Kasai-Like Hepaticojejunostomy As Salvage Reconstruction for Bile Duct Injury in an Infant: A Case Report and Technical Consideration

Stereo-electroencephalography (sEEG) is a minimally invasive technique for intracranial monitoring that was traditionally reserved for adults but is increasingly used in very young pediatric patients with drug-resistant epilepsy. The aim of this study was to evaluate its safety, feasibility, and technical considerations in pediatric patients younger than 3 years. The authors reviewed the records of 21 children younger than 3 years who underwent sEEG monitoring at Lucile Packard Children's Hospital between February 2013 and March 2025. Data were collected from patients' clinical records and operative reports. Skull thickness was measured at the thinnest point under electrodes. Primary outcome variables were 1) sEEG-related complications, and 2) electrode placement entry point error (EPE) and target point error (TPE). Twenty-one patients (67% male) had a mean ± SE age at seizure onset of 0.5 ± 0.5 years (range birth-1.6 years). Patients underwent 23 sEEG surgeries at a mean age of 2.2 ± 0.1 years (range 0.9-2.7 years). The Mayfield headframe with the Infinity Support System was used in 65% of cases. Overall, a mean of 19 ± 1 (range 9-27) depth electrodes were placed per patient. In total, 443 electrodes were placed, most often in the frontal (189 electrodes, 43%) and temporal (121 electrodes, 27%) regions. A total of 440 bolts were used, and the most common sizes were 20 mm (68%) and 13 mm (18%); 3 electrodes were placed without bolts. The mean skull thickness at the thinnest point of electrode placement was 2.0 ± 0.1 mm (range 1.5-3.2 mm). For 417 electrodes available for analysis, the mean EPE was 1.9 ± 0.1 mm, and the mean TPE was 2.8 ± 0.1 mm. Aside from a CSF leak from a bolt in 1 patient, there were no complications. The most common procedures included open resection (61% of sEEG cases) and laser ablation (30%). Procedures were performed at a mean of 43 ± 11 days (range 0-150 days) after sEEG removal, with a mean patient age of 2.3 ± 0.1 years (range 1.2-2.9 years). This study supports the safety and feasibility of sEEG in children younger than 3 years, even in those with a skull thickness < 2 mm. Moreover, the authors report the youngest patient in the literature to have undergone sEEG at 11 months, without complications. The minimum skull thickness in which an electrode was successfully secured with a bolt was 1.5 mm. With appropriate technical adaptations, sEEG can be accurately performed in children younger than 3 years.

In recent years, the anterior intercostal artery perforator (AICAP) flap has gained increasing attention for its minimal donor-site morbidity, natural contour, and excellent scar concealment. This review begins by outlining the vascular anatomy of the anterior intercostal perforators, including their distribution, perfusion characteristics, and key considerations for preoperative imaging. We then summarize the indications and limitations of other commonly used chest wall perforator flaps, such as the lateral intercostal artery perforator (LICAP) and thoracodorsal artery perforator (TDAP) flaps to contextualize the unique role of AICAP in partial breast reconstruction. Building on this foundation, we focus on the surgical design, harvest dimensions, arc of rotation, and anatomical relationship between AICAP flaps and the inframammary fold. Compared with traditional local flaps, AICAP flaps offer reliable vascularity, excellent tissue compliance, minimal donor-site disruption, and low rates of postoperative complications. Their location within a natural skin crease also allows the resulting scar to remain well concealed. These features make AICAP particularly suitable for precise reconstruction of defects in the lower and lower-inner breast quadrants, where long-term aesthetic stability is often difficult to achieve. Nonetheless, standardized indications, anatomical variability, limited sample sizes, and a lack of long-term follow-up continue to constrain the strength of current evidence. Overall, this review synthesizes the anatomical basis, technical considerations, clinical advantages, and existing limitations of the AICAP flap. We further highlight emerging directions—including image-guided perforator mapping, personalized flap design, and long-term outcome assessment—to support the development of more standardized and reproducible clinical pathways for AICAP-based breast reconstruction.

Protein biologics are indispensable in disease prevention, diagnosis, and therapy, yet their development remains largely constrained by reliance on native protein scaffolds, resulting in long development timelines, limited structural and functional tunability, challenges in manufacturing consistency, and high production costs. De novo protein design moves beyond the structural and functional constraints inherent to traditional approaches, enabling the direct creation of proteins with tailored structures and functions and offering a new avenue to address these challenges. In this review, we summarize the principal computational strategies underlying de novo protein design and the contribution of deep learning to its recent progress, and highlight prospective applications, major translational barriers, and the current limitations and future challenges of the field. Despite notable methodological progress in de novo protein design, its path toward clinical application continues to be limited by a range of biological, technical, and translational considerations. Future work will need closer coordination between computational design, experimental validation, engineering optimization, and clinical needs, with clinical feasibility considered early and refined throughout development.

A BSTRACT Background: Hepatoblastoma (HB) is the most common malignant liver tumor in children under 3 years of age. Surgical resection, combined with neoadjuvant chemotherapy, is essential for optimal outcomes. We present a 10-year institutional experience focusing on technical tips for liver resection in children with HB. Materials and Methods: A retrospective review of pediatric HB patients who underwent liver resection at a tertiary care Children’s hospital from January 2014 to June 2024 was conducted. All patients received preoperative PLADO (cisplatin + doxorubicin) chemotherapy per SIOPEL guidelines. Surgical resection type, outcomes, recurrence, and survival data were analyzed. Technical considerations for standard and complex hepatectomies were described. Results: Out of 26 children with HB (mean age 15 months), 19 (73%) underwent liver resection. Right hepatectomy was the most common (42%), followed by left hepatectomy and segmentectomies. No patient developed postoperative liver failure. Two patients (10.5%) experienced recurrence; one was salvaged successfully. The disease-free survival rate was 89.5%, and overall survival at 3 and 5 years was 81.8%. Surgical margins were negative in all patients. Technical tips adopted to improve visualization, minimize blood loss, avoid bile duct injury, and vascular inflow and outflow control are detailed. Conclusion: Liver resection with adjuvant chemotherapy (PLADO and SIOPEL) results in favorable outcome in children with HB. Understanding the anatomical nuances and meticulous surgical technique improves outcomes and minimizes complications.

Circumferential Minimally Invasive Adult Spinal Deformity Surgery: A Systematic Review With Key Concepts and Technical Considerations.

Extended Deep Plane Facelift and Structural Neck Contouring: Technical Considerations for Comprehensive Surgical Facial Rejuvenation.

Translating Biomechanics to Clinic: Validating a Spine-Specific Wearable for Remote Functional Assessment.

Using the stem alignment index to assess coronal plane alignment of the femoral stem in total hip arthroplasty.

Research progress and applications of reverse genetics systems for infectious bronchitis virus.

This article explores how technology has historically been an extension of human biological and intellectual development. It analyzes the transformative role of digital twins in Industry 4.0 and their projection into Industry 5.0, highlighting their capacity to optimize processes through precise virtual simulations, their applications, strategic advantages, and implementation challenges. These digital representations connected to physical objects allow for anticipating failures and improving design, production, and maintenance. Although they offer advantages in cost, time, and customization, they face challenges in connectivity, security, infrastructure, and training. The review demonstrates that the convergence of these technologies represents a paradigm shift in the way modern production systems are designed, operated, and optimized. It also addresses ethical, technical, and organizational considerations for their effective adoption.

Radial access has become more common among interventionalists for neurointerventional procedures due to lower complication rates and patient comfort.1, 2 However, rare but serious complications such as catheter fracture and retention require recognition and investigation of advanced retrieval strategies.3 We present a two-stage case involving a patient in their 70s who initially underwent successful mechanical thrombectomy for left M1 occlusion. Hours later, new onset of neurological deficits led to repeat digital subtraction angiography via right radial access. During catheter withdrawal and after initial medical management of suspected vasospasm, the RIST guide catheter became entrapped and fractured within the axillary artery. Transfemoral access was used to retrieve the distal catheter fragment using a snare technique. Post-retrieval imaging confirmed vessel integrity, though ulnar artery occlusion led to ischemia requiring vascular surgery. This case illustrates a rare complication of radial access and highlights suspected novel technical considerations for retrieval, rescue planning, and catheter system selection.

BackgroundIn aesthetic clinical trials, image self-capture using mobile devices may help reduce burden on clinic resources, increase data quality, and lower barriers to study participation.ObjectiveThis study aimed to develop a mobile device app to help participants self-capture clinically usable images.MethodsThe Allergan Aesthetic (an AbbVie Company) mobile image app was designed to auto-capture images while directing study participants on distance, head position, and expression to capture a high-quality clinical image. To assess resolution and optimal lighting conditions, images captured using the app in office, at home, and in outdoor settings were compared with those from a Canfield VISIA-CR system (Canfield Scientific). Objective image quality assessment of facial images captured using the app with an iPhone XR (Apple Inc) and iPhone 12 (Apple Inc), compared with images captured using the Canfield VISIA-CR with a digital single-lens reflex camera and the Canfield mobile image capture app with a variety of Android (Google) and iOS (Apple Inc) devices, was conducted using the Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE). Clinical utility was assessed by calculating inter- and intrarater variability for severity ratings of participants’ lateral canthal lines (LCL) or forehead lines (FHL) obtained from app-captured images compared with ratings based on in-person evaluations performed by a physician. Usability was assessed according to the ISO (International Organization for Standardization)/IEC (International Electrotechnical Commission) 250101 standard.ResultsThe Allergan Aesthetic mobile image app was found to perform best under natural light and had image resolution insufficient for assessing minor facial structures, but appropriate for larger structures (eg, FHL). A total of 3968 images were assessed using BRISQUE. Images captured with the Allergan Aesthetic mobile image app had better image quality than those captured using other modalities, as indicated by lower mean BRISQUE scores of 14.05‐19.81 compared with Canfield VISIA-CR with a DSLR (34.47) and the Canfield mobile image capture app (23.43). LCL and FHL were rated both in person and digitally in 68 and 71 participants, respectively (median age 52‐56 y; 48% to 52% female; 75% to 78% White). Interrater reliability between clinician live evaluations and independent photo review of self-captured photos based on intraclass correlation coefficients (ICCs) was substantial (0.61‐0.80) to almost perfect (0.81‐1.00) for all raters (LCL: ICC 0.75‐0.91 at rest and 0.79‐0.89 at maximum contraction; FHL: ICC 0.77‐0.93 at rest and 0.70‐0.89 at maximum contraction). After 2 iterations of improvements, mean usability ratings of the app experience (out of 5) were as follows: easy to complete=3.2, enjoyable=3.1, satisfied with the level of guidance provided=3.2, and likely to complete a full session without exiting=4.1.ConclusionsThe Allergan Aesthetic mobile image app delivers consistent, high-quality images that allow for assessment of LCL and FHL in good agreement with in-person evaluation. Image self-capture using mobile devices may help reduce clinic costs and remove barriers to participation in aesthetic clinical trials.

Spatial context is becoming increasingly important in the omics disciplines. Spatial proteomics is a diverse field encompassing numerous techniques that provide both the location and identity of proteins in biological samples. Improving upon bulk analyses, spatial proteomics can map peptides and intact proteins within tissue. This review focuses on the application of matrix-assisted laser desorption/ionization (MALDI) in spatial proteomics. Approaches are grouped into two general categories and discussed: protein MALDI MSI and MSI-guided spatial proteomics. A discussion of the workflow for each method is presented, and challenges to each approach are discussed. Recent and technically interesting cases in the literature are presented for each category. This review aims to guide researchers interested in MALDI protein imaging through the strengths, weaknesses, and technical considerations of the many workflows available to them.

Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for various thoracic aortic pathologies, including blunt thoracic aortic injury, aneurysms, and dissections. Involvement of Ishimaru Zone 2 occurs in up to 60% of TEVAR cases requiring extension across the distal aortic arch and left subclavian artery (LSA). Coverage of the LSA without revascularization increases the risk of complications such as upper extremity ischemia, stroke, and spinal cord injury. Therefore, the preservation of LSA perfusion during TEVAR is essential. Cervical debranching remains an effective alternative to preserve flow to the LSA, but it poses risks of bleeding, infection, and nerve injury. Similarly, although technically feasible, other endovascular approaches, such as parallel grafts, in situ fenestrations and physician-modified endografts, may lead to added risk of stent-graft complications and are considered off-label indications. To address these challenges, the Gore Thoracic Branch Endoprosthesis® (TBE; W.L. Gore & Associates, Flagstaff, AZ, USA) has emerged as an off-the-shelf thoracic branch stent-graft for the treatment of distal aortic arch lesions that require extension of the proximal seal into Zone 2 while enabling LSA incorporation. Recent literature has reinforced its promising results across different clinical scenarios. This article outlines the technical considerations of the Gore TBE® and provides a contemporary narrative review of its clinical outcomes.

Introduction: In the United States, vaccine development is a complicated and multifaceted process governed by a myriad of regulatory authorities and structures. In addition to industry laboratory, clinical, and manufacturing best practices, biosecurity restrictions are also placed on vaccine development for “select agents,” those agents that are considered to pose the greatest risk to public health. Regulations imposed on select agent vaccine development must necessarily be adaptable in consideration of the opinions and experiences of practitioners, but, to date, those involved in vaccine development for select agents have not been specifically represented in published studies assessing researcher viewpoints. The perspectives of this community thus represent a gap in our knowledge of the effects of regulations on biosecurity preparedness infrastructures. Objectives: In this study, we sought to capture personal experiences of scientists working on select agent vaccines, who face unique technical considerations that differ from other vaccine research. Methods: We interviewed U.S. Government researchers and independent contractors who are directly involved in creating vaccines to assess how the select agent regulations (SARs) affect vaccine development in the United States. These personal narratives were transcribed and compiled thematically, covering topics of financial and governmental incentives, administrative and regulatory challenges, subcontracting, personnel security measures, and safety and efficacy testing. Results: Across eight interviews, there was a consensus that the SARs, while burdensome, are fair provisions that mitigate the inherent risk of conducting select agent work. Their perspectives exhibited how the SARs are primarily relevant during the preclinical stage of vaccine development and generally restrict progression to later stages of development typical of nonselect agent vaccines. In addition, lacking government financial incentives, the need for subcontracting, and the limited availability of validated animal models, while not exclusive to SAR work, all serve as significant obstacles to researcher involvement and overall progress in select agent vaccine development. Conclusions: Collectively, these perspectives provide valuable insight into the strengths, weaknesses, and potential areas for improvement in the implementation of the SARs for select agent vaccine development. In addition, these accounts were complimentary of the SARs in ways not currently represented in the literature, which merits further evaluation by larger-scale studies of this subgroup as well as select agent researchers as a whole. These insights provide important context for future discussions of regulatory oversight and its impact on biosecurity preparedness.

Reconstructive surgery is fundamentally dedicated to restoring tissues and organs damaged by trauma, disease, or congenital anomalies, with the goal of re-establishing both physiological function and anatomical form. Facial reconstruction, as one of the most representative and technically demanding areas of the discipline, embodies the evolution of its concepts and technological progress. Using facial reconstruction as the point of departure, this article systematically delineates the scientific underpinnings and developmental frontiers of the field. Centered on four core elements-donor construction, vascular reconstruction, precision transplantation, and functional recovery, this article articulates the internal logic and technical considerations of both autologous and allogeneic reconstructive methods. Further, from the perspectives of regenerative donor fabrication, the digital and intelligent transformation of reconstructive surgery, breakthroughs in immune tolerance strategies, and the integration of engineering technologies to enhance functional outcomes, the article envisions potential paradigm shifts that may redefine the discipline. By leveraging facial reconstruction as a highly integrated lens, this work aims to elucidate the key drivers of innovation and chart the future directions of reconstructive surgery.

The accelerating global transition to electric mobility demands data-driven infrastructure planning that balances technical, economic, and spatial considerations. This study develops a scenario-based demand and economic modeling framework to estimate electric vehicle (EV) charging infrastructure needs across Abu Dhabi’s urban and rural regions through 2050. Two adoption pathways, Progressive and Thriving, were constructed to capture contrasting policy and technological trajectories consistent with the UAE’s Net Zero 2050 targets. The model integrates regional travel behavior, energy consumption (0.23–0.26 kWh/km), and differentiated charging patterns to project EV penetration, charging demand, and economic feasibility. Results indicate that EV stocks may reach 750,000 (Progressive) and 1.1 million (Thriving) by 2050. The Thriving scenario, while demanding greater capital investment (≈108 million AED), yields higher utilization, improved spatial equity (Gini = 0.27), and stronger long-term returns compared to the Progressive case. Only 17.6% of communities currently meet infrastructure readiness thresholds, emphasizing the need for coordinated grid expansion and equitable deployment strategies. Findings provide a quantitative basis for balancing economic efficiency, spatial equity, and policy ambition in the design of sustainable EV charging networks for emerging low-carbon cities.

Blood RNA sequencing (RNA-seq) is increasingly used to enhance diagnostic yield in genetic disorders; however, technical optimization is critical for clinical implementation. We evaluated key technical considerations for blood RNA-seq, including globin depletion methods, inter-batch variability, and sample types (whole blood vs. isolated peripheral blood mononuclear cells [PBMCs]). We compared the applicability of reagent-based globin removal (globin-RR) with bioinformatic globin removal (globin-BR) in whole-blood RNA-seq in terms of globin depletion efficiency and required sequencing depth, assessed batch effects in globin-RR samples using principal component and correlation analyses, and compared the use of whole blood versus PBMCs in terms of expression correlations and the number of detected Mendelian disease-associated genes. Globin-RR performed better than globin-BR, achieved better coverage of clinically relevant Mendelian disease-associated genes (51.85% vs. 40.79%), and required fewer total sequencing reads (mean, ~107 vs. ~149 million) to obtain 100 million non-globin reads. Batch effects of globin-RR were low (inter-batch correlation, R2>0.96). PBMCs out-performed whole blood in terms of the number of Mendelian disease-associated genes (3,675 in PBMCs vs. 3,598 in whole blood) and percentage of highly expressed (transcripts per million >5) Mendelian disease-associated genes (54.46% vs. 51.85%) detected and therefore was the preferred sample type for RNA-seq. Globin-RR is effective, reproducible, and practical for use in clinical whole-blood RNA-seq. With high concordance and a slightly broader gene detection range than whole blood, PBMCs are a viable alternative sample type for routine genetic diagnostic tests.

The growing volume of municipal solid waste and increasing demand for sustainable energy solutions have intensified interest in waste-to-energy (WtE) infrastructure among local government units (LGUs) in the Philippines. While WtE presents a promising approach to integrating solid waste management and renewable energy generation, its implementation at the municipal level, particularly in second-class municipalities remains limited. These municipalities face distinct challenges related to institutional capacity, fragmented governance arrangements, financing constraints, and stakeholder coordination. Existing studies on WtE in the Philippine context have largely focused on technical feasibility, environmental impacts, and policy considerations, while giving limited attention to the project governance mechanisms that shape project outcomes. This study responds to this gap by examining project governance as a practical, rather than purely theoretical, determinant of waste- to-energy (WtE) development in second-class municipalities. Rather than assuming that governance readiness directly leads to implementation, the study investigates how specific governance arrangements, such as institutional roles, coordination mechanisms, and decision-making processes, are perceived and operationalized at the local level. Drawing on project governance and infrastructure governance literature, the analysis focuses on how these arrangements shape planning readiness, risk management, and stakeholder engagement over the WtE project lifecycle. The proposed governance model is situated within the Philippine decentralized governance context, where local governments exercise primary responsibility for solid waste management but operate within fragmented regulatory and institutional environments. While the model aligns with national energy and sustainability objectives, it is developed with explicit attention to the practical constraints faced by second-class municipalities, including capacity limitations, coordination gaps, and implementation uncertainty. In this sense, the study does not present governance as a guaranteed pathway to WtE deployment, but instead treats it as a necessary, although not sufficient, condition for advancing project feasibility and accountability. This research contributes to the limited body of literature on municipal-level project governance for WtE infrastructure in developing country contexts. It provides both theoretical and practical insights for policymakers, LGU officials, and project practitioners seeking to advance sustainable waste and energy solutions through improved governance mechanisms.