Background and Objectives: Foot wedges are widely used to modulate ankle alignment in clinical and athletic settings, yet the effects of mediolateral wedge placement on multi-planar lower limb biomechanics during functional unilateral exercises remain poorly characterized. This study aimed to quantify the effects of medial and lateral foot wedge placement on lower limb joint kinematics, muscle activation, and ground reaction forces (GRFs) during the split squat. Materials and Methods: Thirty healthy young adults (12 males, 18 females; 24.5 ± 2.7 years) performed split squats under three randomized conditions using a rigid inclined platform rather than a custom foot orthosis: no wedge (NW), medial wedge (MW), and lateral wedge (LW). Three-dimensional kinematics (Qualisys, 100 Hz), bilateral GRFs (Bertec, 1000 Hz), and surface electromyography (sEMG, 1000 Hz) of the peroneus longus (PL), tibialis anterior (TA), vastus medialis (VM), and vastus lateralis (VL) were recorded synchronously. Repeated-measures ANOVA with Bonferroni post hoc tests and partial eta-squared (η2p) were used (α = 0.05). Results: LW significantly increased PL and VM activation, sagittal-plane range of motion (ROM) at the ankle, knee, and pelvis, and vertical GRF, compared with MW and NW (p < 0.05). MW significantly increased TA and VL activation and reduced sagittal hip ROM (p < 0.05). No significant differences were observed for mediolateral or anteroposterior GRF. Conclusions: Mediolateral foot wedge placement acutely reorganizes lower limb neuromuscular recruitment, joint kinematics, and vertical ground reaction force during the split squat in healthy young adults. These preliminary findings indicate that wedge orientation, applied via a rigid inclined platform, can acutely and selectively modulate muscle activation patterns; any therapeutic or performance applications, however, were not evaluated here and should not be generalized to conventional clinical orthoses without further investigation.

We report a rare case of simultaneous well-differentiated papillary mesothelial tumor (WDPMT) and multicystic mesothelioma. The concurrent occurrence of these entities is exceptionally uncommon and may pose challenges during surgical intervention. Both lesions are rare mesothelial proliferations that are often identified incidentally during surgery. Well differentiated papillary mesothelial tumor (WDPMT) is a neoplastic mesothelial proliferation of low malignant potential, which predominantly involves the peritoneum of young women. Microscopically it is composed of branching plump papillae lined by a single layer of bland cuboidal mesothelial cells. Cytologic atypia is minimal, and mitoses usually absent (or at most 1 mitosis per 10 high power fields). Differential diagnosis includes: 1. diffuse malignant peritoneal mesothelioma, 2. localized malignant peritoneal mesothelioma, 3. serous borderline tumors. A 41-year-old patient was admitted for laparoscopic surgery due to a tumor mass localized near the left ovary. Ultrasound examination revealed solid lesion adjacent to the left ovary, exhibiting central vascularization. The patient was diagnosed with the solid tumor mass during routine gynecological examination. The mass was extraovarian and positioned between the left ovary and the uterus. Over the course of the next 18 months, the tumor increased 5 cm in size. Given the fact that the patient presented with no symptoms, such as abdominal pain, distension or ascites, and that the tumor markers were not elevated, additional radiological imaging such as CT or MRI of the abdomen and pelvis was not performed. Intraoperatively, the mass appeared as an extraovarian solid tumor of soft consistency positioned between the left ovary and the uterus. Extirpation of the tumor was performed. Frozen section analysis of the extirpated tumor mass confirmed the diagnosis of WDPMT. During the laparoscopic procedure, a left adnexectomy was also performed and multiple biopsies of white nodules were found dispersed in the peritoneal cavity. Final patohystological analysis concluded that these nodules were peritoneal inclusion cysts. Almost three years after the procedure, the patient is without symptoms and regular clinical and ultrasound examinations were performed every six months, which showed no signs of recurrence or dissemination of the primary tumor. Recognizing well-differentiated papillary mesothelial tumor and multicystic mesothelioma is critical for accurate differential diagnosis from malignant mesothelioma. Awareness of these entities informs appropriate surgical management and follow-up protocols.

Preoperative decision-making regarding extended pelvic lymph node dissection (ePLND) in prostate cancer remains challenging. Existing nodal-risk prediction tools are mainly based on clinicopathologic variables and may show suboptimal performance across different clinical settings. This study aimed to develop and temporally validate a preoperative prediction model for pathological pelvic lymph node metastasis (pN1) by integrating clinicopathologic and 68Ga-PSMA PET/CT-derived features in a single-center Chinese surgical cohort. In this single-center retrospective study, consecutive patients with prostate cancer who underwent robot-assisted radical prostatectomy with ePLND and preoperative 68Ga-PSMA PET/CT were screened. Of 617 patients assessed for eligibility, 315 met the final analytic criteria. Patients treated from 2020 to 2024 formed the development cohort (n = 210), and patients treated in 2025 served as an independent temporal validation cohort (n = 105). Two elastic net regularized logistic regression models were developed using preoperative variables: a clinicopathologic model and an integrated model combining clinicopathologic and PSMA PET/CT-derived features. Internal robustness was assessed using 50 repeated stratified random splits of the development cohort. Final locked models were then applied, without re-tuning, to the temporal validation cohort. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration, Brier score, and decision curve analysis. The Memorial Sloan Kettering Cancer Center (MSKCC) model was evaluated as a benchmark. In the development cohort, 57/210 (27.1%) patients had pathologically confirmed pN1 disease, compared with 27/105 (25.7%) in the temporal validation cohort. Across 50 repeated stratified splits in the development cohort, the clinicopathologic model achieved a mean test AUC of 0.910 (SD 0.029), whereas the integrated model achieved a mean test AUC of 0.962 (SD 0.022). In the temporal validation cohort, the clinicopathologic model achieved an AUC of 0.877 (95% CI 0.799-0.955), whereas the integrated model achieved an AUC of 0.943 (95% CI 0.898-0.989). The integrated model showed sensitivity of 0.852, specificity of 0.897, negative predictive value of 0.946, accuracy of 0.886, and a Brier score of 0.080. Calibration was acceptable, with more favorable calibration for the integrated model than for the clinicopathologic model. Decision curve analysis showed greater net benefit for the integrated model than for both the clinicopathologic model and the MSKCC benchmark across most clinically relevant threshold probabilities. In this single-center Chinese surgical cohort, an elastic net model integrating clinicopathologic and 68Ga-PSMA PET/CT-derived features showed favorable performance for preoperative pN1 prediction, including in temporal validation. Compared with a clinicopathologic model alone and a locally implemented MSKCC benchmark, the integrated model showed more favorable discrimination and potential clinical utility. Multicenter external validation is required before broader clinical application.

Morel-Lavallée lesions (MLLs) are closed soft-tissue degloving injuries most often reported in the pelvis and lower extremity after high-energy shear trauma. Upper extremity (UE) involvement is exceedingly rare and frequently misdiagnosed as cellulitis or abscess. We report a 49-year-old Black male with a history of psychiatric disorders and intravenous drug use (IVDU) who presented to the Hospital of Central Connecticut's Emergency Department (ED) with a swollen, erythematous, and painful right forearm one week after blunt trauma. Contrast-enhanced computed tomography (CT) was inconclusive, but ultrasonography demonstrated a 20-cm unencapsulated suprafascial fluid collection. Magnetic resonance imaging was not obtained, given the emergent presentation requiring urgent intervention. Empiric intravenous vancomycin and piperacillin-tazobactam were initiated, and within 12 hours, spontaneous drainage confirmed infection and prompted urgent incision, drainage, and wide debridement, which established the definitive diagnosis. Intraoperative findings revealed a shearing-induced hematoma with overlying necrotic tissue, and pathology was consistent with an infected MLL. Given the large defect, marginal wound bed viability, and the patient's refusal of split-thickness skin grafting (STSG) due to concerns about donor-site morbidity, a dermal allograft skin substitute was used to provide immediate coverage without graft harvest. The substitute integrated successfully, and longitudinal follow-up demonstrated progressive epithelialization with durable closure. This case expands the limited literature on UE MLLs by illustrating how delayed history, atypical anatomy, and equivocal imaging can obscure diagnosis and delay definitive care. Forearm MLLs may closely mimic cellulitis or abscess, underscoring the importance of maintaining diagnostic suspicion for closed degloving injuries in patients presenting with post-traumatic UE swelling. Once infection and necrosis are evident, timely surgical intervention is essential to achieve source control and preserve soft-tissue viability. Management should be individualized based on lesion characteristics and patient-specific risk factors. In this case, use of a dermal allograft provided durable closure in a high-risk patient who declined STSG, demonstrating a viable reconstructive alternative. Early recognition and tailored operative strategy are critical to reducing morbidity in anatomically uncommon presentations such as the forearm.

Morel-Lavallée lesions are closed, shearing injuries that occur in polytrauma patients, most commonly affecting the thigh, hip, and pelvis due to mobile skin over thick fascia. These lesions are often missed upon initial evaluation due to the severity of accompanying traumatic injuries and the focus on life-threatening conditions. We present a case of a missed Morel-Lavallée lesion in a Level 1 trauma patient and our innovative approach to treatment. A 36-year-old female patient was air-transported to the emergency department after a motorcycle accident, where she was struck by a vehicle. She arrived intubated with a Glasgow Coma Scale of 3, sustaining a skull fracture and multiple injuries requiring exploratory laparotomy and fracture fixation. Amidst these critical injuries, a Morel-Lavallée lesion in the right anterior-medial thigh was overlooked. On hospital day 10, the patient developed increasing pain and swelling in her right thigh, prompting further evaluation. A computed tomography (CT) scan revealed the Morel-Lavallée lesion. The lesion, now with an eschar, was managed with serial washouts, debridements, and wound vacuum-assisted therapy. Persistent pain and inflammation necessitated surgical intervention, revealing dermal and subcutaneous defects. Treatment included split-thickness skin grafts, autologous skin harvesting, autografts, and dermal substitute application, followed by vacuum-assisted closure. The patient underwent a final wound washout three weeks later before discharge to rehabilitation. This case highlights how Morel-Lavallée lesions are easily missed in the acute setting due to the prioritization of life-threatening injuries. Recognizing and managing these lesions is crucial to preventing complications such as infection and skin necrosis. This case provides insight into both operative and non-operative innovative treatment strategies for these complex soft tissue injuries.

Accurate identification of anatomical landmarks on three-dimensional (3D) pelvic surface scans is essential for musculoskeletal assessment, yet manual procedures remain limited by operator dependence and soft tissue variability. This study presents a fully automated deep learning pipeline for localizing anatomical landmarks on the posterior pelvic region from raw 3D point cloud data. The pipeline integrates three modules: PelvicROINet for extracting the region of interest, PelvicAlignNet for rotation correction to standardize posture, and PelvicLandmarkNet for localizing six anatomical landmarks including the bilateral posterior superior iliac spines, bilateral iliac crests, L1, and L4. The models were trained independently with task-specific annotations and combined sequentially during inference. Under a subject-level split evaluation setting, the fully integrated system achieved a median error of 11.25 mm, demonstrating consistent localization performance across unseen subjects. Compared with manual landmark marking, the automated measurements showed improved within-visit repeatability, with reduced variability and higher intraclass correlation coefficients. The entire inference process required approximately three seconds per scan, supporting near real-time clinical applicability. These results indicate that the proposed modular framework enhances numerical consistency and robustness in surface-based pelvic landmark assessment and provides a scalable foundation for AI-assisted musculoskeletal evaluation and longitudinal monitoring.

Nail-patella syndrome (NPS) is an uncommon autosomal dominant condition marked by nail dysplasia, skeletal abnormalities, and variable renal manifestations, resulting from mutations in the LMX1B gene. We report a rare case of a 23-year-old male presenting with nephrotic-range proteinuria, characteristic skeletal manifestations of NPS, and a family history of renal failure. Genetic testing identified a previously unreported heterozygous missense variant in the homeodomain of LMX1B (c.791A>C; p.Gln264Pro), supporting its pathogenicity. The absence of patellar hypoplasia in our patient highlights the phenotypic variability of NPS. This case reinforces the importance of detailed physical examination and targeted genetic testing in diagnosing nephrotic syndromes.