Trichoblastic carcinoma (TBC) is an extremely rare cutaneous malignancy of the hair follicle, first described in the literature in 1962 as a “primary neoplasm of the hair matrix” (1). Besides its rarity, TBC shares many clinical and histologic characteristics with basal cell carcinoma (BCC), making the diagnosis of TBC difficult to make. Many authors have described TBC as a malignant transformation of a benign trichoblastoma (TB), but a universal understanding of the pathophysiological origin of TBC has not been established (2, 3). We present a case of this uncommon tumor with the hope that this report will add to the small repertoire of available research, and aid clinicians in diagnosis and management of this rare tumor.

Background: Cytomegalovirus (CMV) is a common cause of viral infection. In immunocompetent patients, CMV infection is usually mild or asymptomatic and does not require any treatment. However, in some patients systemic manifestations can occur.

Case presentation: We report the case of a 40-year-old woman with a medical history of Graves’ disease and papilloma virus infection presenting with swollen ankles associated with fever and pain in the lower limbs for several weeks. Clinical examination revealed bilateral in duration of the calf. Laboratory tests showed elevated liver enzymes and systemic inflammation. Exploration by ultrasound of lower limbs and CT scan of the abdomen demonstrated superficial venous thrombosis of the lower limbs and thrombosis of the left hepatic vein. A thorough evaluation for hypercoagulability and septic states were negative. Finally, serological conversion for CMV was demonstrated with positive IgM and IgG with negative prior testing done seven years earlier. The patient was given an anticoagulation treatment and oral contraception was discontinued. The patient improved clinically and biologically after few weeks.

Conclusion: We describe a rare case of sub-acute CMV primary infection in an immunocompetent patient complicated with multiple thromboses. This case illustrates a rare complication of a common infection in order to raise awareness of this entity.

Purpose: Adequate reliability of Body Composition (BC) assessment is a requirement before such measures can be considered valid. Many studies to date have only examined a single source of measurement error such as that from trials (test-retest). Generalizability Theory (G-theory) is a statistical technique that allows for the examination of different sources of measurement error simultaneously in a single analysis. Therefore, the aim of this study was to examine the different sources of error seen in the assessment of BC. A secondary purpose was to determine the appropriate number of facet conditions required to gain a reliable BC measure.

Methods: This measurement study included 38 participants who had been assessed on two different occasions (in the same week) and on each of four different BC field methods: Percent Body Fat (PBF) by Skinfold Technique (SF), Waist Circumference (WC), Body Mass Index (BMI) and PBF by Hand-Held Bioelectrical Impedance (HH). Two different G-theory designs were used in this research. First, a two-facet crossed p×t×m design was analyzed treating all facets as random. Then, the same design was performed treating BC method as a fixed facet. In both designs, a Generalizability Study (G-study) and Decision Study (D-study) were conducted. Three different software packages were used to ensure consistent and valid results (GENOVA, SPSS macro, and SAS GLM).

Results: The completely random design showed the largest variance component for persons (p) (57.8%). Variance components for both trials (t) and BC method (m) were negligible. However, the interaction between person and method (p×m) was substantial (38.6%). D-study results indicated reliable BC scores for measurement designs administered once using three different methods (G=.803). The mixed design, averaging over BC method, showed majority of variance due to persons (98.5%) and each of the four BC methods showed reliable scores with a single trial (G’s>.945).

Conclusion: Results from this G-theory research indicate that the equivalence reliability of commonly administered BC assessments may be inadequate. Although different BC assessments individually are reliable, for dependable BC trait generalization to the universe, a minimum of three different methods administered once may be required.

This report describes a long rectal duplication cyst found during routine dissection of an 82 year old male cadaver. The cyst was tubular, blind-ending and non-communicating. It emerged from the posterior rectal wall approximately 13cm superior to the anal verge and was 12cm in length. Long duplication cysts such as that described may cause complications such as perforation, bleeding and chronic pain. Hence duplication cysts should form part of the differential work up in a clinical setting.

Background: Alcoholic hepatitis (AH) is a severe inflammatory liver disorder with mortality rates of 20–50% at 90 days. Ferritin is an acute-phase reactant elevated in AH due to hepatocellular injury, systemic inflammation, and altered iron homeostasis. Its prognostic significance in AH has not been fully elucidated. To evaluate the association between serum ferritin levels and short-term clinical outcomes in patients with alcoholic hepatitis.

Methods: This retrospective cohort study utilized the TriNetX US Collaborative Network. Patients with AH (ICD-10: K70.1, K70.10, K70.11) and documented serum ferritin were included. Patients with autoimmune hepatitis, viral hepatitis, hemochromatosis, Wilson disease, and primary biliary or sclerosing cholangitis were excluded. Patients were stratified into low-ferritin (1,000 ng/mL) and high-ferritin (≥1,000 ng/mL) cohorts. The primary outcome was all-cause mortality within 90 days. Secondary outcomes included hepatic failure, sepsis, shock, ascites, spontaneous bacterial peritonitis (SBP), esophageal variceal bleeding, and hepatic encephalopathy.

Results: Of 73,476 patients, 58,815 had ferritin 1,000 ng/mL, and 14,661 had ferritin ≥1,000 ng/mL. Patients with elevated ferritin had significantly higher 90-day mortality (20.0% vs. 8.7%; HR 2.66, p 0.001). Elevated ferritin was also associated with increased risks of hepatic failure (HR 1.55), sepsis (HR 1.85), shock (HR 1.94), ascites (HR 1.17), SBP (HR 1.52), and hepatic encephalopathy (HR 1.32) (all p 0.001). Esophageal variceal bleeding was less frequent in the high-ferritin cohort (HR 0.73, p 0.001).

Conclusion: Serum ferritin ≥1,000 ng/mL is associated with significantly worse 90-day outcomes in AH. Ferritin represents a simple, inexpensive biomarker that may aid in prognostic assessment and risk stratification. Prospective studies with multivariable adjustment are warranted.

Background: Patients with cirrhosis are at increased risk of sepsis due to cirrhosis-associated immune dysfunction, bacterial translocation, and hemodynamic derangements. However, large-scale propensity matched data comparing outcomes between cirrhotic and non-cirrhotic patients with septic shock remain limited. This study aimed to evaluate the impact of cirrhosis on mortality, renal, hemorrhagic, thromboembolic, and respiratory outcomes in patients with septic shock.

Methods: We conducted a retrospective propensity score-matched cohort study using the US Collaborative Network from 43 healthcare organizations in the TriNetX research network. Patients with septic shock were identified using ICD-10 CM codes and stratified by the presence or absence of cirrhosis. Propensity score matching (1:1) was performed for age, sex, race, BMI, diabetes, and baseline laboratory values, yielding 96,986 patients per cohort. Outcomes included mortality, acute kidney injury (AKI), continuous renal replacement therapy (CRRT), disseminated intravascular coagulation (DIC), gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), pulmonary embolism (PE), hospital-acquired pneumonia (HAP), and mechanical ventilation. Cross-sectional risk analysis and Kaplan-Meier survival analysis with hazard ratios (HR) were performed.

Results: Patients with cirrhosis and septic shock had significantly higher mortality compared to non-cirrhotic patients (32.8% vs 27.3%; HR 1.23, 95% CI 1.21–1.25, p = 0.001). Cirrhosis was associated with significantly increased risks of AKI (39.0% vs 34.1%; HR 1.18, 95% CI 1.16–1.20, p = 0.001), CRRT (8.2% vs 6.0%; HR 1.39, 95% CI 1.34–1.44, p = 0.001), DIC (2.3% vs 1.4%; HR 1.68, 95% CI 1.57–1.80, p = 0.001), GIB (7.6% vs 4.6%; HR 1.67, 95% CI 1.61–1.73, p = 0.001), and mechanical ventilation (22.5% vs 19.3%; HR 1.18, 95% CI 1.16–1.21, p = 0.001). There was no significant difference in ICH (HR 1.01, p = 0.906) or HAP (HR 0.96, p = 0.371). PE risk was marginally lower in cirrhotic patients on cross-sectional analysis (RR 0.95, p = 0.025) but did not reach significance on survival analysis (HR 0.96, p = 0.054).

Conclusions: In this large propensity score-matched cohort, cirrhosis was independently associated with significantly higher rates of mortality, AKI, CRRT, DIC, GIB, and mechanical ventilation in patients with septic shock. These findings highlight the need for early aggressive management and close monitoring of hemorrhagic, renal, and coagulation complications in cirrhotic patients presenting with septic shock.

Background: Ketamine use is increasingly associated with lower urinary tract symptoms, including ketamine-induced uropathy (KIU). Characterising affected patients and treatment outcomes is essential to guide management.

Method: A cross-sectional study included 20 patients diagnosed with KIU between January and June 2024 at our institution. Urinary symptoms were assessed at presentation and three months after treatment, including frequency, dysuria, urgency, nocturia, incontinence, incomplete emptying, weak stream, and straining. Symptom severity was measured using the International Prostate Symptom Score (IPSS). Statistical analysis was performed using SPSS version 26.0.

Results: Most patients were male (n=15; 75%) and aged 16–21 yr (n=11; 55%). Regular ketamine use was reported by 14 patients (70%), and 15 (75%) had used ketamine for over six years. At presentation, all patients reported urinary frequency and dysuria (100%), and 17 reported urgency (85%). After treatment, significant improvement was observed in dysuria (100% vs 75%; p=0.016), urgency (85% vs 40%; p=0.003), urinary incontinence (35% vs 10%; p=0.047), and incomplete emptying (30% vs 5%; p=0.037). IPSS scores shifted from severe to mild symptoms, although this change was not statistically significant (p=0.546).

Conclusions: KIU is associated with a high burden of urinary symptoms in young users. Recognition and targeted treatment can significantly improve key urinary outcomes. Patient summary: Young ketamine users frequently develop bladder symptoms. Symptoms improved following treatment, suggesting intervention may improve quality of life.

Keywords: Ketamine; Uropathy; Urinary Symptoms.

Highlights

• Ketamine-induced uropathy is associated with a significant burden of lower urinary tract symptoms in a predominantly young patient population.

• Urinary frequency, dysuria, and urgency were the most common presenting symptoms, with frequency and dysuria reported in all patients.

• Targeted treatment resulted in statistically significant improvement in dysuria, urgency, urinary incontinence, and incomplete bladder emptying at three months.

• Despite treatment, a proportion of patients continued to experience persistent symptoms, highlighting the chronic nature of the condition.

• These findings emphasise the importance of early recognition and structured management in patients with ketamine-induced uropathy.

Background: There are over one million dialysis patients in China, 80% of whom receive maintenance hemodialysis. Long-term dialysis increases the risk of oral frailty. This study reviews its influencing factors to provide evidence for early prevention and control.

Objective: This study conducted a systematic review of the factors associated with the occurrence of oral frailty in maintenance hemodialysis (MHD) patients based on relevant literature, to provide a reference for the clinical prevention of oral frailty in this population.

Methods: Computerized searches were performed in CNKI, WanFang Data, VIP Database, CBM, PubMed, Web of Science, Embase, and Cochrane Library from the establishment of each database to February 9, 2026. Quality assessment and analysis were conducted on the included literature.

Results: A total of 7 studies involving 1450 participants were finally included. The results of the meta-analysis showed that advanced age, sarcopenia, and malnutrition were risk factors for oral frailty in MHD patients, while higher grip strength and higher educational level were protective factors.

Conclusion: The factors influencing the occurrence of oral frailty in MHD patients are diverse and complex. In clinical practice, nursing staff should pay attention to the oral health of patients, identify the influencing factors, and implement interventions as early as possible. In the future, a risk prediction model for oral frailty in MHD patients should be constructed and validated to provide further evidence in support of relevant clinical interventions.

Background: Accurate thoracolumbar fracture classification is central to treatment planning, but manual interpretation of CT images can be time-consuming and variable.

Objective: To develop a CT-based deep learning workflow for automated vertebral localization, fracture screening, AOSpine thoracolumbar ABC classification, and Osteoporotic Fracture (OF) grading.

Methods: This retrospective study included 845 spinal CT examinations with expert consensus labels. Total Segmentator was used for vertebral segmentation and level identification. Three-dimensional vertebral CT patches were then processed by cascaded 3D ResNet-18 models. The AOSpine model fused CT image features with four automatically extracted bone-void features: total void volume, void-volume ratio, void count, and maximum void volume. The OF model used a hierarchical multi-head structure for OF1–OF5 grading. Performance was assessed using Dice, level-identification accuracy, accuracy, precision, recall, specificity, F1-score, AUC, average precision, and quadratic weighted kappa.

Results: Total Segmentator achieved a mean Dice coefficient of 0.846 and vertebral level-identification accuracy of 92.22%. The fracture screening model achieved an accuracy of 0.988. For AOSpine ABC classification, the CT plus bone-void model achieved an overall accuracy of 62.5% and macro-F1 of 0.512. For OF grading, the hierarchical CT-only model achieved an accuracy of 0.737, macro-F1 of 0.692, quadratic weighted kappa of 0.639, macro-AUC of 0.894, and macro-AP of 0.767.

Conclusion: The proposed CT-based workflow demonstrated feasibility for automated vertebral segmentation, fracture screening, AOSpine ABC classification, and OF grading. Further multicenter validation is required before clinical deployment.

Herbal medicine has long been characterized by multi-component, multi-target, and multi-pathway therapeutic actions, but its complex mechanisms remain difficult to explain using conventional single-target pharmacology. Network pharmacology provides a systems-level framework for decoding these effects by integrating herbal compound databases, disease-associated gene resources, protein–protein interaction networks, and graph-theoretical algorithms. This review summarizes the most recent advances in herbal network pharmacology, with emphasis on core databases, network topology metrics, hub-target identification, and multiscale interactome analysis. It further discusses how artificial intelligence, especially graph neural networks, knowledge graph embedding, and explainable AI, is improving herb target prediction and mechanistic interpretation. The integration of single-cell transcriptomics, spatial metabolomics, molecular docking, and transfer-learning frameworks has expanded the field from static pathway mapping toward cell-type-specific and spatially resolved systems pharmacology. Despite these advances, major limitations remain, including overreliance on in silico predictions, insufficient wet-laboratory validation, neglect of dose–response relationships, inadequate consideration of pharmacokinetics and physiological barriers, and poor reproducibility caused by extract heterogeneity. Future development should move toward quantitative, dynamic, and experimentally validated systems pharmacology, supported by standardized reporting guidelines and rigorous biophysical, omics-based, and phenotypic validation. Such advances may help transform herbal medicine into a more precise, reproducible, and internationally acceptable therapeutic resource.