Journal of Anatomy

The human bony labyrinth has attracted increasing interest because of its taxonomic, evolutionary, and functional significance. Although sexual dimorphism has been reported in several aspects of the temporal bone, the extent to which sex, age, size, and allometry contribute to labyrinth shape variation remains poorly understood. Here, we investigated patterns of sexual shape variation in the human bony labyrinth using three-dimensional geometric morphometrics in a sample of 98 archaeological individuals from South America with known genomic sex. Centroid size and allometric effects were assessed in a subset of 90 individuals with comparable metric scaling. In addition to analysing the complete labyrinth, the cochlea and semicircular canals were examined separately to evaluate region-specific patterns of sexual shape variation. Principal Component Analysis showed extensive overlap between females and males, and overall labyrinth shape did not differ significantly between sexes. Males exhibited significantly larger labyrinths than females, and centroid size explained a small but significant proportion of overall shape variation. Regional analyses showed no evidence of significant sexual shape differences in the cochlea or in any individual semicircular canal when analysed separately. In contrast, the combined semicircular canal system exhibited subtle but significant sexual shape variation independent of centroid size, whereas morphological disparity did not differ between sexes. The geometric comparison of the female and male consensus configurations further showed that sexual shape variation was regionally heterogeneous. Whereas the cochlea exhibited a pattern of localized changes with low directional coherence, the semicircular canals displayed more coordinated regional shape changes. The male consensus also exhibited slightly higher canal circularity across all three semicircular canals, particularly the posterior canal, while differences in canal-plane orientation remained minimal. These findings demonstrate that sexual shape variation in the human bony labyrinth is subtle and anatomically partitioned among its components. Although significant sex differences in centroid size were detected across most anatomical regions, overall labyrinth shape and cochlear morphology were primarily influenced by allometry, whereas significant sex-related shape differences were detected only when the semicircular canals were considered as an integrated anatomical system. These findings demonstrate that sexual dimorphism in the human bony labyrinth is subtle but regionally heterogeneous, with the cochlea and semicircular canals exhibiting distinct patterns of shape variation, suggesting that these structures are influenced by different developmental, functional, and evolutionary processes.

Tessellated calcified cartilage (TCC) is a hallmark of the chondrichthyan skeleton, yet its development early in ontogeny across the four major groups (batoids, galeomorphs, squalomorphs, and holocephalans) remains poorly understood. Specialised traits of TCC, such as multi-layered TCC and internal mineralised trabeculae, typically develop in response to feeding mechanics. In this study, we evaluated TCC morphology in the jaws of 12 representative taxa to observe its structure at an early ontogenetic stage to determine whether these specialised features had yet developed. Batoids consistently exhibited well-developed, homogeneous, polygonal tesserae early in ontogeny regardless of jaw morphology or feeding habit. In contrast, galeomorphs displayed high morphological heterogeneity. Notably, we document the first report of an extensive internal trabecular network in a non-batoid elasmobranch, observed in Ginglymostoma cirratum, which may serve to resist the mechanical pressures of specialised suction feeding. Furthermore, we identified voussoir tesserae in galeomorphs for the first time, extending their documented presence across all elasmobranch groups, where they display an inverted aspect ratio (wider than tall) compared to mature forms. The durophagous Mustelus mustelus exhibited surprisingly poor TCC development despite being a durophagous feeder, pointing to a pronounced ontogenetic lag. In Squatina oculata, TCC was characterised by large and thick tesserae and extensive fused tesseral regions which may relate to its explosive ambush predation mode, whereas the holocephalan Chimaera exhibited a poorly mineralized, mesh-like structure without resolvable discrete tesserae or trabeculae-matching findings from previous studies. Across all specimens, multi-layered TCC was absent, confirming that multi-layering develops later in ontogeny. These results demonstrate that generalised models of TCC development based on one group or a few taxa fail to capture the broader diversity of TCC morphology. It also opens up many exciting avenues for further study, and forms the basis for comparisons with fossil chondrichthyans, to investigate the evolution of TCC.

Study design Retrospective cohort study. Objectives To correlate Hounsfield unit (HU) values, using elliptical regions of interest (ROI), that can be easily defined in routine clinical practice with magnetic resonance imaging (MRI) T2-hyperintense area fraction, as a surrogate for paraspinal muscle fat infiltration and to establish specific HU screening thresholds that may be applied with standard picture archiving and communication system (PACS). Methods We included 136 patients (71 men; 61.0 {+/-} 15.4 years) who underwent preoperative computed tomography (CT) and MRI within an 8-week period. Elliptical ROI HU values were measured at L2/3 and L4/5 for erector spinae, multifidus, and psoas major. MRI T2-hyperintense area fraction (Otsu thresholding) served as the fat infiltration reference. Linear mixed-effects (LME) models were used to assess the HU-T2 association and level-specific receiver operating characteristic (ROC) analyses (lower HU value side; n=136 per muscle-level) to identify thresholds for [≥]30% and [≥]50% infiltration criteria. Results Intraclass coefficients = 0.709 (HU) and 0.857 (T2 fraction); Goutallier weighted kappa = 0.579. In the overall LME, {beta} was -0.880 HU per 1% T2-fraction increase (95% confidence interval -0.935 to -0.825; marginal R2 =0.502); the association was steeper in multifidus ({beta} = -1.020) than in erector spinae ({beta} = -0.753). Psoas major (R = -0.226) was excluded from ROC analyses. Difference between L2/3 and L4/5 HU cutoffs was ~20 HU. The [≥]50% criterion revealed higher discrimination. Conclusions Elliptical ROI-based HU measurements may reliably screen paraspinal muscle fat infiltration in erector spinae and multifidus using standard PACS. Specific thresholds may allow practical preoperative evaluation without additional costs or radiation.

Background: Acute osteoporotic vertebral fractures (OVFs) may be difficult to detect on conventional radiographs, particularly before substantial vertebral collapse occurs. Comparing supine and sitting lateral radiographs may reveal load-dependent vertebral mobility. This preliminary study evaluated the diagnostic accuracy of supine to sitting dynamic radiography for detecting MRI confirmed acute OVFs. Methods: This retrospective, single center diagnostic accuracy study included consecutive patients who underwent paired supine and sitting lateral radiography and MRI of the same spinal region between April 2024 and July 2026. Dynamic radiographs were interpreted by a board certified orthopedic and spine surgeon who was blinded to the MRI findings. MRI was independently interpreted by a second board certified orthopedic surgeon and served as the reference standard. The primary outcome was patient-level sensitivity and specificity. Vertebra level diagnostic accuracy was evaluated secondarily, with patient cluster bootstrap confidence intervals used to account for within patient correlation. Results: Sixty three patients (mean age, 80.6 years; 51 women [81.0%]) and 490 evaluable vertebrae were analyzed. MRI identified acute OVFs in 34 patients and 36 vertebrae. At the patient level, dynamic radiography yielded 31 true positive, no false-positive, three false negative, and 29 true negative results. Sensitivity was 91.2% (95% confidence interval [CI], 76.3%-98.1%), specificity was 100.0% (95% CI, 88.1%-100.0%), positive predictive value was 100.0%, negative predictive value was 90.6%, and overall accuracy was 95.2%. At the vertebral level, sensitivity was 91.7% (33/36; patient cluster bootstrap 95% CI, 81.3%-100.0%) and specificity was 100.0% (454/454). The three missed fractures involved T9, L2, and L3. No false-positive vertebrae were observed. Conclusions: Supine to sitting dynamic radiography demonstrated high patient level sensitivity and no observed false positive findings for MRI confirmed acute OVFs. It may provide a practical complementary diagnostic option when MRI is not immediately available. However, a negative dynamic radiographic examination does not exclude an acute fracture, and the apparent perfect specificity requires validation in larger, prospective multi-reader studies.

Abstract Background: Most animal models of HCM are mouse-based, but the thin interventricular septum in mice makes it difficult to clearly distinguish pathological hypertrophy, which introduces substantial errors and constrains basic HCM research. Cats develop HCM spontaneously, and the common MYBPC3-A31P variant in cats is homologous to human mutations in both genetics and pathology, with a larger body size that makes them suitable as large-animal models. This study examines how heterozygosity or homozygosity for the p.A31P mutation (c.91G>C) in the MYBPC3 gene affects the phenotype and severity of HCM in affected cats, with the aim of establishing an ideal large-animal model for clinical risk stratification and precision diagnosis and treatment of human HCM. Methods: Forty-nine Maine Coon cats were enrolled and stratified into homozygous mutant (HOM, n=8), heterozygous mutant (HET, n=26), and wild-type (WT, n=15) groups. All cats underwent echocardiography, blood pressure measurement, physiological assessment, hematological and biochemical analyses, and cross-species sequence conservation analysis. Results: No significant differences in baseline characteristics including age and body weight were observed among groups (P>0.05). HOM cats exhibited significantly higher left ventricular outflow tract pressure gradients and greater basal septal thickness compared to WT cats (P<0.05), with HET cats showing intermediate values. Analysis of hematological and serum biochemical parameters revealed no evidence of systemic inflammation or hepatic injury. Sequence conservation analysis confirmed that the A31 residue is highly conserved across mammalian species. Conclusions: This study provides a phenotypic characterization of Maine Coon cats carrying the MYBPC3-A31P mutation, revealing marked gene-dose effects on cardiac structure and function, with homozygous individuals exhibiting more severe phenotypic features. This model serves as a large-animal translational platform that not only clarifies genotype-phenotype correlations but also supports risk stratification and precision therapeutic strategies in human HCM. Its spontaneous nature and genetic homology to human disease make it particularly valuable for bridging preclinical findings to clinical application.

Hydrozoa is a group of relatively simple animals with a well-developed nervous system. The nervous system in all hydrozoan medusae is highly conserved and includes outer and inner nerve rings at the bell margin, a neural network in the manubrium, and radial neural pathways that connect them. However, one element of the nervous system shows substantial variability among species: the subumbrella neural network. We examined the structure of the nervous and muscular systems in the subumbrella of 14 species of hydrozoan medusae. The main conclusion of this study is that the distribution of neural networks in the subumbrella strongly correlates with the distribution of smooth radial muscles. This correlation suggests that smooth radial muscles are the primary target of the subumbrella nervous system. Most species in the order Anthoathecata show a trend toward secondary loss of the neural networks and radial smooth muscle fibers in the subumbrella region, concentrating neural elements and smooth muscles only in the radial pathways along the radial canals. By contrast, all studied species in the order Leptothecata have neural networks in the subumbrella area, as well as radial smooth muscle fibers spread throughout the entire subumbrella region. The correlation between radial smooth muscles and the nervous system is also observed in the radial pathways along the radial canals. All species with thick bundles of smooth radial muscles along the radial canals have clearly defined, dense neural pathways running along or even embedded within the smooth muscle bundles.

INTRODUCTION: Osteogenesis imperfecta (OI) is a genetic disorder primarily due to mutations in collagen type I-encoding genes, resulting in fragile bones, frequent fractures, pain, and mobility issues. Disease severity and phenotype vary widely, even with the same mutation, suggesting the importance of other factors within the bone microenvironment that influence disease severity. To study the role of such factors, we analyzed bone samples from OI patients and healthy controls using single-cell RNA sequencing to reveal if RNA expression profiles may uncover mechanisms behind OI phenotype. METHODS: Bone samples from surgeries of OI patients and healthy individuals isolated and RNA single-cell sequencing was performed, followed by quality control and bioinformatics analysis. Two healthy and three OI patients were included: two with type-I OI, characterized by a mutation in COL1A1 (collagen type I), and another with type-VIII OI, associated with LEPRE1 mutations, which disrupt the 3-hydroxylation of type I collagen. RESULTS: Clustering and differential expression analysis showed distinct subpopulations in mesenchymal and immune cells. In all OI samples, mesenchymal stromal cell (MSC) proportions were reduced compared to healthy controls. OI type-I patients showed decreased osteoblast numbers alongside an increase in osteoclast precursor cells. Whereas in OI type-VIII, all bone turnover-related cells (osteoblast, osteoclast precursor, and osteoclast) were elevated. Notably, BMP5 and RUNX1 were downregulated in MSCs from both OI types. DISCUSSION: This study demonstrates that the bone marrow microenvironment in OI is significantly altered beyond the known collagen defects. Single-cell RNA sequencing revealed reduced MSC numbers and downregulated osteogenic gene expression. Furthermore, alterations are patient-specific: OI type-I is characterized by reduced osteoblast counts, whereas OI type-VIII exhibits increased osteoblasts and osteoclasts. These findings highlight the critical role of impaired osteogenic differentiation and an abnormal bone remodeling environment in the pathology of OI.

Background: Viable pediatric human growth plate (GP) tissue is rarely available for translational research, limiting direct investigation of human longitudinal bone growth and pediatric growth disorders. In this proof-of-concept study, we aimed to determine whether it is feasible to establish a clinically integrated ex vivo human GP model using tissue obtained during routine percutaneous epiphysiodesis (PE) procedures in adolescents treated for extreme tall stature or leg length difference due to trauma. Methods: GP tissue and cells were collected during PE and processed using protocols adapted from established methods of human osteoarthritic cartilage processing within the RAAK study. Feasibility was assessed by evaluating tissue collection, cell isolation, contamination rate, monolayer expansion, and generation of three-dimensional cartilage pellets. Proliferation of GP-derived chondrocytes was compared with osteoarthritis-derived articular chondrocytes, and histological assessment was performed to evaluate cartilage-like matrix formation. Results: Across consecutive surgical procedures, viable GP tissue could be obtained reproducibly, with only few samples failing to yield cells and no relevant contamination issues. Isolated GP chondrocytes expanded successfully in two-dimensional culture and showed a strong early proliferative response compared with RAAK-derived chondrocytes. In addition, GP-derived cells formed three-dimensional organoids and histology confirmed cartilage-like matrix deposition supporting their capacity to generate neo-cartilage tissue in vitro. Conclusion: This study demonstrates feasibility to obtain, culture, and functionally assess viable human GP tissue from routine PE surgery. As such, the Leiden ex vivo human GP model provides a unique platform to study local mechanisms of endochondral bone growth, link genetic determinants of height to functional GP biology, and support future therapeutic research in pediatric growth disorders.

AIM: To evaluate whether selective motor control quantified from spontaneous infant movement recordings provides diagnostic and prognostic information for cerebral palsy (CP) beyond established movement-based assessments. METHOD: This multicenter diagnostic and prognostic accuracy study included 302 infants (151 with CP) with spontaneous movement recordings obtained between 10 and 20 weeks corrected age from cohorts in Australia and the United States. All eligible infants with CP were included, and a comparison sample without CP was randomly selected. Recordings were scored using the Baby Observational Selective Control Appraisal (BabyOSCAR), Motor Optimality Score Revised (MOS-R), and General Movements Assessment (GMA). Outcomes at 2 years or older included CP diagnosis, Gross Motor Function Classification System (GMFCS) level, and motor distribution. RESULTS: BabyOSCAR discriminated CP diagnosis (area under the curve [AUC] 0.98), including children later classified in GMFCS level I. Among infants with CP, BabyOSCAR discriminated GMFCS levels I - II from III - V (AUC 0.89). BabyOSCAR absolute asymmetry also discriminated unilateral CP from all other infants (AUC 0.90). Diagnostic discrimination was also observed for MOS-R (AUC 0.94) and GMA (AUC 0.86). INTERPRETATION: Quantifying selective motor control from brief infant movement recordings may provide complementary early information about CP diagnosis, functional level, and motor distribution.

Background: Transcranial direct current stimulation (tDCS) is increasingly used as an adjunct to rehabilitation for young people with cerebral palsy (CP), yet considerable variability exists in clinical response. Individualised electric field modelling provides an opportunity to estimate the distribution of electrical fields generated by the stimulation delivered to the brain and explore potential relationships with functional outcomes. Methods: Structural MRI scans from nineteen participants (10-16 years) from a previously published randomised controlled trial (ISRCTN74235136) investigating the effects of tDCS combined with motor training, underwent participant-specific finite element modelling using SimNIBS. Electric field strength was quantified within anatomically defined motor regions of interest, including the primary motor cortex (M1), dorsal premotor cortex (PMd), supplementary motor area (SMA), and a combined motor network. Global grey matter electric field metrics and stimulation focality were also extracted. Results: Estimated electric field strength differed significantly across motor regions (p<0.001), with PMd receiving significantly greater stimulation than both M1 and SMA. Electric field strength within a control region (primary visual cortex) was significantly lower than within M1 (p<0.001). Despite inter-individual variability in regional and global electric field metrics, no significant associations were observed between estimated electric field strength or focality and changes in function following intervention. Conclusion: Individualised electric field modelling demonstrated that an M1-targeted tDCS montage preferentially stimulated PMd rather than M1 in young people with CP. These findings highlight the importance of subject-specific modelling when characterising current distribution and suggest that variability in electric field strength alone does not explain variability in behavioural response.

Deep learning tools are increasingly used today, particularly in medical segmentation. A gap nonetheless remains in automating segmentation for insects. This work addresses the following question: can a generalist segmentation model, trained on several phylogenetically related orthopteran species, reliably automate head tissue segmentation from micro-CT images? To answer this, we used nnU-Net, a self-configuring 3D deep learning segmentation framework originally developed for medical imaging, whose core function, learning to recognize tissues of interest, applies directly to this context. Six anatomical classes were automated, comparing two training strategies: sequential fine-tuning, which adds species one at a time under the assumption that progressive learning would strengthen predictive power, and from-scratch training, in which the model learns the entire dataset simultaneously. The fine-tuning model (ModelB) reached a Dice coefficient (a measure of overlap between automated segmentation and manual ground truth, ranging from 0 to 1) of 0.7715, compared to 0.7664 for the from-scratch model (ModelC). Although both models produced accurate automated segmentations, no significant difference was found between the two training strategies (paired Wilcoxon test, n = 24, p = 0.243). Despite a dataset limited to 20 individuals and the absence of one method clearly outperforming the other, the models remain usable across the three species studied (Gryllus bimaculatus, Loxoblemmus equestris, L. doenitzi), including in the presence of pronounced sexual dimorphism. It reduces a 20 hour segmentation task to under a minute.

Perceptual experiments show that listeners recognize female speakers with lower accuracy than male speakers. Automatic speaker recognition systems may also show performance bias against female speakers even when training data sets are gender balanced. The underlying reasons for this discrepancy are unclear. Here, we apply geometric morphometrics to quantify sex-related morphological vocal tract disparity -- the extent of shape variation -- across both resting and articulatory configurations. We find that male speakers exhibit greater disparity in both resting and articulatory configurations. This morphological idiosyncrasy may in turn generate more discriminable acoustic signatures and offer a biological explanation for higher recognition accuracies for male voices by humans and machines. Our results suggest that innate variation in vocal tract morphology may contribute to performance bias in voice technology and voice perception by human listeners.

Dense semilandmarks describe 3D surfaces with hundreds to thousands of points, and sliding them by bending energy or Procrustes distance is a near-universal default. Three questions remain open: does dense sampling add shape beyond fixed landmarks, how many points are needed, and does sliding help or harm? Real specimens cannot answer them: the true correspondence is unknown. We tested two workflows, ALPACA (single-template registration) and DeCAL (landmark-anchored correspondence), on 496 mouse skulls at 250-1,000 points, with and without sliding, scored by surface reconstruction. We repeated it on 500 synthetic skulls with exact correspondence, measuring each point's distance to its true homologue. Dense semilandmarks lowered error for almost every specimen; the fixed landmarks added little but supplied anchoring the semilandmarks could not, and the anchored method was more accurate. The benefit saturated near 250 points for ALPACA but kept improving to 1,000 for DeCAL. Procrustes-distance sliding harmed every configuration; bending-energy sliding helped only a poor, landmark-free correspondence, vanishing once anatomical anchors spanned the form. Match the sliding decision to the correspondence in hand: relax a poor one, leave a good one alone, never slide toward the mean. Known-correspondence specimens offer a general test of landmarking and sliding against ground truth.

The highly conserved body plan of nematodes makes members of this phylum excellent models to study cell type evolution. Early branching nematode lineages, mostly occupying aquatic habitats, usually contain caudal glands deployed for underwater attachment to a substrate, but have been thought to lack phasmid sensory organs, resulting in their historical classification as "Aphasmidia". With the transition to a terrestrial environment, nematodes lost caudal glands and gained phasmid sensory neurons. The supposed mutually exclusive existence of caudal glands and phasmids has led to the suggestion that phasmid neurons may have evolved from caudal glands. Here, we rule out this possibility through light and electron microscopical analysis of Mononchus aquaticus, a member of the early branching Dorylaimia lineage, showing that phasmid sensory neurons and caudal glands do coexist. This observation not only argues against a proposed cell type evolution scenario accompanying aquatic-to-terrestrial transitions but also indicates that the presence of phasmid sensory organs may have been an ancestral trait of the nematode phylum.

Background: Lumbar disc herniation, with or without concomitant disc degeneration, is a major cause of lumbar radiculopathy and low back pain, which also a key public musculoskeletal disorder without an exact pathophysiology. Studies have suggested that inflammatory cells and biochemical markers of inflammation also play an important role in lumbar radiculopathy in addition to nerve compression. The aim of the present study was to assess the association of selected circulatory inflammatory markers (CRP, hs-CRP and E-selectin) in patients with lumbar disc herniation without radiological degeneration (LDH) and lumbar disc herniation with radiological degeneration (LDHD). Materials & methods: This case-control study included 208 participants, comprising 104 patients with lumbar disc pathology and 104 controls. Patients were further stratified into LDH (n=67) and LDHD (n=37). Serum CRP, hs-CRP and E-selectin concentrations were measured. Results: Among the patients, 35.6 % presented with LDHD while 64.4 % had only LDH. Significantly increased median hs-CRP (p<0.001) and CRP (p<0.001) were observed in patients groups compared to controls, while CRP showing a consistent independent association across the combined disease (OR=1.68, 95% CI=1.33-2.14, p<0.001), LDHD (OR=1.62, 95% CI=1.16-2.20, p=0.005) and LDH (OR=1.69, 95% CI=1.30-2.20, p<0.001) multivariable models. No significant difference was observed in serum E-selectin between the study groups. Multivariable models incorporating inflammatory and clinical variables demonstrated substantially greater discriminatory performance than individual biomarkers alone. Conclusion: Elevated circulating CRP and hs-CRP concentrations were associated with lumbar disc pathology, with CRP showing a consistent independent association across the combined disease, LDH and LDHD multivariable models, whereas E-selectin showed no significant association. Multivariable models incorporating inflammatory and clinical variables demonstrated greater discriminatory performance than individual biomarkers. These findings support a potential systemic inflammatory component in lumbar disc pathology, although the cross-sectional nature of the measurements does not establish causality or a local inflammatory response within the disc.

Gaps remain in the evidence base for postoperative management following forefoot surgery. A recent randomized controlled trial (ClinicalTrials.gov NCT04927234) demonstrated improved outcomes with intermittent one Hertz (Hz) neuromuscular electrical stimulation (NMES) of the common peroneal nerve. This sub-analysis evaluates its effect in patients undergoing forefoot surgery. Forty-two patients undergoing forefoot procedures were included; 26 received NMES plus standard of care (SOC) and 16 received SOC alone. Wound healing was assessed at 14 days. Edema was measured using the figure-of-eight (FO8) method. Patient-reported outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). At 14 days, complete wound healing occurred in 77% of patients receiving NMES plus SOC compared with 40% in the SOC group (p<0.05). Edema reduction was significantly greater in the NMES group, with a 74% relative reduction compared with SOC (p=0.02). Intermittent one Hz NMES of the common peroneal nerve was associated with improved wound healing and reduced postoperative edema following forefoot surgery.

While movement variability is a natural element of human expression, in sign languages it may affect mutual understanding, learning, and potential overuse injury. Sign language variability is not well-understood in part because quantitative analytical methods are yet to be clearly defined. Hence the aim of this study was to assess intra-subject reliability across repeated sessions for three signers, to identify features sensitive to experience-related differences in motor control consistency, and to establish movement consistency metrics for treating sign language kinematic differences as linguistically meaningful. Three signers were assigned to three different proficiency levels of sign language: Deaf (D), proficient (P), and student (S). Sign production variables were evaluated using intraclass correlation coefficients (ICCs) and coefficients of variation(CVs).Most kinematic features showed good to excellent ICCs such as duration, path length, signing space volume, and average and peak velocity. Some EMG features such as mean forearm amplitudes and co-contraction also showed good to excellent ICCs. These data can be used to improve the scientific investigation of sign languages, improve educational resources, and establish baseline thresholds to inform ergonomic or scheduling guidelines for interpreters.

Objective: To identify patient, clinician, therapist and service priorities for a health-literacy intervention combining patient education with patient-reported outcome measure (PROM) feedback in routine hand surgery and hand therapy. Methods: A qualitative co-design study was undertaken across public and private hand-care contexts in New South Wales, Australia. Twelve stakeholders participated: five consumers, three hand surgeons, one hand therapist and three administrative/managerial staff. Individual interviews plus a clinician group discussion were conducted. Data were collected in March 2026, audio-recorded, transcribed verbatim and de-identified. General inductive thematic analysis was undertaken in NVivo by one researcher, with final themes reviewed by co-investigators. Results: Four themes guided intervention design: (1) providing information is not enough, it must be understood, retained and reinforced; (2) patients need a practical roadmap of diagnosis, treatment, recovery and rehabilitation; (3) education should be multimodal, reusable and adaptable to individual needs; and (4) PROMs should improve the clinical conversation rather than become another burden. Participants supported brief, accessible PROMs and visual feedback over time, but views differed on comparison with other patients because benchmarking could either reassure or create anxiety and unrealistic expectations. Conclusion: Health-literate hand care requires more than readable leaflets. It requires repeated, practical and adaptable communication across the care pathway, with PROM feedback embedded in patient-clinician conversations. Practice implications: Hand services should pair standardized core education with flexible delivery and use brief PROMs as conversation tools. Longitudinal displays may support monitoring and shared decisions, while group comparisons should be optional and carefully explained.

Background and AimsMutations in the desmin (DES) gene cause a variety of cardiomyopathies associated with arrhythmias, yet the electrophysiological consequences of these variants remain largely uncharacterized. The aim of this study was to investigate the pathogenic mechanisms of the de novo DES p.R406W variant, which was identified in a 9-year-old patient who suffered from severe ventricular arrhythmias and sudden cardiac death without overt structural heart disease. MethodsHuman induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) carrying the DES p.R406W variant (including the patients line) were compared to isogenic controls. Action potentials (AP) of hiPSC-CMs were recorded using patch-clamp. Furthermore, 3D engineered heart tissues (EHTs) were generated from hiPSC-CMs and their APs were recorded with sharp microelectrodes. Analytical techniques also included transmission electron microscopy (TEM) and integrated transcriptomic and proteomic profiling. Finally, a heterozygous knock-in (KI) mouse model carrying the Des p.R405W ortholog was evaluated through surface ECG, echocardiography and ex vivo cardiac optical mapping. ResultsThe DES p.R406W mutation prolonged AP duration in IM-R406W hiPSC-CMs and EHTs vs Control ones. Multi-omics analysis of EHTs revealed a dysregulation of genes and proteins involved in contractile function, cell adhesion, and electrical activity. TEM imaging revealed changes in Z-disc architecture in mutant tissues. Twenty-week-old Des p.R405W KI mice exhibited ventricular conduction slowing (prolonged QRS) and a high susceptibility to ventricular tachyarrhythmias, likely due to reentrant mechanisms. Mild hypertrophy was also observed, but only in females. ConclusionThe DES p.R406W variant is highly pathogenic, causing electrical and structural remodeling of the myocardium. This study highlights the effectiveness of hiPSC-CMs and EHTs in recapitulating the clinical phenotype of desminopathy, providing a platform for investigating the mechanisms of early-onset cardiac arrhythmias and SCD.

This study investigates the impact temperature-induced vertebral anomalies have on the C-start escape response of Astyanax mexicanus, a model species in evolutionary developmental biology. Employing three temperature treatments to induce varying degrees of skeletal anomalies, we assessed their effects on key swimming performance metrics including, C-start time, curvature coefficient, head displacement distance, and displacement velocity. Through the use of linear mixed models and generalized linear mixed models, our results reveal that specific anomalies such as vertebral fusions and anomalous haemal and neural spines affected the curving ability of C-start escape responses. However, these did not negatively impact other performance parameters, with velocity, distance, and response time showing no significant impacts from any anomaly types, when assessed individually. This suggests a complex interplay between structural deformities and compensatory physiological mechanisms that maintain functional performance. Other variables measured had a stronger and significant impact on swimming performance, including standard length, vertebral number, and temperature treatment, which influenced escape speed, curving ability, and overall locomotor performance. Our findings challenge conventional perceptions about the debilitating impact of vertebral anomalies, indicating that many affected fish can still effectively perform escape maneuvers critical for survival.