Background: Photon-counting detector CT (PCCT) combines high-resolution anatomical and spectral imaging by directly counting individual x-ray photons and discriminating their energies. Its role in surgical planning in complex multi-trauma with concurrent pulmonary embolism remains undefined. Case Presentation: A 58-year-old previously healthy woman was entrapped by a cement mixer, sustaining traumatic scalp avulsion (20 × 20 cm) with exposed skull, depressed right parietal fractures, subdural and epidural hematoma, right 3rd-9th rib fractures, mid-shaft radius and ulna fractures with tendon and radial-nerve injury, and a left maxillary frontal-process fracture. After emergent craniotomy, debridement, open reduction and internal fixation of the forearm, and prolonged immobilization, bilateral soleal vein thrombosis and bilateral segmental pulmonary embolism developed. Before scalp reconstruction, PCCT angiography (NAEOTOM Alpha, Siemens) was performed with cinematic rendering and iodine-density mapping. Mean pulmonary iodine density was 1.82 mg/mL on the right versus 0.74 mg/mL on the left (right-to-left ratio 2.46:1), suggesting relatively preserved iodine distribution on the right and reduced iodine distribution on the left despite bilateral emboli on CTPA. A pedicled fasciocutaneous flap from the right anterolateral thigh was performed under tiered enoxaparin anticoagulation with anti-activated factor X (anti-Xa)-guided dose escalation. The flap survived completely, the donor site healed, and the patient was discharged on day 14 with stable wound coverage. At three-month follow-up she had no recurrent thromboembolism and recovered near-normal right upper-extremity function. Conclusion: PCCT angiography provided an arterial map for reconstructive planning and quantitative iodine maps in a single acquisition, supplementing CTPA with a quantitative surrogate of pulmonary blood-volume distribution. The novelty of this case is the integrated use of a single PCCT examination for vascular mapping and spectral pulmonary iodine assessment in a complex multi-trauma setting, not the demonstration of PCCT superiority over dual-energy CT. Whether this integrated approach changes outcomes compared with dual-energy CT protocols requires prospective comparison.

Positive leadership is frequently associated with work engagement, but it remains unclear whether teachers' perceptions of displayed charismatic leadership behaviors are directly associated with engagement or are linked to it through distinct professional resources. This study examined the indirect associations connecting perceived charismatic leadership with teachers' work engagement through professional efficacy, professional belonging, and professional values.

Primary neuroendocrine carcinoma of the breast is a rare malignancy. Tumors demonstrating predominant neuroendocrine differentiation with focal squamous features are exceptionally uncommon, and metachronous contralateral development following previously treated invasive ductal carcinoma (IDC) has been reported only rarely. We present the case of a 68-year-old woman with a history of estrogen receptor-positive, HER2-negative left breast IDC treated with neoadjuvant chemotherapy, mastectomy, adjuvant radiation therapy, and endocrine therapy who developed a distinct contralateral high-grade breast carcinoma seven years later. Following the discovery of right axillary lymphadenopathy, imaging revealed a right breast mass with progressive axillary adenopathy. Histopathologic examination demonstrated a primary small-cell neuroendocrine carcinoma of the breast with focal squamous differentiation. Immunohistochemistry showed diffuse positivity for INSM1, synaptophysin, and p63, with negativity for estrogen receptor, progesterone receptor, HER2, TTF-1, CDX2, SOX10, and GATA3, supporting a primary breast origin. This case highlights the diagnostic complexity and therapeutic uncertainty surrounding a metachronous contralateral neuroendocrine breast carcinoma following treatment of a separate primary breast malignancy. This exceptionally rare entity underscores the importance of continued case reporting to improve understanding of its clinicopathologic features and guide future management strategies.

A woman in her mid-50s presented with lifelong poor vision and progressive, painless bilateral visual deterioration. Clinical evaluation revealed markedly reduced visual acuity, elevated intraocular pressure, bilateral inferior iris coloboma, zonular laxity, nuclear cataracts, partially closed angles and hypoplastic trabecular meshwork. Sequential phacoemulsification with intraocular lens implantation combined with a 120° goniotomy was performed in both eyes. Intraoperatively, residual embryonic tissue overlying the trabecular meshwork and a diminished red reflex were observed. Postoperatively, the patient experienced rapid improvement in visual acuity and intraocular pressure, with restoration of corneal clarity and wide opening of the anterior chamber angles within 1 week. Fundus examination subsequently revealed an inferonasal choroidal coloboma with retinal vessels traversing the defect. At 1-year, visual acuity remained significantly improved and intraocular pressure was stable without medication, with no complications such as hypotony or retinal detachment. This case demonstrates the safety and efficacy of combined cataract extraction and goniotomy in patients with complex anterior segment anomalies associated with iris and choroidal coloboma.