Felines are susceptible toLeishmaniaspp. infection in endemic areas; however, histopathological studies on the organs of infected felines remain scarce. This study evaluated the inflammatory response and cutaneous parasitism in 13 naturally infected felines in Teresina, Piauí, Brazil. After diagnosis, the animals were euthanized, and skin fragments from the face, external ear, periocular region, muzzle, and dorsum were histopathologically analyzed. The cytology of the ear skin revealed amastigote forms ofLeishmaniaspp. in 84.62% of the felines, with this region being the most parasitized. The inflammatory infiltrate was mild-to-moderate in 38.5%, with a diffuse distribution in 77% of cases. Mononuclear cells predominated in 92%, while polymorphonuclear cells were rare (8%). Amastigote forms were discrete in 46%, and 46% presented with granulomatous dermatitis. The main epidermal changes were exocytosis (92.5%), acanthosis, and spongiosis (61.5%). These findings highlight the importance of histopathology as a diagnostic tool and contribute to the understanding of the pathogenesis of feline leishmaniasis, aiding in the development of diagnostic and therapeutic research.

Despite advances in the management of head and neck squamous cell carcinoma (HNSCC), mortality within 6 months of diagnosis remains a substantial clinical challenge. The objectives of this study are: (i) to develop a machine learning (ML) model using data from the Surveillance, Epidemiology, and End Results (SEER) program to assess the influence of patient characteristics, tumor features, and treatment modalities on early mortality in HNSCC; (ii) to explore and compare the prognostic potentials of patient-, tumor, and treatment-related factors across distinct mortality time points-6-month mortality (early mortality), 24-month mortality, and 5-year mortality; and (iii) to externally and independently validate the early mortality model using multicenter data from the Thuringian Cancer Registry (Jena, Germany) and a prospective observational cohort from the Helsinki University Hospital (Helsinki, Finland). We identified 4802 patients with HNSCC from the SEER for model development. Permutation-based feature importance was used to identify risk factors associated with early mortality. External validation was conducted using 1952 cases from the Thuringian Cancer Registry and 58 cases from the Helsinki University Hospital. The ML model achieved a weighted area under curve (AUC) of 0.75 for predicting early mortality in the SEER cohort. External validation yielded weighted AUC values of 0.70 (Germany) and 0.60 (Finland). Aggregate feature importance for early mortality indicated that higher age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, unmarried patients with T1-T3 HNSCC, T3 stage, and having hypopharyngeal or laryngeal cancer, in decreasing order of significance, were important. For 24-month mortality, the associated risk factors in decreasing order of significance were T3 stage, being elderly in terms of age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, having hypopharyngeal or oral cavity cancer, and N3 stage. The associated risk factors for 5-year mortality were found to be the same with those of early mortality with the additional inclusion of T2 stage. Identification of patients at elevated risk of early death supports timely intervention and individualized therapeutic decision-making. The developed ML model identified several risk factors associated with early death and may aid in clinical decision-making with the potential to improve survival outcomes.

Ménière's disease (endolymphatic hydrops) is a multifactorial syndrome affecting the inner ear, typically distinguished by attacks of variable frequency which include vertigo, aural fullness, tinnitus, and fluctuating hearing loss. Red ear syndrome is characterized by paroxysmal erythema of the external ear, either unilaterally or bilaterally, with pain, burning sensation, and/or swelling. Both conditions have complex and heterogeneous etiologies. Ménière's disease and red ear syndrome have not previously been associated in the literature, yet they can have overlapping characteristics. This case describes the co-occurrence of Ménière's disease and red ear syndrome in the right ear of a 43-year-old female patient. It highlights the potential association between the two conditions and proposes possible pathophysiological mechanisms linking them, including atypical migraine, autonomic dysregulation, vascular permeability, and hormonal factors.

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) serves as an advanced extracorporeal life support modality capable of totally or partially substituting pulmonary gas exchange function. It is indicated for severe acute respiratory distress syndrome, chronic obstructive pulmonary disease, and bridging therapy prior to lung transplantation. Currently, the fixation of the internal jugular vein catheter for ECMO mainly relies on transparent dressings supplemented by secondary securing with ties. However, this method has drawbacks such as insecure fixation, susceptibility to catheter displacement, and the risk of inducing device related pressure injuries. To address the aforementioned issues, research team from the Department of Critical Care Medicine, Zhongda Hospital, Southeast University, developed a novel neck catheter fixation device for ECMO, which was granted a national utility model patent (Patent number: ZL 2021 2 1130686.8). The device consists of two main components: a head fixation strap and a catheter fixation device. The head immobilization strap comprises a frontoparietal strap, a circumferential fronto-occipital strap, and a mandibular strap. These components utilize Velcro to achieve three-dimensional force equilibrium, thereby preventing overall slippage. The tube fixation module consists of a fixation patch and an anti-slip silicone pad. By employing a hook and loop fastener in combination with the anti slip silicone pad and wrapping the catheter with a fold back locking strap, the device achieves effective fixation of the catheter. The catheter fixation unit is positioned posteroinferior to the auricle and is equipped with a dual-locking structure (U-shaped strap combined with an anti-slip silicone clip). This design allows bidirectional fixation of the catheter, helping to prevent catheter dislodgement, alleviate local skin compression, and reduce the risk of catheter related bloodstream infection. The device is easy to operate, can be repeatedly disinfected and reused, and demonstrates good clinical application prospects.

Connective tissue diseases comprise a spectrum of autoimmune disorders characterized by chronic inflammation and immune-mediated injury affecting the skin, vasculature, cartilage, and internal organs. The external ear, owing to its unique composition of elastic cartilage, thin dermis, and end-arterial vasculature, represents a visible and diagnostically informative site of connective tissue disease involvement. Auricular lesions may manifest as erythematous chondritis, purpura, necrosis, nodules, or sclerotic plaques, often providing dermatologists with early clinical clues to systemic disease. This review focuses on the dermatologic and histopathologic features of ear involvement in connective tissue diseases, including relapsing polychondritis, systemic lupus erythematosus, rheumatoid arthritis, granulomatosis with polyangiitis, levamisole-adulterate-cocaine-associated anti-neutrophil cytoplasmic antibody vasculitis, dermatomyositis, systemic sclerosis, Cogan syndrome, and mixed connective tissue disease. Although audio-vestibular dysfunction may accompany these diseases, the emphasis here is on the cutaneous, vascular, and chondral manifestations visible to dermatologists,with correlation of the histopathology with clinical morphology. Enhanced recognition of auricular signs can facilitate earlier diagnosis, guide biopsy, and prompt appropriate multidisciplinary evaluation.

Osteosarcoma of the head and neck is an uncommon malignancy with heterogeneous clinical and radiological presentations, often leading to diagnostic challenges. Its occurrence during pregnancy further complicates management due to the need to balance maternal and fetal outcomes. We report the case of a 23-year-old pregnant woman who initially presented with right-sided otalgia, managed as otitis externa. She subsequently developed a rapidly progressive, highly vascular mass protruding through the external auditory canal, associated with conductive hearing loss and vestibular symptoms. Magnetic resonance imaging revealed an aggressive lesion involving the external auditory canal, middle ear, and mastoid air cells and extending to the dura of the middle and posterior cranial fossae. An initial biopsy performed at 17.5 weeks of gestation was suggestive of cholesteatoma. However, due to clinical progression, surgical resection via mastoidectomy was performed. Definitive histopathological analysis revealed a high-grade spindle cell and epithelioid sarcoma with osteoid formation, consistent with osteosarcoma. The patient developed early recurrence with intracranial progression, requiring multidisciplinary management. Radiotherapy was initiated at 28 weeks of gestation, followed by termination of pregnancy at 29 weeks due to maternal oncologic progression and oligohydramnios. Systemic chemotherapy was subsequently administered, achieving a partial response. In our case, the lesion was initially approached as a benign otologic condition, which delayed definitive diagnosis despite imaging findings suggestive of aggressive disease. Both clinical evaluation and initial histopathological assessment failed to establish the correct diagnosis. This case also underscores the complexity of oncologic decision-making during pregnancy and the critical importance of a multidisciplinary approach.

Diabetic populations are predisposed to atypical, or sometimes silent, responses to myocardial ischemia. This is often the result of chronic neuropathy involving the nociceptive sympathetic pathways of the heart that converge at the T1-T4/5 spinal columns. When these signals are blunted, ischemic pain signals may be delivered via the "Arnold's nerve," the auricular branch of the vagus that innervates the external auditory canal. A 70-year-old woman with a history of type 2 diabetes (diagnosed 14 years before presentation), hypertension, hyperlipidemia, and chronic obstructive pulmonary disease presented to the urgent care for a 24-hour history of left ear pain. Following a negative otoscopic exam, she was advised to apply warm compresses and use Tylenol. The subsequent day, she developed intractable nausea, vomiting, and generalized weakness. Emergency medical services were notified and en route identified an acute inferior ST-elevation myocardial infarction (STEMI) via 12-lead electrocardiogram. Emergent left heart catheterization revealed total right coronary artery occlusion, which resolved after deployment of two drug-eluting stents. Her symptoms of left ear pain and nausea resolved postintervention, and she was discharged the following day. This case thus underscores an exceedingly rare but critical anginal equivalent in diabetics, left otalgia.

Proteomics represents a powerful but underutilized approach for characterizing eye aging. Here, leveraging data from three large-scale, cross-national cohorts of over 55,000 transethnic participants, we demonstrate the ability of high-throughput proteomics combined with deep learning (DL) phenotyping to track eye aging and disease in both discovery and external validation settings. Proteomic aging driven by machine learning modeling closely aligns with signals of eye aging and DL aging phenotypes. We identifiy and validate premature proteomic aging in individuals with major age-related eye diseases (AREDs), including cataract, diabetic retinopathy, age-related macular degeneration, and glaucoma, and propose evidence supporting proteomic aging acceleration as a robust biomarker for predicting these conditions beyond chronological age, with adaptability across sexes and ethnicities. We also develop a streamlined, cost-effective proteomic aging clock that preserves predictive performance while reducing assay complexity. By integrating advanced tomographic and angiographic imaging, we derive structural and functional biomarkers through DL-driven pipelines and link accelerated proteomic aging to both neuroretinal degeneration and microvascular rarefaction in the Guangzhou Diabetic Eye Study (GDES) and the High-definition Oculo-Phenomic Evaluation (HOPE) study, highlighting coupled neural-vascular decline in eye aging. Our findings position proteomic aging combined with AI as a scalable tool for tracking eye health and disease, and provides new insights into shared aging pathways underlying multiple ocular pathologies.

Skin diseases of the external ear (auricle and external auditory canal) are not uncommon. The major findings include erythema, pain, edema, discharge, pruritus, and changes in the shape of the ears. Infectious diseases are quite common in infants and children, inflammatory diseases are more prevalent in adolescents and adults, while keratinocytic malignancies increase by age. The dermatologist can serve as a pilot for patients with dermatoses of the outer ear. When there are discharge and pain, collaboration with specialists for ear, nose, and throat is recommended. In case of infants and children, collaboration with pediatrics is recommended. Whenever a malignancy is suspected, a skin biopsy for histopathologic study is crucial. In any patient with discharge, microbiologic and mycologic investigations should be performed. For the best outcome, a multidisciplinary approach is the optimum. Early diagnosis and efficient treatment are the cornerstones of a good prognosis and the best way to limit complications.

Chronic inflammatory skin disorders cover both frequent and rare dermatoses. The etiopathology of these diseases is broad and ranges from genetic factors to environmental and life-style issues. In this review, we focus on affections of the auricle by the eczema group, psoriasis, and pityriasis rubra pilaris, autoimmune disorders like relapsing polychondritis and cutaneous lupus erythematosus, and juvenile spring dermatosis. The anatomy of this particular region may alter the clinical presentation, course and treatment options for those skin disorders. Atopic dermatitis, seborrheic dermatitis, and psoriasis may be indistinguishable from the clinical point of view. A careful medical history and examination of the whole skin may be the clue for diagnosis. In difficult cases, histopathology is essential. Epidemiologic data, etiopathology, diagnostic criteria, and treatment modalities are discussed. Knowledge of these manifestations on the outer ear are of importance not only for dermatologists, but general practitioners, pediatricians and Ear-Nose-Throat specialists to avoid unnecessary diagnostics, misdiagnoses, and delay in treatment.

The external ear presents unique challenges in dermatosurgery due to its complex three-dimensional anatomy, aesthetic significance, and status as a high-risk "H-zone" for sun-induced malignancies. We present a guide for managing auricular lesions, encompassing essential anatomy, pathology, and reconstructive strategies. We discuss a wide range of conditions, including malignant (basal cell carcinoma, squamous cell carcinoma, melanoma), premalignant (actinic keratosis, Bowen's disease), and benign (keloids, chondrodermatitis nodularis helicis chronicus) lesions. Surgical principles prioritize functional integrity, such as maintaining support for eyewear or hearing aids, and aesthetic balance. Dermatosurgeons should be familiar with appropriate techniques for tumor removal and reconstruction. In the surgical removal of skin lesions (excision), anatomic considerations and specific characteristics of the lesion are crucial for the healing process, functionality, and aesthetic outcome. The planning considers the type of lesion, its location, and skin tension. The surgical ladder ranges from primary closure and secondary intention to skin grafts and local flaps. Postoperative wound care is essential for best possible outcome. In several cases, complexity of the auricle warrants a multidisciplinary approach, integrating dermatology, otolaryngology, and plastic surgery, to achieve optimal functional and cosmetic outcomes.

Pseudoprogression during immunotherapy (IO) - defined as clinical documentation of tumor growth or new lesions during treatment with immune checkpoint inhibitors, followed by disease regression - has been reported in ≤10% of cases. Its incidence appears to be lower in cSCC patients (1.5-4%). We report a rare case of pseudoprogression of an advanced cSCC during IO (cemiplimab). Following initial surgery for a cSCC of the left auricular area, the tumor recurred and infiltrated the ear cartilage and external auditory meatus. At the time of administration of the second IO, the tumor had rapidly grown with a fulminant pattern and doubled in size. Treatment with IO continued, as per protocol, and by the third infusion appointment, the tumor had disappeared, and complete re-epithelialization of the auricular area was observed, confirming pseudoprogression. So far, the patient has received ten cycles of IO without experiencing toxicity, and there has been no sign of disease recurrence. Clinicians should be aware of this rare response when treating advanced cSCC patients with cemiplimab.