Malocclusions involving the maxillary canine teeth are common in brachycephalic dogs and may require active force orthodontics. Orthodontic anchorage is influenced by root surface area (RSA), yet the RSA of orthodontically important teeth has not been quantified in brachycephalic dogs. The objectives were to quantify the RSA of the maxillary canine, fourth premolar (PM4), and first molar (M1) teeth using cone-beam computed tomography (CBCT), compare the canine RSA with the PM4, M1, and combined PM4 + M1 RSAs, and evaluate the relationship of body weight to these ratios. A retrospective observational study was performed using CBCT scans from 68 brachycephalic dogs (119 dental arcades). Teeth were segmented, and RSA was calculated. Dogs were grouped by body weight (<10 kg, 10-25 kg, >25 kg), and RSA ratios were compared between weight classes. All dental arcades (119/119, 100%) had a canine-to-combined PM4 + M1 RSA ratio (C:PM4 + M1) of less than 1. The canine-to-PM4 ratio was less than 1 in 61.35% of arcades, whereas the canine-to-M1 ratio was less than 1 in 1.68% of arcades, all in dogs weighing <10 kg. Body weight was positively associated with the C:PM4 + M1 ratio (P = .0006); however, the ratio remained less than 1 in all arcades. Small dogs had significantly lower C:PM4 + M1 ratios than medium (P = .006) and large dogs (P = .03). These findings support the use of the maxillary PM4 and M1 as a reinforced anchorage unit for orthodontic movement of the maxillary canine tooth in brachycephalic dogs.

Coronary Artery Disease (CAD) remains a significant worldwide health problem, making accurate evaluation of disease severity essential for treatment planning. The SYNTAX score, derived from X-ray coronary angiography (XCA) images, plays a key role in guiding treatment decisions. However, manual scoring is time-consuming, subject and prone to inter-observer variability, necessitating the development of an objective and reliable system. We proposed VMamba-QAG-Net, a novel five-stage pipeline designed for SYNTAX score estimation directly from XCA images. Stage 1 performs binary vessel segmentation to resolve extreme class imbalance, using a preprocessing of Bilateral Filtering, CLAHE, and Unsharp Masking to enhance vessel boundaries, an EfficientSS2D block with parallel five direction visual mamba scanning and Quantum Attention Gate (QAG) to preserve long-range vascular connectivity. Stage 2, executes multi-class anatomical labelling into 27 distinct coronary artery segments using a four-channel guided input, supported by a Vessel Prototype Memory Bank with metric learning and a centreline-weighted skeleton loss for thin distal structures. Stage 3 and 4 extract ordered vessel centrelines via skeletonization, calculates percentage diameter stenosis through perpendicular ray casting, and detects grade stenotic lesions, using Aquila Optimiser. Stage 5 combines the stenosis information to calculate the SYNTAX score and support treatment decisions in revascularisation. Our proposed model was evaluated on the ARCADE dataset and attained a Dice coefficient of 0.9070 and accuracy of 0.9841 for binary segmentation. For 27-class coronary artery segmentation achieved a Dice coefficient of 0.7512, accuracy of 0.9514, and present class Dice of 0.8214. These results demonstrate the effectiveness of the proposed framework and its potential to support cardiologists in clinical decision-making.

Aneurysms of the pancreaticoduodenal arcade are uncommon visceral artery aneurysms that are strongly associated with stenosis or occlusion of the celiac axis and that may rupture irrespective of size. Rupture produces a peripancreatic or retroperitoneal hematoma, and duodenal stenosis is a recognized sequela; biliary complications have rarely been reported. An 84-year-old man admitted with an acute Stanford type B aortic dissection with a thrombosed false lumen was managed conservatively with strict blood pressure control. Surveillance non-contrast computed tomography (CT) on day 7 incidentally showed a periduodenal hematoma, absent on day 5, in a patient who had no abdominal pain. Contrast-enhanced CT on day 8 demonstrated a 5-mm aneurysm of the anterior inferior pancreaticoduodenal artery (AIPDA) adjacent to the hematoma, together with severe celiac origin stenosis. The same narrowing was present on the day 0 study, as demonstrated on retrospective review. Coil embolization on day 12 occluded the aneurysm, and the arcade remained patent, maintaining collateral blood flow to the liver; the celiac origin stenosis was not treated. Postprandial vomiting began on day 16, and imaging on day 19 confirmed high-grade stenosis at the distal descending duodenum. He was managed with nasogastric decompression and parenteral nutrition, and endoscopy showed a short, tight stenosis of extrinsic appearance with normal mucosa. On day 37, he developed septic shock with direct-predominant hyperbilirubinemia, and CT showed a dilated biliary tree with severe narrowing of the common bile duct at the level of the coils. According to the Tokyo Guidelines 2018, grade III acute cholangitis was diagnosed, and an endoscopic nasobiliary drainage catheter was placed without sphincterotomy; blood and bile grew extended-spectrum beta-lactamase-producing Escherichia coli. The duodenal stenosis improved sufficiently for an oral elemental diet on day 45 and a full oral diet on day 47, and he was discharged home walking unaided on day 60. Rupture of an AIPDA aneurysm may be painless, although this is not the usual presentation, and may be detected only on surveillance imaging; severe cholangitis may follow in a patient with a persistent periduodenal hematoma and duodenal obstruction. Both complications were managed nonoperatively.

Transcatheter arterial embolisation is an established treatment for visceral pseudoaneurysms and pancreaticoduodenal arcade embolisation is generally well tolerated because of rich collateral flow. We report a man in his 70s with metastatic rectal cancer previously treated with bevacizumab who developed duodenal perforation and retroperitoneal abscess 15 days after embolisation of an inferior pancreaticoduodenal artery pseudoaneurysm using coils and adjunctive N-butyl cyanoacrylate-Lipiodol. He improved with broad-spectrum antibiotics, CT-guided drainage and conservative management, avoiding emergency surgery. The course is compatible with a multifactorial process in which procedure-related local ischaemic stress, altered collateral reserve, prior surgical alteration of regional vessels and impaired tissue repair after prior bevacizumab and recent fruquintinib exposure may have contributed. Pancreatic inflammation or leakage was not confirmed but remains a possible alternative or interacting mechanism. Causality cannot be established from a single case.

This essay explores the role of visual images in dream imagery as a space where unconscious processes intersect with historical forces. It offers a comparative reading in Freud's Interpretation of Dreams (1900) and Benjamin's Arcades Project (1982). Freud conceptualizes dream images as condensed memory traces that navigate between perception and hallucination, revealing repressed desires. Conversely, Benjamin's dream images critique modernity's loss of aura, offering moments of "Now-Time" as opportunities for historical creation. The essay argues that both Freud and Benjamin share a foundational premise: turning a blind eye to the obscure and unknown dimensions of individual and collective experience fosters crises and destruction, whereas striving to reveal these hidden areas promotes transformation. Exploring disruptions and ruptures in the continuity of experience challenges the inclination to act according to Freud's concept of repetition compulsion or Nietzsche's eternal return, as interpreted by Benjamin. These ideas are explored through the dream of the burning child presented by Freud and the ghost dream presented by Benjamin. The dialectic of insight and blindness, alongside the image of open doors in both dreams, invite us to consider how, even amidst loss and rupture, dream images can open pathways to new realms of experiencing and remembering.

Background: Anastomotic leak (AL) is a major complication after esophagectomy, and gastric conduit perfusion is considered a key determinant of anastomotic integrity. Indocyanine green (ICG) fluorescence angiography is increasingly used for intraoperative perfusion assessment, although its clinical effect remains uncertain. We evaluated whether routine implementation of ICG assessment was associated with a lower incidence of AL compared with a historical no-ICG cohort, and explored intraoperative factors potentially associated with AL. Methods: Single-center before-after cohort study of consecutive adults undergoing Ivor-Lewis esophagectomy for cancer between January 2023 and December 2025, using a prospectively maintained database. ICG entered routine practice in March 2025, defining a historical no-ICG cohort and an ICG cohort. ICG (2 mL of a 25 mg/10 mL solution) was administered at three intraoperative timepoints; time to fluorescence (TTF), arcade-conduit fluorescence pattern, arterial blood gas values, and hemodynamic parameters were recorded. AL was defined according to Esophagectomy Complications Consensus Group criteria. Results: Sixty patients were included (ICG, n = 17; no-ICG, n = 43). AL occurred in 4/17 (23.5%) versus 5/43 (11.6%) patients (odds ratio 2.34, 95% CI 0.54-10.05; p = 0.256). Overall postoperative morbidity, conduit necrosis, pulmonary and infectious complications, reintubation, and 90-day mortality did not differ; a single death occurred, in the no-ICG cohort. All TTF values were below 60 s (range 23-46 s) and did not differ between patients with and without AL, nor did the fluorescence pattern; ICG never modified the planned anastomotic site or prompted additional conduit resection. Exploratory within-ICG analyses showed lower thoracic-phase PaO2 and PaCO2 and higher pH in patients who developed AL. Conclusions: Routine qualitative ICG assessment of gastric conduit perfusion was feasible; however, this small before-after cohort was insufficient to determine its effect on AL. Larger studies using standardized quantitative fluorescence assessment are required.

Esophageal reconstruction becomes necessary whenever the continuity of the alimentary tract between the pharynx and stomach is lost and cannot be restored by direct anastomosis. This occurs after esophagectomy for adenocarcinoma or squamous cell carcinoma, after resection for corrosive injury, when a stricture from prior radiation or caustic injury is refractory to endoscopic dilation, and when a congenital esophageal defect, most often long-gap esophageal atresia, cannot be repaired primarily without excessive anastomotic tension. The esophagus lacks a serosal layer and depends on a segmental, watershed blood supply from the inferior thyroid, bronchial and aortic esophageal, and left gastric arteries; this limits how much of the esophagus can be mobilized and reanastomosed directly, which is why a substitute conduit or flap is often required rather than simple end-to-end repair. The gastric conduit, tubularized along the greater curvature and based on the right gastroepiploic pedicle, is the default reconstructive option after esophagectomy because it requires only a single anastomosis and reliably reaches from the abdomen to the neck on a single vascular pedicle. When the stomach is unavailable, whether from resection, disease, or prior gastric surgery, colon interposition based on the right or left colic vascular arcade provides an alternative conduit of adequate length. Free tissue transfer, using jejunum, radial forearm, or anterolateral thigh flap, is reserved primarily for segmental defects of the cervical esophagus and hypopharynx, where a gastric or colonic conduit may not reach the neck without tension; pedicled local flaps such as the pectoralis major or supraclavicular island flap remain useful when free tissue transfer is contraindicated. Conduit selection depends on defect length and location, prior abdominal or thoracic surgery, and the availability of suitable donor vessels.

The inferior mesenteric artery (IMA) arises from the abdominal aorta a few inches inferior to the origin of the superior mesenteric artery (SMA). After originating at the level of the 3rd lumbar vertebra (L3), the IMA courses slightly lateral to the abdominal aorta, posterior to the 3rd part of the duodenum. Embryologically, the IMA supplies the hindgut, which comprises the distal portion of the intestinal tract. The hindgut consists of the distal 1/3 of the transverse colon, descending colon, sigmoid colon, and superior segment of the rectum. The IMA classically terminates in 3 branches. From proximal to distal, these branches are the left colic, sigmoid, and superior rectal arteries. Arterial arcades carry blood from the IMA branches to the colon. See "Anatomy, Abdomen and Pelvis: Superior Mesenteric Artery" for further information. The marginal artery of Drummond is a collateral pathway connecting the superior and inferior mesenteric arterial systems. The anastomotic network begins with the ascending branch of the ileocolic artery, the inferior-most branch of the SMA. The ileocolic artery connects with the right colic artery through the ascending and descending branches of the right colic artery. The network also connects with the right and left branches of the middle colic artery, the ascending and descending branches of the left colic artery, and the sigmoid branches of the IMA, which terminate in the superior rectal artery. The marginal artery often courses close to the bowel wall or within the mesentery. Less than 50% of the population has a fully continuous collateral network around the splenic flexure, known as Griffith point. Collateral insufficiency between the left branch of the middle colic artery and the ascending left colic artery may result in colonic ischemia when bowel surgery disrupts collateral circulation or occlusive disease restricts arterial blood flow. Further anastomosis occurs through the arc of Riolan, also known as the meandering artery. When present, the pathway connects the middle colic artery of the SMA with the left colic artery of the IMA. This collateral supply has surgical relevance in endovascular aneurysm repair. Collateralization through the arc of Riolan provides an important pathway for coil embolization of type II endoleaks.

Atherosclerosis, a chronic vascular disorder caused by the abnormal functioning of blood vessels, remains a major contributor to cardiovascular diseases. Although recent advances in machine learning and deep learning have improved atherosclerosis classification, several critical challenges persist, particularly class imbalance, high computational complexity, limited interpretability, and poor generalisation, which constrain their clinical utility. To address these limitations, this paper proposes a novel Memory-Aware Fractional optimisation-assisted Knowledge-distilled mutual-conditioned dynamic Transformer-enabled Convolutional neural network-bidirectional long short-term Memory (MemAF-KTCBM) framework that employs knowledge distillation and mutual information fusion to reduce computational complexity while preserving classification performance. Initially, coronary artery structures are segmented using a memory-aware fractional optimisation-enabled Modified Pyramid Scene Parsing Network to improve classification reliability. Furthermore, a Memory-Aware Fractional optimisation-enabled Style Generative Adversarial Network is employed to generate high-quality synthetic angiographic images, thereby mitigating class imbalance and reducing prediction bias. In addition, pretrained local descriptors are incorporated to enhance feature extraction, interpretability, and classification reliability. The proposed framework is evaluated using the ARCADE and CADICA datasets using multiple training percentages and 10-fold cross-validation. On the ARCADE dataset, the MemAF-KTCBM model achieved an accuracy of 97.53%, a precision of 97.82%, a recall of 96.94%, an NPV of 0.97, a PPV of 0.98, and an MCC of 0.95. Similarly, on the CADICA dataset, it attained an accuracy of 96.65%, a precision of 96.94%, a recall of 96.07%, an NPV of 0.97, a PPV of 0.97, and an MCC of 0.94. These findings confirm that the proposed framework acts as a robust and effective solution for atherosclerosis classification across heterogeneous atherosclerosis datasets.