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Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients’ characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.

A humidity microsensor integrated with a readout circuit on-a-chip fabricated using the commercial 0.18 μm CMOS (complementary metal oxide semiconductor) process was presented. The integrated sensor chip consists of a humidity sensor and a readout circuit. The humidity sensor is composed of a sensitive film and interdigitated electrodes. The sensitive film is titanium dioxide prepared by the sol-gel method. The titanium dioxide is coated on the interdigitated electrodes. The humidity sensor requires a post-process to remove the sacrificial layer and to coat the titanium dioxide. The resistance of the sensor changes as the sensitive film absorbs or desorbs vapor. The readout circuit is employed to convert the resistance variation of the sensor into the output voltage. The experimental results show that the integrated humidity sensor has a sensitivity of 4.5 mV/RH% (relative humidity) at room temperature.

Computed tomography of the temporal bone revealed a right-sided, 2 × 2-cm soft-tissue mass in the EAC, with erosion of mastoid air cells but a normal eardrum and middle ear cavity. The technique chosen is generally based on the extent of the disease and the surgeon's preference, and it ranges from canalplasty with skin grafting for lesions confined to EAC, to canalplasty or canal-wall-up mastoidectomy with reconstruction of canal defects for lesions involving mastoid cells, to canal-wall-down mastoidectomy for lesions with large wall defects exhibiting mastoid erosion.4 If an EAC defect is to be reconstructed, as in our case, nonretractable materials such as cartilage make ideal grafts. From the School of Medicine, National Taiwan University, Taiwan (Dr. Lee); the School of Medicine, Chang Gung University, Taiwan (Dr. Hu, Dr. Chuang, and Dr. Chan); the Division of Otology, Department of Otolaryngology-Head and Neck Surgery (Dr. Hu and Dr. Chan); and the Department of Anatomic Pathology (Dr. Chuang), Chang Gung Memorial Hospital, Linkou, Taiwan References 1.

本研究以敘事探究的方式，探討個人在美國南加州中文學校，親子中文學前班五年的教學歷程。由幼兒節慶教學課程設計，帶出跨文化與多元文化的議題。藉由分析幼兒跨文化教學歷程與僑校課室經營，探討反思所遇到的挑戰、困境與成效。最終，給予美國僑校、幼兒華語老師和未來研究者，實質建議。 本研究的研究問題為：（1）經營跨文化華語課堂中，所面臨的文化衝擊與困境為何？（2）僑校課室經營的難點為何？（3）僑校華語教師如何學習美國教育?如何提高教學效能？（4）ACTFL全球公民素養標準帶入幼兒跨文化教學的歷程與成效為何？ 本研究結果為：（1）海外華語教學所遇到的文化衝突包含性別議題、宗教議題、多元家庭議題，是一個跨文化的歷程。尊重並理解學生多元文化背景，透過敘事探究找到教學動力；（2）僑校租借學區教室諸多限制，專業師資長期缺乏；（3）重視僑校教師需求，補助支持教師專業華語進修；（4）透過ACTFL「全球公民素養標準」，設計合適的跨文化華語節慶教學。 本研究額外發現：（1）敘事探究用於教學，可深入探究與反思多元文化課堂；教師亦能透過跨文化課程設計，領悟教學前後的相關性。（2）僑校轉型開設親子中文學前班，成為進入沉浸式小學的跳板，與沉浸式小學共同成長。

Background The standard treatment for periprosthetic joint infections (PJI) typically involves a two-stage resection arthroplasty using antibiotic-loaded bone cement (ALBC) spacers. This study hypothesizes that there is no significant correlation between antibiotic levels in blood and synovial fluid and the patient’s kidney function, and that the success rates of staged resection arthroplasty are comparable between groups, specifically targeting gram-positive bacterial infections. Methods This retrospective review included patients treated from 2017 to 2022 with two-stage arthroplasty using vancomycin-loaded ALBC spacers, selectively targeting gram-positive infections. Patients with non-gram-positive infections or those with allergies or treatments affecting serum antibiotic levels were excluded. The study assessed comorbidities, renal function, specifics of the spacers, and vancomycin concentrations in joint fluid and blood. Results Among 62 PJI cases analyzed (22 hips and 40 knees), 34 patients (54.8%) had renal insufficiency (RI), associated with significantly lower albumin (2.64 g/dL vs. 3.43 g/dL, p  < 0.05) and estimated glomerular filtration rate (eGFR) (58.17 mL/min/1.73 m² vs. 121.74 mL/min/1.73 m², p  < 0.05). No significant differences were found in comorbidities, antibiotic regimen, or the weight of the ALBC spacers between the groups ( p  > 0.05). Both groups exhibited high vancomycin levels in joint fluid, with peak blood vancomycin levels inversely correlated with eGFR (coefficient − 3.612, 95% CI -8.543 to -2.753, p  < 0.001). RI patients displayed higher peak blood vancomycin levels (1.23–5.43 mg/L) but remained below toxicity thresholds. The infection-free interval, aseptic revision rates, and bacterial profiles specific to gram-positive species showed no significant differences between the groups. Conclusion Systemic absorption of vancomycin from ALBC spacers was evident in patients with RI and inversely correlated with eGFR, yet remained well below toxic thresholds across all patients. These findings suggest that the use of vancomycin-loaded ALBC spacers appears to be safe for managing gram-positive infections in patients with varying renal function. Additionally, renal insufficiency did not adversely affect the infection-free interval, aseptic revision rates, or bacterial diversity. Level of evidence III.

Purpose The Coronavirus Disease 2019 (COVID-19) pandemic delayed elective procedures such as total joint arthroplasty. As surgical volumes return to prepandemic levels, understanding the implications of COVID-19 becomes imperative. This study explored the effects of COVID-19 on the short-term outcomes of hip arthroplasty. Methods This multicenter, retrospective, case–control study included patients who had undergone hip arthroplasty between 2020 and 2022. Propensity score matching (PSM) was performed to compare demographic characteristics, primary outcomes, and secondary outcomes between patients with a history of COVID-19 (COVID-19 cohort) and those without it (control cohort). The primary outcomes were surgical site infection, periprosthetic joint infection (PJI), dislocation, prosthesis loosening, deep vein thrombosis, and pulmonary embolism. The secondary outcomes were intraoperative blood loss, nerve injury, renal injury, urinary tract infection (UTI), pneumonia, and acute coronary syndrome. Results The COVID-19 and control cohorts comprised 153 and 4925 patients, respectively. After PSM, significant between-cohort differences were observed in the incidence of pneumonia ( p  < 0.001) and UTI ( p  = 0.0424). The odds ratio for PJI was 1.62, which is not significant ( p  = 0.3238) but the culture-negativity rate is higher in the COVID-19 cohort (25%). Conclusion Our findings suggest that COVID-19 only elevated risks of postoperative pneumonia and UTI after hip arthroplasty. This disease significantly increases the risk of postoperative pneumonia but not of 90-day mortality or any major perioperative complication. On the other hand, PJI still remains a concern because its treatment is challenging owing to its culture-negativity, often necessitating the Girdlestone procedure.

Background In total knee arthroplasty (TKA), isolated aseptic loosening (IAL) requires the replacement of prosthetic components, with ongoing debate regarding the effectiveness of partial component revision (PCR) compared to total component revision (TCR). This study aims to compare implant survival and surgical outcomes between PCR and TCR in the context of IAL. Methods This retrospective study analyzed data from 285 patients who underwent revision TKA for IAL between January 2000 and December 2013. After applying exclusion criteria, 112 patients were included in the analysis—60 undergoing TCR and 52 undergoing PCR. Results PCR was associated with shorter operative times and hospital stays compared to TCR, alongside significant differences in the choice of revision prostheses. Although the prosthesis failure rates were comparable between the groups (13.6% for TCR and 18.33% for PCR), significant risk factors for failure were identified, including a canal filling ratio (CFR) below 0.8 and a discrepancy over 0.2 between CFR views. However, no significant differences in overall survivorship were observed between the groups. Conclusions Both PCR and TCR provide similar survival rates and clinical outcomes for managing IAL in TKA. PCR provides advantages in terms of surgical efficiency and patient recovery, while reducing the need for more constrained prosthetic solutions. The study identifies CFR as a critical predictor of prosthesis failure, highlighting the importance of detailed preoperative planning and implant selection. These findings contribute valuable insights for improving revision strategies in IAL, enhancing surgical outcomes in TKA. Level of evidence III.

Background The application of artificial intelligence (AI) in medical education and patient interaction is rapidly growing. Large language models (LLMs) such as GPT-3.5, GPT-4, Google Gemini, and Claude 3 Opus have shown potential in providing relevant medical information. This study aims to evaluate and compare the performance of these LLMs in answering frequently asked questions (FAQs) about Total Knee Arthroplasty (TKA), with a specific focus on the impact of role-playing prompts. Methods Four leading LLMs—GPT-3.5, GPT-4, Google Gemini, and Claude 3 Opus—were evaluated using ten standardized patient inquiries related to TKA. Each model produced two distinct responses per question: one generated under zero-shot prompting (question-only), and one under role-playing prompting (instructed to simulate an experienced orthopaedic surgeon). Four orthopaedic surgeons evaluated responses for accuracy and comprehensiveness on a 5-point Likert scale, along with a binary measure for acceptability. Statistical analyses (Wilcoxon rank sum and Chi-squared tests; P  < 0.05) were conducted to compare model performance. Results ChatGPT-4 with role-playing prompts achieved the highest scores for accuracy (3.73), comprehensiveness (4.05), and acceptability (77.5%), followed closely by ChatGPT-3.5 with role-playing prompts (3.70, 3.85, 72.5%, respectively). Google Gemini and Claude 3 Opus demonstrated lower performance across all metrics. In between-model comparisons based on zero-shot prompting, ChatGPT-4 achieved significantly higher scores of both accuracy and comprehensiveness relative to Google Gemini ( P  = 0.031 and P  = 0.009, respectively) and Claude 3 Opus ( P  = 0.019 and P  = 0.002), and demonstrated higher acceptability than Claude 3 Opus ( P  = 0.006). Within-model comparisons showed role-playing significantly improved all metrics for ChatGPT-3.5 ( P  < 0.05) and acceptability for ChatGPT-4 ( P  = 0.033). No significant prompting effects were observed for Gemini or Claude. Conclusions This study demonstrates that role-playing prompts significantly enhance the performance of LLMs, particularly for ChatGPT-3.5 and ChatGPT-4, in answering FAQs related to TKA. ChatGPT-4, with role-playing prompts, showed superior performance in terms of accuracy, comprehensiveness, and acceptability. Despite occasional inaccuracies, LLMs hold promise for improving patient education and clinical decision-making in orthopaedic practice. Clinical trial number Not applicable.

Research on eye detection and segmentation is even more important with mask-wearing measures implemented during the COVID-19 pandemic. Thus, it is necessary to build an eye image detection and segmentation dataset (EIMDSD), including labels for detecting and segmenting. In this study, we established a dataset to reduce elaboration for chipping eye images and denoting labels. An improved DeepLabv3+ network architecture (IDLN) was also proposed for applying it to the benchmark segmentation datasets. The IDLN was modified by cascading convolutional block attention modules (CBAM) with MobileNetV2. Experiments were carried out to verify the effectiveness of the EIMDSD dataset in human eye image detection and segmentation with different deep learning models. The result shows that the IDLN model achieves the appropriate segmentation accuracy for both eye images, while the UNet and ISANet models show the best results for the left eye data and the right eye data among the tested models.

Background This study aimed to report the long-term survival of fixed-bearing medial unicompartmental knee arthroplasty (UKA) with a mean of 14-year follow-up, and to determine possible risk factors of failure. Methods We retrospectively evaluated 337 fixed-bearing medial UKAs implanted between 2003 and 2014. Demographic and radiographic parameters were measured, including pre-operative and post-operative anatomical femorotibial angle (aFTA), posterior tibial slope (PTS), and anatomical medial proximal tibial angle (aMPTA). Multivariate logistic regression analysis was applied to figure out risk factors. Results The mean follow-up time was 14.0 years. There were 32 failures categorized into implant loosening ( n  = 11), osteoarthritis progression ( n  = 7), insert wear ( n  = 7), infection ( n  = 4), and periprosthetic fracture ( n  = 3). Cumulative survival was 91.6% at 10 years and 90.0% at 15 years. No statistically significant parameters were found between the overall survival and failure groups. Age and hypertension were significant factors of implant loosening with odds ratio (OR) 0.909 ( p  = 0.02) and 0.179 ( p  = 0.04) respectively. In the insert wear group, post-operative aFTA and correction of PTS showed significance with OR 0.363 ( p  = 0.02) and 0.415 ( p  = 0.03) respectively. Post-operative aMPTA was a significant factor of periprosthetic fracture with OR 0.680 ( p  < 0.05). Conclusions The fixed-bearing medial UKA provides successful long-term survivorship. Tibial component loosening is the major cause of failure. Older age and hypertension were factors with decreased risk of implant loosening.