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Background: Nodular fasciitis is a benign, singularly occurring nodular fibroblastic/myofibroblastic neoplasia. Due to the rapid growth and cellular atypia, this rare differential diagnosis in the head and neck region can be mistaken for malignant sarcomas. Methods: We present a 40-year-old female patient with an unclear, rough, and poorly displaceable supraclavicular swelling on the right as part of a medical check-up. Sonographically, the lump was poorly circumscribed with little vascularization. A consecutive core needle biopsy of the lesion yielded inconclusive results showing spindle-shaped tumor cells. 68 Ga-FAPI-PET/CT showed an intensive uptake of the right supraclavicular lesion in addition to postoperative changes in the right tonsil. Subsequent operative partial excision of the lesion confirmed the histopathological diagnosis of nodular fasciitis. Results: Nodular fasciitis is the most prevalent pseudosarcoma found in soft tissues. This case is the first description of 68 Ga-FAPI-PET/CT in nodular fasciitis. Surgical removal is advised; nevertheless, the tumor frequently diminishes on its own, and recurrence is rare. Extensive surgical therapy is not necessary. Conlcusions: The recognition of nodular fasciitis and its benign characteristics is crucial to prevent diagnostic errors and the subsequent unnecessary operative treatment of the patient.

We report a [ 18 F]fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) scan of a 17-year-old male presenting increased focal glucose metabolism of a histologically proven solitary nodular fasciitis mimicking an extranodal manifestation of Hodgkin lymphoma. This interesting image should draw attention to considering nodular fasciitis as a possible pitfall in the staging of malignant diseases.

BACKGROUND Due to several factors such as its specific cellular and biochemical microenvironment, the spleen is not a predestined organ of frequent metastatic colonization in the case of primary solid carcinoma. Hence, the mode of diagnosis and the preferred treatment of a lesion highly suspicious of splenic metastasis must be decided on a case-by-case basis, considering not only the biological tumor entity but also the stage of the primary disease. CASE REPORT In the present case, we demonstrate the clinical course of a 37-year-old female patient who initially presented to our clinic with irregular vaginal bleeding. A consecutive gynecological examination revealed a 3×3-cm large mass of the cervix uteri, and the subsequent histomorphological workup led to the diagnosis of an adenosquamous carcinoma of the cervix uteri. Therapeutically, the patient received multimodal treatment, namely radical hysterectomy with adjuvant radio-chemotherapy. After 1.5 years, the patient presented to our Emergency Department with intermittent left-sided abdominal pain. Subsequent abdominal imaging (computed tomography scan, magnetic resonance imaging, positron emission tomography) determined a metabolically active splenic lesion with a central necrosis - signs of malignancy in line with a splenic metastasis. Presentation and discussion of the case within our interdisciplinary tumor board led to the decision of splenectomy followed by chemotherapy, a procedure that could be considered as therapeutic treatment in such exceptional cases. CONCLUSIONS The collection and reporting of atypical clinical courses remains a key factor in precision medicine to enable the most evidence-based decision making in such cases.

Background: New methods are constantly being developed to adapt cognitive load measurement to different contexts. However, research on middle childhood students' cognitive load measurement is rare. Research indicates that the three cognitive load dimensions (intrinsic, extraneous, and germane) can be measured well in adults and teenagers using differentiated subjective rating instruments. Moreover, digital ink recorded by smartpens could serve as an indicator for cognitive load in adults., Aims: With the present research, we aimed at investigating the relation between subjective cognitive load ratings, velocity and pressure measures recorded with a smartpen, and performance in standardized sketching tasks in middle childhood students., Sample: Thirty-six children (age 7-12) participated at the university's laboratory., Methods: The children performed two standardized sketching tasks, each in two versions. The induced intrinsic cognitive load or the extraneous cognitive load was varied between the versions. Digital ink was recorded while the children drew with a smartpen on real paper and after each task, they were asked to report their perceived intrinsic and extraneous cognitive load using a newly developed 5-item scale., Results: Results indicated that cognitive load ratings as well as velocity and pressure measures were substantially related to the induced cognitive load and to performance in both sketching tasks. However, cognitive load ratings and smartpen measures were not substantially related., Conclusions: Both subjective rating and digital ink hold potential for cognitive load and performance measurement. However, it is questionable whether they measure the exact same constructs., (© 2023 The Authors. British Journal of Educational Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Representational competence is commonly considered a prerequisite for the acquisition of conceptual knowledge, yet little exploration has been undertaken into the relation between these two constructs. Using an assessment instrument of representational competence with vector fields that functions without confounding topical context, we examined its relation with N  = 515 undergraduates' conceptual knowledge about electromagnetism., Results: Applying latent variable modeling, we found that students' representational competence and conceptual knowledge are related yet clearly distinguishable constructs (manifest correlation: r  = .54; latent correlation: r  = .71). The relation was weaker for female than for male students, which could not be explained by measurement differences between the two groups. There were several students with high representational competence and low conceptual knowledge, but only few students with low representational competence and high conceptual knowledge., Conclusions: These results support the assumption that representational competence is a prerequisite, yet insufficient condition for the acquisition of conceptual knowledge. We provide suggestions for supporting learners in building representational competence, and particularly female learners in utilizing their representational competence to build conceptual knowledge., Supplementary Information: The online version contains supplementary material available at 10.1186/s40594-023-00435-6., Competing Interests: Competing interestsAuthors declare that there are no competing interests., (© The Author(s) 2023.)

Competing Interests: The authors have no funding or conflicts of interest to disclose.

Multimedia learning theories suggest presenting associated pieces of information in spatial and temporal contiguity. New technologies like Augmented Reality allow for realizing these principles in science laboratory courses by presenting virtual real-time information during hands-on experimentation. Spatial integration can be achieved by pinning virtual representations of measurement data to corresponding real components. In the present study, an Augmented Reality-based presentation format was realized via a head-mounted display and contrasted to a separate display, which provided a well-arranged data matrix in spatial distance to the real components and was therefore expected to result in a spatial split-attention effect. Two groups of engineering students ( N = 107; Augmented Reality vs. separate display) performed six experiments exploring fundamental laws of electric circuits. Cognitive load and conceptual knowledge acquisition were assessed as main outcome variables. In contrast to our hypotheses and previous findings, the Augmented Reality group did not report lower extraneous load and the separate display group showed higher learning gains. The pre- and posttest assessing conceptual knowledge were monitored by eye tracking. Results indicate that the condition affected the visual relevancy of circuit diagrams to final problem completion. The unexpected reverse effects could be traced back to emphasizing coherence formation processes regarding multiple measurements., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Thees, Altmeyer, Kapp, Rexigel, Beil, Klein, Malone, Brünken and Kuhn.)

Augmenting reality via head-mounted displays (HMD-AR) is an emerging technology in education. The interactivity provided by HMD-AR devices is particularly promising for learning, but presents a challenge to human activity recognition, especially with children. Recent technological advances regarding speech and gesture recognition concerning Microsoft's HoloLens 2 may address this prevailing issue. In a within-subjects study with 47 elementary school children (2nd to 6th grade), we examined the usability of the HoloLens 2 using a standardized tutorial on multimodal interaction in AR. The overall system usability was rated "good". However, several behavioral metrics indicated that specific interaction modes differed in their efficiency. The results are of major importance for the development of learning applications in HMD-AR as they partially deviate from previous findings. In particular, the well-functioning recognition of children's voice commands that we observed represents a novelty. Furthermore, we found different interaction preferences in HMD-AR among the children. We also found the use of HMD-AR to have a positive effect on children's activity-related achievement emotions. Overall, our findings can serve as a basis for determining general requirements, possibilities, and limitations of the implementation of educational HMD-AR environments in elementary school classrooms.

We present a female neonate with a sternal cleft (SC) and additional aortic aneurysm who presented with respiratory failure. Stabilization of the SC was achieved by using the xyphoid process as an autologous graft bridging the upper part of the SC. We conclude that a step-wise correction of the SC with the use of an autologous graft may improve respiratory function, and should be considered when complete surgical correction is not feasible.

Objective: The aim of this study was to compare a retrospectively self-gated fast low angle shot sequence (RSG-FLASH) with a prospectively triggered fast low angle shot sequence (PT-FLASH) using an external trigger device for dynamic contrast-enhanced magnetic resonance imaging of the liver at 9.4 T in a rat model of colorectal cancer metastases., Materials and Methods: In 10 rats with hepatic metastases, we acquired an axial RSG-FLASH sequence through the liver. A FLASH sequence with prospective triggering (PT-FLASH) using an external trigger device was acquired at the same location with the same imaging parameters. After intravenous injection of 0.2 mmol/kg body weight of Gd-DTPA, alternating acquisitions of both sequences were performed at 4 consecutive time points.Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and lesion enhancement were obtained for liver tumors and parenchyma. In addition, we assessed the total acquisition times of the different imaging approaches for each acquisition, including triggering and gating. Two independent readers performed a qualitative evaluation of each sequence. Statistical analyses included paired t tests and Wilcoxon matched pairs signed rank tests., Results: No statistically significant differences in SNR, CNR, or lesion enhancement were observed. Qualitative assessments of the sequences were comparable. However, acquisition times of PT-FLASH were significantly longer (mean [SD], 160.6 [25.7] seconds; P < 0.0001) and markedly variable (minimum, 120 seconds; maximum, 209 seconds), whereas the RSG-FLASH approach demonstrated a constant mean (SD) acquisition time of 59.0 (0) seconds., Conclusions: The RSG-FLASH and PT-FLASH sequences do not differ qualitatively or quantitatively regarding SNR, CNR, and lesion enhancement for magnetic resonance imaging of the liver in the rats at 9.4 T. However, the variability of acquisition times for the PT-FLASH sequences is a major factor of inconsistency, and we therefore consider this approach as inappropriate for dynamic contrast-enhanced studies with multiple-measurement time points. In contrast, the RSG-FLASH sequence represents a fast, consistent, and reproducible technique suitable for contrast-agent kinetic studies in experimental small-animal imaging of the abdomen.

Introduction: To correlate cross sections of the intercondylar notch to cross sections of the anterior cruciate ligament (ACL) and to analyze gender-related differences in notch and ACL morphometry with an attempt to explain the observation that a small intercondylar notch and the female gender predispose to a rupture of the ACL., Material and Methods: High resolution MR imaging was performed on a 1.5 T magnet using a dedicated extremity-coil in ten left and ten right knee joints of 20 volunteers (10 male, 10 female, mean age 25 years) with no history of knee abnormalities. Continuous axial T2-weighted MR images perpendicular to the longitudinal axis of the ACL were acquired. Cross-sectional areas of the ACL midsubstance at the contact area to the posterior cruciate ligament were measured. For imaging and evaluation of the osseous limits of the intercondylar notch a 3D-dataset of the knee was acquired. Anterior, middle and posterior planes of the intercondylar notch were calculated and analyzed for measurement of the notch area AN and notch width index NWI. The ratio of the ACL cross-sectional area of the ACL and the cross-sectional area of the notch was defined as the ACL notch index (ANI) and used as a standardized tool for evaluation. For statistical evaluation, linear regression analysis was performed. Mean values between male and female were compared using a t test. In addition, five matched pairs of male and female volunteers of same height were analyzed., Results: Mean cross-sectional size of the ACL at the crossing with the PCL was 54.4 +/- 20.4 mm2. Regression analysis showed a significant correlation (P < 0.05) of the ACL cross-sectional area to the notch areas on all three planes and NWI, respectively. Comparison between the sexes revealed that female participants had significantly smaller cross-sectional areas of the ACL, the notch areas, the NWI and ANI. This difference was found for both the complete study group and the matched pairs of same height., Conclusions: The smaller the intercondylar notch the smaller the cross-sectional area of the ACL midsubstance. In addition to the impingement of the ACL at the anterior and posterior roof of the notch, a biomechanically weaker ACL may be the reason for disposition to an ACL rupture in patients with a small intercondylar notch. Women have a thinner ACL midsubstance than men of the same height which may be one of the critical etiologic factors that predispose women to an ACL rupture.

Objective: We sought to evaluate gadobenate dimeglumine for the detection and characterization of focal liver lesions in the unenhanced and already pre-enhanced liver., Materials and Methods: Sixty patients were evaluated prospectively. Unenhanced T1-weighted gradient echo (T1wGRE) and T2-weighted turbo spin echo (T2wTSE) images were acquired followed by contrast-enhanced T1wGRE images during the dynamic, equilibrium, and delayed phases after the bolus injection of 0.05 mmol/kg gadobenate dimeglumine. An identical series of dynamic images was then acquired after the delayed scan following a second 0.05 mmol/kg bolus of gadobenate dimeglumine. Images were evaluated randomly in 2 sessions by 3 independent blinded readers. Evaluated images in the first session comprised the unenhanced images, the first or second set of dynamic images, and the delayed images. The second session included the unenhanced images, the dynamic images not yet evaluated in the first session, and the delayed images. The 2 reading sessions were compared for lesion characterization and diagnosis, and kappa (kappa) values for interobserver agreement were determined. Quantitative evaluation of lesion contrast enhancement was also performed., Results: The enhancement behavior in the second dynamic series was similar to that in the first series, although pre-enhancement of the normal liver resulted in reduced lesion-liver contrast-to-noise ratios and the visualization of some lesions only on arterial phase images. Typical imaging features for the lesions included in the study were visualized clearly in both series. Strong agreement (kappa=0.56-0.89; all evaluations) between the 2 images sets was noted by all readers for differentiation of benign from malignant lesions and for definition of specific diagnosis, and between readers for diagnoses established based on images acquired in the unenhanced and pre-enhanced liver., Conclusion: Dynamic imaging in the hepatobiliary phase gives similar information as dynamic imaging of the unenhanced liver. This might prove advantageous for screening protocols involving same session imaging of primary extrahepatic tumors and liver.