Background/Objectives: Fluoroquinolones cause Achilles tendinopathy within a narrow, early therapeutic window, yet preventive strategies given alongside these antibiotics remain largely untested. This exploratory pilot study assessed whether four mechanistically distinct adjuvants attenuated histopathological tendon change in a rabbit model of levofloxacin exposure. Methods: Twenty-one male New Zealand White rabbits received oral levofloxacin (100 µg/kg/day, seven days). A contralateral-limb design yielded 42 tendons (two cohorts provided paired limb-specific comparisons and a third cohort received the systemic intervention). Animals were allocated to various groups, receiving platelet-rich plasma (PRP), injectable porcine collagen, oral vitamin E + selenium, topical essential oils with augmented soft-tissue mobilization (ASTM), or a levofloxacin-only control. The main outcome was a modified Bonar composite (tenocyte morphology, cellularity, vascularity, paratendinous fibrosis; 0–12) at three months; additional outcomes were the individual domains and ultrasonographic tendon thickness. Results: Composite scores were low throughout (group medians 2.0–4.0) and did not differ between groups (H = 3.663, p = 0.45); no domain differed, and the untreated control did not show the greatest change. Within animals, collagen-treated tendons scored higher than the paired essential-oil tendons (median difference +3.0, nominal p = 0.031, Bonferroni-adjusted p = 0.062). Tendon thickness increased by day 14 only with vitamin E + selenium (+14.1%; p = 0.003, and p = 0.006 adjusted for baseline); this finding arose in a separate cohort with thinner baseline tendons, cannot be confidently attributed to the intervention, and was unrelated to histopathology (ρ = −0.02, p = 0.91). Macroscopic findings differed between groups (nominal p = 0.031) without predicting tissue grade. Conclusions: No statistically detectable difference in the study-specific four-domain composite was identified among the treatment conditions; the study lacked a levofloxacin-free control and could not provide a definitive efficacy assessment. The model produced only mild pathology, limiting its power, and neither imaging nor gross inspection predicted tissue-level change. These preliminary observations are hypothesis-generating and are intended to inform the design of an adequately powered confirmatory study. The findings are inconclusive for efficacy; the design cannot distinguish lack of adjuvant efficacy from failure of the model to induce measurable disease.

Artificial intelligence (AI) is entering surgical planning along a continuum that runs from imaging assistance to near-autonomous plan generation, and facial reconstructive surgery—where outcomes bear directly on identity and social functioning—is among the most sensitive settings for this transition. Existing acceptability research has largely compared AI-supported care with conventional care in binary designs, and Central and Eastern European populations remain underrepresented. This protocol describes a cross-sectional, within-subjects vignette experiment among Romanian adults recruited online (target N = 300 valid responses; minimum analyzable N = 140, raised by a pre-registered rule if the pilot’s inter-scenario correlation falls below the planning assumption). Each participant will read four hypothetical scenarios describing progressively autonomous AI involvement in facial reconstructive surgical planning: imaging assistance, decision support, outcome simulation, and autonomous planning. Participants are randomly allocated to one of the four sequences of a Williams balanced Latin-square design, so that the autonomy level is orthogonal to serial position and to first-order carry-over. After each scenario, they will rate acceptability, trust, and perceived risk (three seven-point Likert items each), responsibility attribution across four loci (surgeon, hospital, AI developer, unavoidable medical uncertainty), perceived AI control and perceived technical sophistication (manipulation checks), and scenario difficulty. Primary analyses are mixed repeated-measures ANOVAs with presentation sequence as a between-subjects factor, orthogonal polynomial (linear, quadratic, cubic) trend contrasts, and Holm-corrected pairwise comparisons, complemented by a position-adjusted linear mixed model; secondary analyses address responsibility migration and concentration, moderation by AI familiarity, and global implementation preferences. A pilot study (N = 50, allocated 1:1 to the ascending and descending sequences) will establish reliability, factor structure, comprehension, manipulation validity, and a first bound on order effects before pre-registration on the Open Science Framework and the start of data collection.

Background/Objectives: Occupational contact dermatitis (OCD) is the most common work-related skin disease, accounting for roughly 90–95% of occupational dermatoses and falling predominantly on the hands. It is rarely dangerous yet imposes a substantial burden through impaired quality of life, lost productivity, and premature exit from affected trades. The COVID-19 pandemic intensified this burden among healthcare workers, in whom the pooled one-year prevalence of self-reported hand eczema reaches around 27%; meta-analytic data link the increased risk principally to frequent handwashing and wet work rather than to alcohol-based hand rub. Methods: This narrative review, which follows a non-systematic, thematically organised search strategy rather than PRISMA methodology, integrates current evidence on the epidemiology, pathophysiology, diagnosis, prevention, and management of OCD, with particular emphasis on the self-reinforcing cycle linking skin barrier disruption, microbiome dysbiosis, and antimicrobial-peptide dysregulation to inflammation. Results: We critically appraise the prevention evidence, foregrounding the low certainty of the existing trial base and the tension between the randomised trials of primary and secondary prevention, which have been null, and the encouraging but uncontrolled results of structured tertiary-prevention programmes. We summarise recent therapeutic advances, including topical delgocitinib, and situate the field within the World Health Organisation’s 2025 recognition of skin diseases as a global public health priority. Established evidence and hypotheses are kept separate throughout: we additionally advance, explicitly as a conjecture rather than as a demonstrated mechanism, a conceptual trans-kingdom dialogue model in which protease-generated LL-37 fragments may modulate staphylococcal quorum sensing, and each step of that model is labelled according to whether the supporting evidence is direct, extrapolated, or as yet untested. Conclusions: We argue that the prevention failure is less one of biology than of trial design and measurement, and outline the research needed to close the gap.

Chordoma is a rare notochordal malignancy of the axial skeleton, and distant cutaneous metastasis is among its rarest manifestations—an under-recognised mimic of benign and malignant skin tumours that often presents with an incomplete clinical history. Methods: We performed a systematic review and one-stage individual-participant-data (IPD) meta-analysis of all reported cases of distant cutaneous chordoma metastasis, following PRISMA 2020, and complemented it with an illustrative index case of cutaneous poorly differentiated chordoma in a young adult. Missing case-level data were handled by available-case analysis without imputation, with denominators reported throughout. Pooled prevalences were estimated by logistic-normal random-effects models (heterogeneity by I²); latency to cutaneous metastasis was modelled as a time-to-event outcome, and brachyury uptake over time by meta-regression. Results: Forty reports (52 cases) were included; individual data were analysable in 43. Median age was 59 years (range, 2 months–88), male-to-female ratio 2.3:1, sacrococcygeal primary 74% (31/42) and median latency 4.0 years (synchronous to 15). Physaliphorous cells, myxoid stroma and vacuolated cytoplasm dominated, yet brachyury and SMARCB1/INI1 were documented in only 6/52 and 1/52 cases. Pooled prevalences were 74% (95% CI 59–85) for a sacrococcygeal primary, 70% (55–82) for male sex and 77% (62–87) for physaliphorous morphology, with no between-report heterogeneity (I² = 0%)—expected when almost every report contributes one patient, so these values consolidate rather than extend the descriptive data. Patients younger than 40 years reached cutaneous metastasis far earlier (hazard ratio 17.2, 95% CI 4.7–62.9; p < 0.001), and brachyury use rose across eras (ρ = 0.43, p = 0.008). Conclusions: Distant cutaneous chordoma metastasis is a late event that usually signals disseminated disease and a limited life expectancy, commonly months to a few years. Its recognition rests on integrating morphology with nuclear brachyury and, in epithelioid or young presentations, SMARCB1/INI1. We provide a differential-diagnostic framework and algorithm, distinguishing cohort-supported findings from expert interpretation.

Background: Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine malignancy. Like cutaneous malignant melanomas, a subset of MCCs can clinically present without an identifiable primary tumour, termed Merkel cell carcinoma of unknown primary (UPMCC), with incompletely understood behaviour and prognosis. Our objectives are to evaluate the clinical presentation, management and survival outcomes in UPMCC and compare overall survival with metastatic MCC of known-primary origin. Methods: A retrospective review of 252 consecutive MCC patients (1992–2023) identified 20 cases of histologically confirmed nodal or metastatic UPMCC. Demographics, anatomical distribution, treatment and oncological outcomes were analysed. Overall survival was compared with patients presenting with metastatic MCC of known primary. Results: The cohort included 15 males and 5 females (mean age 76 years). Presentation most commonly involved inguinal (n = 7) and axillary (n = 6) nodes, followed by parotid and cervical basins (n = 4). Management was multimodal, including lymphadenectomy, radiotherapy and systemic therapy. Six patients remained disease-free at a mean follow-up of 63.3 months. The mean overall survival was 43.65 months for UPMCC versus 39.29 months for known-primary metastatic MCC. Conclusions: UPMCC most commonly presents as inguinal or axillary nodal disease. Survival outcomes suggest a trend toward improved prognosis compared to known-primary metastatic MCC.