Humeral head avascular necrosis (AVN) can cause significant shoulder morbidity and represents the second most common site of nontraumatic osteonecrosis after the femoral head. The pathophysiology centers on disrupted blood supply, ultimately leading to bone death and structural compromise. It is associated with various etiologies, including trauma, iatrogenic factors, hematologic conditions, lifestyle factors, certain environmental exposures, and systemic diseases. Diagnosis relies on a combination of clinical assessment and radiographic evaluation, with magnetic resonance imaging serving as the most sensitive modality for early detection. The Cruess classification system guides treatment decisions. Although conservative measures are used in early stages, they carry a risk of progression, as they do not alter the disease course—unlike surgical techniques such as core decompression. Arthroplasty is reserved for later stages with evidence of collapse, with research suggesting that the use of pyrocarbon in hemiarthroplasty may help reduce glenoid erosion. This review provides a comprehensive overview of humeral head osteonecrosis, emphasizing its etiology, clinical evaluation, imaging findings, and treatment strategies. It highlights the growing support for early operative intervention over conservative management, emerging treatment modalities such as biologic augmentation and allografting, and promising new materials like pyrocarbon in hemiarthroplasty to mitigate glenoid erosion.

Oral squamous cell carcinoma (OSCC) progresses from preneoplastic precursors via genetic and epigenetic alterations. Previous studies have focused on the treatment of terminally developed OSCC. However, the role of epigenetic regulators as therapeutic targets during the transition from preneoplastic precursors to OSCC has not been well studied. Our study identified lysine-specific demethylase 1 (LSD1) as a crucial promoter of OSCC, demonstrating that its knockout or pharmacological inhibition in mice reversed OSCC preneoplasia. LSD1 inhibition by SP2509 disrupted cell cycle, reduced immunosuppression, and enhanced CD4+ and CD8+ T-cell infiltration. In a feline model of spontaneous OSCC, a clinical LSD1 inhibitor (Seclidemstat or SP2577) was found to be safe and effectively inhibit the STAT3 network. Mechanistic studies revealed that LSD1 drives OSCC progression through STAT3 signaling, which is regulated by phosphorylation of the cell cycle mediator CDK7 and immunosuppressive CTLA4. Notably, LSD1 inhibition reduced the phosphorylation of CDK7 at Tyr170 and eIF4B at Ser422, offering insights into a novel mechanism by which LSD1 regulates the preneoplastic-to-OSCC transition. This study provides a deeper understanding of OSCC progression and highlights LSD1 as a potential therapeutic target for controlling OSCC progression from preneoplastic lesions.
STAT3 Transcription Factor/metabolism* ; Animals ; Histone Demethylases/genetics* ; Phosphorylation ; Mouth Neoplasms/immunology* ; Mice ; Carcinoma, Squamous Cell/immunology* ; Disease Progression ; Cyclin-Dependent Kinase-Activating Kinase ; Precancerous Conditions/metabolism* ; Humans ; Cyclin-Dependent Kinases/metabolism* ; Disease Models, Animal

Obesity and sleep apnea contribute to significant challenges in ambulatory surgical centers which include airway management and perioperative recovery. This narrative review was written following a literature review of articles available on ScienceDirect, PubMed, and Google Scholar from 2009 to 2024. This article highlights that obesity-related anatomical changes, such as increased neck circumference (NC) and reduced cervical extension, may complicate airway management. Successful ambulatory surgery for these high-risk patients depends on detailed attention throughout the perioperative period. Advanced airway techniques, along with continuous pulse oximetry and capnography, are vital for safe care. The use of continuous positive airway pressure or bilevel positive airway pressure in the perioperative phase is particularly beneficial in preventing respiratory complications. A systematic, multidisciplinary approach emphasizing preoperative screening, risk stratification, and standardized protocols is crucial for optimizing results.

Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.
Humans ; Lung Neoplasms/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods*

Tracheostomy-related pressure injuries and peristomal airway breakdown remain important complications despite standardized bundles and improved tube design. Photobiomodulation (PBM) applies non-thermal red or near-infrared light to modulate the mitochondrial activity, inflammation, perfusion, and tissue repair, with an emerging evidence base in cutaneous wounds and respiratory and tracheal models. This narrative review, written from a nursing practice perspective, synthesizes data on tracheostomy-related wounds, core PBM mechanisms, airway-directed applications, and emerging airway and peristomal data and summarizes the PBM dose-response principles and illustrative parameter ranges relevant to tracheostomy care. Building on this foundation, this paper proposes a practical nursing care framework, which was used as a pragmatic care pathway for integrating PBM as an adjunct to standard tracheostomy care. The work illustrates potential use cases through four clinical vignettes from intensive care, long-term acute care, pediatric, and hospice settings.This paper highlights the safety considerations, including oncologic caution and airway-specific precautions, and outlines knowledge gaps and priorities for nurse-led trials, registries, and standardized reporting to guide safe, effective implementation across diverse care settings.

Irritable bowel syndrome (IBS) is a highly prevalent and chronic functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits. The underlying pathophysiology of IBS is multifactorial, involving gut–brain axis dysregulation, intestinal barrier dysfunction, and imbalances in the gut microbiota.Current therapeutic approaches primarily aim to alleviate symptoms often yielding inconsistent outcomes, highlighting the need for better interventions. Photobiomodulation (PBM) therapy, which involves the application of specific wavelengths of light to modulate cellular activity, has emerged as a promising non-invasive strategy for IBS. PBM primarily targets mitochondrial function, enhancing adenosine triphosphate production, reducing oxidative stress, and promoting cellular repair and resilience. These effects collectively contribute to reduced inflammation, improved gut barrier integrity, and modulation of the neural and immune pathways relevant to IBS.Recent evidence suggests that PBM favorably influence the gut microbiome composition and function and reduce neuroinflammation, both considered key contributors to IBS symptomatology. This review critically examines preclinical and clinical evidence supporting the use of PBM in the context of IBS, exploring its mechanisms of action and therapeutic potential. By addressing multiple pathophysiological targets, PBM represents a novel and potentially transformative approach for managing IBS, particularly in patients unresponsive to conventional therapies.

Facet joint violation (FJV) is a known complication of pedicle screw fixation that may contribute to adjacent segment disease (ASD) by altering spinal biomechanics and increasing loading of the cranial facet joints. However, the prevalence, biomechanical effects, and longterm consequences of FJV remain unclear. A scoping review was conducted using the PubMed, Embase, and Scopus databases. Clinical studies reporting the number of FJVs in relation to screws placed during lumbar fusion or assessing the frequency of ASD in patients with FJV were included. Biomechanical studies evaluating segmental kinematics and loading after FJV were also included. Data regarding study characteristics, surgical techniques, FJV rates, severity grading, and outcomes were extracted. Bayesian statistical models were applied for pooled prevalence estimates. Fifty studies met the inclusion criteria (39 clinical and 11 biomechanical studies). The prevalence of FJV varied, with robotic-assisted percutaneous placement associated with the lowest risk (4.79%; 95% credible interval [CrI], 3.88–5.79), and freehand percutaneous placement associated with the highest risk (19.45%; 95% CrI, 18.15–20.73). FJV rates were highest at L2 (14.5%; 95% CrI, 10.4%–19.0%) compared to lower levels. Biomechanical studies indicate that minor FJV may destabilize the superior segment by disrupting the facet capsule, while severe FJV involving full joint traversal might stabilize the segment due to the screw’s interaction with both articulating processes. Limited evidence suggests an association between FJV and ASD, though methodological limitations, selection bias, and reporting errors limit conclusions. FJV is common during lumbar fusion, especially with percutaneous screw placement. While biomechanical evidence suggests differing grades of FJV may variably alter segmental stability, its role in ASD development remains uncertain. Given its prevalence, biomechanical implications, and potential mitigation through navigation or robotics, determining whether FJV is a clinically significant driver of ASD is a key research imperative.