Background and Objectives: Osteoporosis poses significant health risks, especially among veterans, due to lifestyle factors. This study compares bone density and fracture risks between male veterans and non-veterans. Materials and Methods: We conducted a retrospective analysis of 1427 veterans from the Taichung Veterans General Hospital osteoporosis database (2010–2022), matched 1:1 by age and gender with non-veterans. Bone mineral density (BMD) was measured via dual-energy X-ray absorptiometry (DXA). Comorbidities, fracture sites, and mortality data were tracked. Conditional logistic regression was used to identify factors influencing fracture risk. Results: The study found that veterans have a higher fracture risk (univariable OR 1.24, multivariable OR 1.20, p < 0.001). Fracture victims were slightly younger in the veterans group (78.7 ± 10.0 years vs. 80.1 ± 9.2 years, p = 0.010), who also had better T-scores in the lumbar spine and left femoral neck. Veterans showed a higher post-fracture mortality rate (39.9% vs. 31.9%, p = 0.001) and a greater incidence of radial fractures (5.01% vs. 2.96%, p = 0.036). Importantly, veterans exhibited a trend toward more hip fractures compared with non-veterans (27.0% vs. 23.6%, p = 1.017), suggesting a potential difference despite not reaching statistical significance. Conclusions: In the present study, we found that veterans have higher rates of comorbidities, and higher mortality after a fracture event, highlighting the need for targeted medical interventions to address these differences. Further intervention to prevent avoidable fractures and the provision of adequate care for long-term osteoporosis management remain critical issues.

Background/Objectives: Extracranial–intracranial (EC-IC) bypass, particularly superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, is used to augment cerebral perfusion in selected patients with moyamoya disease or atherosclerotic steno-occlusive disease. This study evaluated the impact of STA-MCA bypass on regional cerebral perfusion using a semi-quantitative SPECT area-based method. Methods: Of 40 patients screened between June 2018 and June 2022, 15 with complete paired pre- and postoperative CTA and SPECT data were included. Postoperative imaging was performed at a median of 12 months (range, 6–15 months). Proportional perfusion area in the basal ganglia and temporal regions was calculated using Labelme annotation, Canny edge detection, and Green’s theorem, normalized to total brain area. Paired comparisons and exploratory subgroup analyses were performed. Normality was assessed by Shapiro–Wilk test; Wilcoxon signed-rank tests served as sensitivity analyses. Results: Mean age was 56 ± 15.7 years (40% female). All 16 anastomoses were patent. Postoperative perfusion area increased significantly in the basal ganglia (mean difference 0.24, 95% CI 0.13–0.35, p = 0.0003) and temporal regions (0.34, 95% CI 0.08–0.60, p = 0.012). Wilcoxon tests confirmed these findings (basal ganglia p = 0.0003; temporal p = 0.008). In unilateral cases, ipsilateral and contralateral basal ganglia improvements did not differ significantly (p = 0.839). Results should be interpreted as exploratory given the limited sample size. Conclusions: STA-MCA bypass was associated with significant increases in semi-quantitative perfusion area on SPECT, particularly in the basal ganglia. The lack of ipsilateral–contralateral difference is consistent with a possible global hemodynamic effect, but this interpretation remains hypothesis-generating. The pragmatic SPECT method is feasible for perioperative monitoring yet requires further validation. Larger prospective studies with standardized protocols are warranted.

Background/Objectives: Sepsis is clinically heterogeneous, and comorbidities may alter physiological patterns associated with sepsis status. This study examined whether comorbidity-specific modeling revealed differences in retrospective sepsis discrimination. Methods: MIMIC-IV data were analyzed across 27 Elixhauser-based analytical subgroups using Random Forest, XGBoost, CatBoost, LightGBM, AdaBoost, multilayer perceptron, TabNet, and FT-Transformer. Available neural-model scripts used a stratified 80/20 training–evaluation split. Class imbalance was addressed using training-partition SMOTE and model-specific loss or sampling settings. SHAP was used to describe model-attributed feature contributions. Results: Tree-based ensembles achieved ROC-AUC values above 0.80 in many subgroups, whereas neural models showed more variable performance and trade-offs between discrimination and sepsis-class recall. Red cell distribution width, age, and magnesium were frequently emphasized by the fitted models. Conclusions: The findings demonstrate subgroup- and model-specific differences in retrospective sepsis-status discrimination. Because a verified pre-sepsis feature-time boundary was not enforced, the results should not be interpreted as prospectively validated early prediction. External validation, calibration, and decision-analytic evaluation are required before clinical use.

Background/Objectives: Extracranial–Intracranial (EC-IC) arterial bypass, particularly superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, is employed in selected patients with moyamoya disease or atherosclerotic steno-occlusive disease to augment cerebral perfusion. Objective hemodynamic monitoring before and after revascularization remains essential. This study evaluated the impact of STA-MCA bypass on regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) with a semi-quantitative area-based method. The proportional perfusion area was used as a pragmatic surrogate marker of regional cerebral blood flow (rCBF) changes. Methods: Fifteen patients who underwent STA-MCA bypass between June 2018 and June 2022 with available pre- and postoperative CTA and rCBF-SPECT studies were retrospectively analyzed. During the study period, 40 patients with complete paired pre- and postoperative CTA and SPECT imaging were included after exclusion of those with missing data or loss to follow-up. Preoperative and postoperative clinical evaluations were performed by the attending neurosurgical team. Postoperative CTA and rCBF-SPECT were typically obtained between 6 and 15 months after surgery, with timing individualized according to clinical status. A custom semi-quantitative technique using Labelme annotation, Canny edge detection, and Green’s theorem was applied to calculate the proportional perfusion area in basal ganglia and temporal regions, normalized to total brain area. Paired pre–post comparisons and subgroup analyses (left- vs. right-sided surgery; ipsilateral vs. contralateral regions) were performed. Normality of differences was assessed with the Shapiro–Wilk test. Post hoc power analyses were conducted. Sensitivity analyses used the Wilcoxon signed-rank test. Subgroup analyses were considered exploratory. Results: Mean age was 56 ± 15.7 years (40% female). Indications included moyamoya disease (20%) and arterial stenosis/occlusion (80%). All 16 anastomoses (14 unilateral, 1 bilateral) were patent postoperatively. One patient underwent bilateral bypass; this patient was included in overall analyses but excluded from ipsilateral/contralateral comparisons to allow clear laterality classification. Overall, postoperative perfusion area proportion improved significantly in basal ganglia (mean difference 0.24, 95% CI 0.13–0.35, p = 0.0003; post hoc power 0.993) and temporal regions (0.34, 95% CI 0.08–0.60, p = 0.013; post hoc power 0.76). Normality assumptions were satisfied (Shapiro–Wilk p > 0.05); Wilcoxon signed-rank tests confirmed significance (basal ganglia p = 0.0003; temporal p = 0.008). Improvement in basal ganglia perfusion was similar between left-sided (Δ 0.23) and right-sided (Δ 0.28) surgery groups. In unilateral cases, there was no significant difference between ipsilateral and contralateral basal ganglia improvement (p = 0.839), consistent with the hypothesis of a more global hemodynamic effect rather than a strictly localized phenomenon. These findings should be interpreted as exploratory given the limited sample size. Conclusions: In our study, STA-MCA bypass was associated with a significant increase in semi-quantitative perfusion area on SPECT, with consistent benefits observed in the basal ganglia regardless of surgical laterality. The absence of a significant ipsilateral–contralateral difference supports the hypothesis that hemodynamic benefit may extend beyond the immediate surgical territory, possibly mediated by increased overall inflow, reversal of steal phenomenon, and collateral recruitment. The pragmatic semi-quantitative SPECT method is feasible for perioperative hemodynamic monitoring but requires further validation against quantitative perfusion techniques. Larger prospective multicenter studies incorporating quantitative imaging and standardized neuropsychological assessment are warranted to confirm these observations and refine patient selection.