.0001]. Good specificity and sensitivity were confirmed. Finally, internal consistency, inter-rater reliability, and test-retest reliability were largely proven. Conclusions: The FDS has been standardized and validated for the subjective assessment of facial diplegia in adults to improve comprehensive assessment.

Left atrioventricular coupling index: association with diastolic dysfunction and prognostic implications in heart failure patients

Abstract Background Left atrioventricular coupling index (LACI), an index coupling left atrial (LA) to left ventricular (LV) volume at end-diastole (Figure 1), showed to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established. Purpose The present study aimed to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF). Methods We retrospectively analyzed 1158 stable HF patients (mean age 66±12 years, 75% men) on optimal medical therapy (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (endpoint: all-cause death/HF-hospitalization) was assessed by Cox regression and spline curve analyses. Results were validated in an external cohort of 242 HF patients. Results In the derivation cohort, the median LACI value was 0.29 (IQR:0.19-0.42). Patients in the third tertile (LACI&amp;gt;0.36) were older and presented with more advanced HF symptoms. While prevalence of grade-1 DD (ASE/EACVI classification) progressively decreased across LACI tertiles, the prevalence of grade-3 DD significantly increased (8%,23%, and 46% respectively, P&amp;lt;0.0001). A cut-off value ³0.26 identified moderate-to-severe DD with an area-under the-curve of 0.75. During follow-up (median 28 months, IQR:11-53), 407 (35%) patients reached the endpoint. On multivariable analysis, LACI was independently associated with outcomes (HR for 1-unit-increase 2.34; 95%CI 1.35-4.03; P=0.002 – Figure 2), showing incremental predictive value over the DD grading system (net reclassification improvement=0.150, P&amp;lt;0.0001). The prognostic value of LACI was consistent in the external validation cohort. Conclusions LACI is associated with DD severity and is an independent predictor of outcomes in HF patients.How to assess LACIPrognostic value of LACI in HF

Long-term facial nerve outcome in surgically treated petrous bone cholesteatoma patients.

The term petrous bone cholesteatoma (PBC) represents a slow-growing epidermal lesion arising from the petrous part of the temporal bone. It is a rare incidence accounting for only 4-9% of all petrous bone lesions. PBC represents a real surgical challenge due to its complex relationship with critical neurovascular structures. To demonstrate our experience in using various options of facial nerve (FN) management during surgical treatment of PBC and analyze the long-term facial function outcomes. Retrospective medical record review in a quaternary skull-base center. Medical records of 298 PBC cases operated between the years 1983 and 2024 were thoroughly evaluated. Sanna's classification scheme was used to classify cases into the appropriate class and the House-Brackmann (HB) grading system of the FN was used to assess the facial function pre- and postoperatively. A total of 298 PBC cases were surgically treated at our center. Males constitute 68% (n = 203) of total operated PBC patients while the rest 32% (95) were females, making the male-to-female ratio 2.2:1. The age in this series ranged from 9 to 85. According to updated Sanna's PBC classification, 44% were supralabyrinthine, 33% were massive, 9% were infralabyrinthine-apical, 8% were infralabyrinthine, and 5% were apical. On preoperative FN function examination, 45% (n = 133) of patients had various degrees of paresis and complete paralysis whereas 55% (n = 165) had normal FN function. The commonest degree of paresis observed was HB-III (18.5%) followed by HB-IV (5.7%). A total of 40(13.4%) patients, however, had complete facial paralysis at the initial presentation. The facial function was compromised more frequently in supralabyrinthine and massive PBCs. Among the total patients who had an abnormal facial function at presentation, 52% had paresis/paralysis for less than a year whereas 48% had FN paresis/paralysis for greater than one year. The most commonly used surgical approaches at our center were transotic (TO), modified transcochlear type A (MTCA) with rerouting of the FN, and translabyrinthine (TLAB) with external auditory canal (EAC) closure. Intraoperatively an intact fallopian canal was found only in 33% (n = 99) cases whereas the rest 67% (n = 199) had erosion of the fallopian canal either with intact (n = 24) or infiltrated FN (n = 175). The FN was maintained in the bony fallopian canal in 35% (n = 104) cases. An active form of FN management, however, was required in 65% (n = 194) of cases either intraoperatively or as a second-stage procedure. Factors affecting postoperative FN function include age, preoperative FN function (HB), duration of paralysis, class of PBC, surgical approach, and method of active FN management. PBCs represent diagnostically and surgically challenging lesions of temporal bone which are usually frustrating to the treating surgeon. Preoperative anatomic classification of the lesion enables the physician to choose the appropriate surgical approach. Sanna's classification is the most widely accepted system used to classify PBC. This classification is based on the relation of the lesion to the labyrinthine block. Active FN management, including rerouting, end-to-end anastomosis, cable nerve grafting, and masseteric-to-FN anastomosis routinely come into play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

Validation of two simple scores to identify increased risk of transthyretin amyloid cardiomyopathy in heart failure with preserved ejection fraction

Abstract Background Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is an emerging underdiagnosed cause of heart failure (HF). 99mTc-3, 3-diphosphono-1,2-propanodicarboxylic acid (DPD) allows ATTR-CM diagnosis in the absence of histology. Recently two simple clinical scores to identify increased risk of ATTR-CM in patients with heart failure and preserved left ventricular ejection fraction have been developed and validated. Purpose To assess the prevalence of ATTR-CM in a Mediterranean cohort of patients at risk, and to externally validate the Mayo ATTR-CM and T-Amylo scores. We also explore its diagnostic accuracy improvement by adding N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods Retrospective cohort study of consecutive patients with suspected cardiac amyloidosis referred to DPD between March 2017 and November 2020. Scans were reported using a visual grading system (0 to 3 increasingly; 2-3 positive) on planar images. Patients with clonal dyscrasia or those without rule-out tests (serum free light chain assay, and serum and urine protein electrophoresis with immunofixation) were excluded. Discrimination was obtained using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve based on the ATTR-CM score [High risk: score ≥ 6. Components: age (60-69 = 2 points; 70-79 = 3 points; ≥80 = 4 points), male sex = 2 points, hypertension = -1 point, ejection fraction &amp;lt;60% = 1 point, posterior wall thickness ≥12 mm = 1 point, relative wall thickness (septal + posterior wall thickness/left ventricular end diastolic diameter) &amp;gt;0.57 = 2 points], and T-amylo score [High risk: score &amp;gt; 6. Components: age ≥ 80 years = 1 point, interventricular septum thickness ≥16 mm = 2 points, low QRS interval voltage = 2 points, male gender = 3 points, and carpal tunnel syndrome = 3 points. Calibration was assessed with the Hosmer-Lemeshow goodness-of-fit test. Results A total of 200 patients were included with a mean age of 78.5 ± 11 years, 45.5% male, left ventricular ejection fraction 58% ± 12 and a median NT-proBNP of 2310 pg/mL (Table 1). 81 (40.5%) and 10 (5.0%) patients were categorized as a high-risk group due to ATTR-CM score value ≥6 and simplified T-Amylo score &amp;gt;6, respectively. Prevalence of ATTR-CM was 17.5%. The AUC for the Mayo ATTR-CM and T-Amylo scores in our cohort were 0.83 (95% CI 0.75-0.90) and 0.79 (95% CI 0.69-0.88) respectively, with an appropriated calibration (Figure 1). The addition of NT-proBNP to the scores did not increase the AUC (p=0.19 and p=0.08), with a Net Reclassification Improvement (NRI) of 0.055 (95% CI - 0.110 to 0.206) and 0.033 (95% CI - 0.113 to 0.224) respectively. Conclusion These two simple clinical scores are valid and reliable tools for ATTR-CM diagnosis in our Mediterranean cohort. Added to clinical suspicion, can improve the diagnostic workup for ATTR-CM, irrespective of NT-proBNP values.

Enhancing Trust and Embracing Vulnerability in the College Classroom: A Reflection on Ungrading and Co-Creation in Teaching and Learning

In this reflective essay, we explore how we and our students experienced trust and opened ourselves up to being vulnerable in two iterations of a course that was built on the pedagogies of ungrading and co-creation in teaching and learning (CCTL). As approaches that fall under the broader umbrella of critical pedagogy, ungrading usually involves an alternative to conventional alphanumeric grading systems, while co-creation in teaching and learning consists of a varied scale of student-and-instructor partnerships in the classroom. The course contexts explored here take ungrading to mean student self-assessment and self-assignment of grades, and our implementation of co-creation focused on significant elements of the course such as expectations, content, assignments, and assessments. We suggest that our combination of these pedagogies exposed the significance of vulnerability to nurturing trust in the college classroom. After an overview of the salient points in the literature on these pedagogies and a discussion of trust and vulnerability, we recollect our own experiences of them in a co-taught second-year honors course. Drawing from our reflections and those expressed in student writing, we observe that we brought a significant level of trust in each other and our students to the course. Further, we note that the processes of sharing authority embedded in both pedagogies significantly deepened that trust while also underscoring, in retrospect, the remarkable degree of vulnerability made accessible to students and instructors alike. Instructors who wish to implement these approaches should be keenly aware of the additional opportunities that trust and vulnerability, as made possible via these pedagogies, offer for building relationships in the classroom and working toward increased inclusivity and equity in the course community.

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Functional Outcomes and Self-Reported Quality of Life in Patients with Facial Nerve Impairment Following Vestibular Schwannoma Surgery.

The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p < 0.001), accumulation of food in the oral vestibule (p < 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices.

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Spontaneous space closure after extraction of young first permanent molar. Retrospective cohort study.

Early compromised first-permanent-molar (FPM) extraction can adversely affect occlusion. However, the current literature does not provide sufficient support for definitive early extraction outcome. This cohort study aimed to evaluate the pattern of post-FPM extraction spontaneous space closure and its pre-extraction indicators. Patients of 7-13 years, with compromised FPM at three-tertiary-centers between 2015 and 2019 were retrospectively screened. Pre-extraction indicators were evaluated (extraction location, direction of the second permanent molar (SPM) long-axis, and SPM Demirjian development stage). Spontaneous space closure pattern was evaluated clinically and radiographically using the American Board of Orthodontics (ABO) grading system. In total, 112 FPMs (73-patients) were identified and five (4.5%) of the extraction sites showed favorable combined-ABO-scores. Distal direction of the SPM long-axis in the maxillary arch significantly decreased the relative risk (RR) of having a SPM rotation/alignment ABO score-1 (P = 0.002; RR = 0.64). For the mandibular arch, Demirjian stage D and E significantly decreased the RR of having ABO score-1 for spacing between the SPMs and second premolars (P = 0.029; RR:0.57, P = 0.004; RR:0.53, respectively) and vertical dimension (P = 0.02; RR = 0.53). The direction of the SPM long-axis and its developmental stage are key indicators of the favorable outcome pattern of spontaneous space closure after FPM early extraction.

Examination of Exercise Physiological Traits According to Usage Grade of National Forest Trails

Forest trail difficulty levels must be investigated to promote their safe usage. However, exercise-based physiological changes are difficult to estimate in a forest environment. Hence, studies comparing indoor and outdoor environmental activities are required. We aimed to investigate the physiological traits associated with different usage grades of national forest trails in the Republic of Korea. We conducted both field and indoor experiments to measure different variables of 20 healthy participants aged 40–50 years to evaluate the exercise intensity and physiological effects of hiking on these trails. Significant variations in physiological responses were observed based on trail difficulty, with the highest heart rate and energy expenditure recorded during the most challenging uphill segments. Specifically, the heart rate increased from 115.4 ± 13.7 bpm in easy segments to 140.3 ± 15.6 bpm in difficult segments, whereas energy expenditure ranged from 404.1 ± 112.2 kcal/h to 518.1 ± 131.0 kcal/h. This study highlights the importance of considering both objective trail difficulty and users’ physiological reactions, including perceived exertion, to enhance user safety and optimize the health benefits of national forest trails. These findings provide essential data for developing comprehensive exercise programs and improving the national forest trail usage grade system.

Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial.

Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method. To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars. Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools. Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects. Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study.

To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD). In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system. This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States. PPAP diagnosis required the following three parameters: (1) postoperative serum hyperamylasemia /hyperlipasemia (POH) persisting on postoperative days 1 and 2, (2) radiologic alterations consistent with PPAP, and (3) a clinically relevant deterioration in the patient's condition. To validate the grading system, clinical and economic parameters were analyzed across all grades. Among 2902 patients undergoing PD, 7.5% (n=218) developed PPAP (6.3% grade B and 1.2% grade C). POH occurred in 24.1% of patients. Hospital stay was associated with PPAP grades (No POH/PPAP 10 days (IQR 7-17) days, grade B 22 days (IQR 15-34) days, and grade C 43 days (IQR 27-54) days; P<0.001), as well as intensive care unit admission (No POH/PPAP 5.4%, grade B 12.6%, grade C 82.9%; P<0.010), and hospital readmission rates (No POH/PPAP 7.3%, grade B 16.1%, grade C 18.5%; P<0.05). Costs of grade B and C PPAP were 2 and 11 times greater than uncomplicated clinical course, resp. (P<0.001). This first prospective, international validation study of the ISGPS definition and grading system for PPAP highlighted the relevant clinical and financial implications of this condition. These results stress the importance of routine screening for PPAP in patients undergoing PD.

A longitudinal study of facial function, quality of life, and depression in Bell’s palsy during pregnancy and puerperium

Bell’s palsy can reduce facial function and quality of life. Pregnancy may also be physically and psychologically challenging. This study investigates depression among pregnant and puerperal women with and without Bell’s palsy and if degree of facial palsy and depression was correlated. Thirty-one women with pregnancy-associated Bell’s and 31 women without Bell’s palsy were prospectively included and followed one year at two University Hospitals, Stockholm. Depression was assessed with Edinburgh Postnatal Depression Scale (EPDS). In women with Bell’s palsy, Facial Disability Index (FDI), Facial Clinimetric Evaluation (FaCE) scale, and Sunnybrook Facial Grading System (SFGS) were collected. The association between Bell’s palsy and EPDS ≥ 11 was assessed by logistic regression, and between EPDS and FDI, FaCE, and SFGS, respectively, by Spearman rank correlation. Median EDPS did not differ between groups (7.0 vs. 6.0, p = 0.74, one month, 6.5 vs. 6.0, p = 0.87, 12 months). EPDS at one month was correlated to FDI (p = 0.002) and FaCE (p = 0.004) and at 12 months to FDI (p = 0.009) but not to FaCE (p = 0.08). No correlation was found between EPDS and SFGS. In summary, no association appeared between pregnancy-associated Bell’s palsy and depression. Patient-reported function correlated well with depression in pregnancy-associated Bell’s palsy, while physician-reported facial function did not.