Progressive supranuclear palsy (PSP) is a rare, relentlessly progressive, ultimately fatal neurodegenerative disease. Clinical phenotypes have been defined to describe observed heterogeneity in clinical characteristics of PSP patients; it is of interest to assess the potential of using datasets such as the one used in this study to determine predominant phenotypes of patients with PSP and enable epidemiological studies. We applied Movement Disorder Society (MDS)-PSP and Multiple Allocation eXtinction (MAX) algorithms for designating patients to PSP phenotypes using real-world data and describe the distribution of these phenotypes.

Data were drawn from the Adelphi PSP Disease Specific Programme, a real-world cross-sectional study of neurologists and people living with PSP in the USA, France, Germany, Italy, Spain, and the UK. Patients were allocated to PSP phenotypes using MDS criteria and MAX Rules.

Data from 892 patients with PSP were evaluated (mean age: 68.9 years; 60.7 % male), and 816 (91 %) patients could be allocated to >1 phenotype (mean: 7.3 per patient). After applying MAX Rules, mean number of phenotypes per patient reduced to 1.0, with only 2 % of patients still allocated multiple phenotypes. While 42 % of patients were initially designated as PSP-Richardson syndrome (RS), this increased to 75 % when signs throughout the entire patient record were considered.

In the largest study done to date, these findings in real-world data confirm that applying of MAX Rules to MDS-PSP criteria can yield a predominant phenotype for majority of PSP patients and reinforce suggestions that PSP-RS becomes the predominant phenotype over time.

Wolves (Canis lupus lupus) and lynx (Lynx lynx) are officially monitored species in Switzerland. Deceased individuals are subjected to post-mortem examination and collection of baseline health data. The procedure includes an assessment of different infectious agents, including Trichinella spp., the cause of a notifiable zoonotic infection. Between May 2009 and May 2023, a total of 100 wolves and 250 lynx were tested at the National Reference Laboratory for Trichinellosis by the artificial digestion method. Additionally, muscle samples from 8838 wild boars (Sus scrofa), 27 red foxes (Vulpes vulpes), and 23 European badgers (Meles meles), mainly submitted by Swiss hunters, were also analysed for Trichinella infection. Trichinella spp. larvae were detected in 16/100 (16 %) wolves, 41/250 (16.4 %) lynx, 2/27 (7.4 %) red foxes, 0/23 (0 %) badgers, and 1/8838 (0.01 %) wild boars. All positive samples were further tested by multiplex PCR to identify the parasite at the species/genotype level. Two species were detected: T. britovi (in 14 wolves, 33 lynx, 2 red foxes and 1 wild boar) and T. spiralis (in one lynx). In nine cases, the molecular identification was not possible. Although no cases of Trichinella spp. infection in domestic swine and horses were detected in the last decades in Switzerland, we revealed that these parasites, most frequently T. britovi, are still present in Swiss wildlife. Therefore, inspection of game meat remains very important, and the occurrence of sporadic infection in domestic animals cannot be excluded.

This study registered rates of specific treatment options for mental disorders as well as their long-term outcome.

The history of mental disorders was used as a proxy for diagnosis. The data came from the COMET-G study (40 countries; 54,826 subjects, 64.73 % females, 35.45±13.51 years old). The analysis included descriptive statistics, Risk Ratios, t-tests, and ANCOVA's.

24.14 % reported a history of any mental disorder (depression >12 %, non-affective psychosis and Bipolar disorder 1 % each, >20 % self-injury, >10 % had attempted suicide, 7.17 % illegal substance abuse). Most patients were not under any kind of treatment (59.44 %) and most were not receiving treatment as recommended (e.g. 90 % of Bipolar and 2/3 of psychotic patients). No treatment at all and psychotherapy as monotherapy were consistently related to poorer outcomes. In anxiety or depression, only antidepressant monotherapy and benzodiazepines, in Bipolar disorder only antipsychotic monotherapy in males and antidepressant monotherapy in females and in non-affective psychosis antipsychotics and psychotherapy in females only, were related to good outcomes. No treatment modality was related to a good outcome in those with a history of self-harm, suicidal attempts, or illegal substance use. Only depression and treatment with antidepressants were related to metabolic syndrome.

In the community, the overwhelming majority of mental patients do not receive appropriate treatment or, even worse, no treatment at all. The outcome is unfavourable for the majority and only a few selective treatment options seem to make a difference.

To analyze the phenotypic and genotypic characteristics of inherited retinal degeneration (IRD) patients of Malay and Indian ethnicity from Singapore and Malaysia.

Ethnic Malay and Indian IRD patients were consecutively enrolled from retina clinics in Singapore and Malaysia. Phenotypic and genetic data were reviewed.

A total of 100 unrelated individuals (Malay: n = 46, Indian: n = 54) were enrolled. Sixteen distinct IRD phenotypes were identified, with nonsyndromic retinitis pigmentosa (RP) comprising 46% of all cases. Stargardt disease and cone-rod dystrophy accounted for 20% and 11% of cases, respectively. Exome sequencing yielded genotypes in 64.3% of Malay and 68.9% of Indian cases. Variants in ABCA4 were the most common cause of IRD overall. Recurrent variants were identified in ABCA4, GUCY2D, PRPH2, and TULP1 for Malays, and in ABCA4 and MFSD8 (CLN7) for Indians. Homozygosity was more frequent among Indians than Malays (58.1% vs. 19.2%; p = 0.003).

This study demonstrated diverse phenotypic and genotypic outcomes in Malay and Indian populations of Singapore and Malaysia, with distinct differences between them. Homozygosity was common among ethnic Indian IRD cases, explaining phenotypic diversity. These findings inform the identification of regionally relevant IRDs for developing targeted therapies in Malay and Indian patients from Southeast Asia.

Our objective was to investigate the accuracy of prenatal diagnoses of congenital lung malformations (CLM) compared to postnatal diagnoses in a population in northern Finland and to estimate the birth prevalence of CLMs in the same population.

A retrospective review of all CLM cases in a tertiary referral center, Oulu University Hospital, Finland, in 2010-2020. Data were collected from medical records. The final postnatal diagnosis was recorded as the pathologic-anatomic diagnosis, if available, and otherwise as the postnatal radiologic diagnosis.

Our case series comprises 37 CLM cases. The prenatal detection rate of CLMs was 100%. The prenatal diagnosis was congenital pulmonary airway malformation (CPAM) in 34/37 cases (92%). The accuracy of prenatal CLM diagnoses was 60% compared to postnatal radiologic diagnoses and 51% compared to final postnatal diagnoses. Relative frequencies of different diagnoses in postnatally confirmed CLM cases were CPAM 47% (16/34 cases), bronchopulmonary sequestration (BPS) 15% (5/34), hybrid CPAM/BPS 15% (5/34), congenital lobar overinflation (CLO) 15% (5/34), bronchial atresia 6% (2/34), and bronchogenic cyst 3% (1/34). Postnatally confirmed cases of CPAM were more likely to have a higher CPAM-volume ratio at diagnosis (p = 0.002), a higher maximum CPAM-volume ratio during pregnancy (p < 0.001), macrocystic appearance on ultrasonography (p = 0.026), and mediastinal shift (p < 0.001) compared with the rest of the cases in this study. The prevalence of all CLMs combined was 3.71 cases per 10 000 live births. The prevalences of CPAM, BPS, hybrid CPAM/BPS, and CLO were 1.69, 0.56, 0.56, and 0.56 cases per 10 000 live births, respectively.

We found that all CLMs were detected prenatally, but almost half of the prenatal diagnoses were inaccurate compared to postnatal diagnoses. Most lesions were diagnosed prenatally as CPAM, but postnatally many of them turned out to be BPS, hybrid CPAM/BPS, or CLO. Postnatally confirmed CPAM cases were more likely to have a high CPAM-volume ratio, mediastinal shift, and macrocystic appearance on prenatal ultrasonography compared with other CLMs. The prevalence of CLMs is still relatively poorly documented, but we provide new estimates in Finland.

In biomedical research, the calculation of sample size is a critical component of study design. Adequate sample size ensures the reliability of statistical tests, including the chi-square test. This manuscript outlines the use of an online sample size calculator for chi-square tests. The paper includes detailed explanations of the formulas used in the calculations and highlights the importance of power analysis in planning research studies. This tool is designed to assist and guide researchers in determining the optimal sample size for detecting statistically significant differences in categorical data. We describe the theory behind the chi-square test, the statistical principles involved in sample size calculation, and the specific methodology for using the sample size calculator. The calculator is freely available to use at https://hanif-shiny.shinyapps.io/chi-sq/ .

Porcine circovirus 2 (PCV2) is an economically significant, ubiquitous pathogen affecting the global swine industry. While vaccines have been highly efficacious in controlling clinical disease, questions have arisen in recent years regarding gaps in clinical protection observed in the field due to heterologous PCV2 infection and coinfections with virulent, contemporary porcine reproductive and respiratory syndrome virus (PRRSV) isolates. Therefore, this study evaluated clinical, pathological, and immunological differences in homologous and heterologous PCV2 vaccinated pigs co-challenged with PCV2d and PRRSV. The study closely mimicked field conditions where 21-day-old commercial pigs were vaccinated with a commercial PRRSV vaccine and either a commercial PCV2a or PCV2d vaccine or left as PCV2 unvaccinated controls. Pigs were co-challenged with PCV2d and PRRSV restriction fragment polymorphism (RFLP) 1-7-4 28 days post-vaccination. In addition to significantly higher mortality, the unvaccinated group had significantly higher tissue viral load and viremia in addition to moderate to severe lymphoid depletion with significantly greater PCV2 antigen detected in the lymph nodes, tonsil, and lung compared to both vaccinated groups. While PCV2 vaccination regardless of subtype prevented the development of severe clinical PCVAD in the majority of vaccinates, the PCV2d vaccinates had reduced tissue viral load, significantly lower viremia, and reduced lymphoid depletion with less PCV2 antigen detected in tissues compared to the PCV2a vaccinates. Additionally, approximately 20 % of the PCV2a vaccinates had moderate to severe lymphoid depletion with moderate to severe antigen detection, which is associated with clinical PCVAD. While total levels of PCV2-specific antibodies measured by ELISA were similar between the PCV2a and PCV2d vaccinates, PCV1-2 chimeric virus neutralization assays revealed differential subtype-specific neutralizing antibody (NA) titers among the PCV2a and PCV2d vaccinates. Prior to challenge on day 28 (28 days post-vaccination), PCV2d vaccinates had significantly higher NA titers against the PCV1-2d vaccine and challenge chimeric viruses, while the PCV2a vaccinates had significantly higher NA titers against the PCV1-2a vaccine chimeric virus. Collectively, homologous vaccination may provide greater protection in virulent co-infection scenarios in the field. This study provides further insight into differences in protection elicited by homologous and heterologous vaccination, resulting in valuable insights to enhance PCV2 control strategies in the current PCV2d/PRRSV co-infection paradigm.

The aim of this study was to evaluate the quality of structured reporting of MRI examinations in patients at risk for HCC using the Liver Imaging Reporting and Data System (LI-RADS) created during the daily clinical routine.In this retrospective study, MRI examinations of 163 patients under HCC surveillance and HCC follow-up were analyzed. The study cohort included a group of 76 patients whose examinations were performed using free-text reporting and a group of 87 patients with structured template reporting based on the LI-RADS criteria. The diagnostic accuracy of the specified LI-RADS category was analyzed for both groups. The impact of structured reporting and the frequency of reporting of the major and ancillary LI-RADS features in free-text reports and structured reports were compared using the χ²-test.Liver lesions were classified according to LI-RADS significantly more often in the structured reports (91.4%) than in the unstructured free-text reports (82.6%) (p < 0.01). Most relevant major LI-RADS criteria were described significantly more frequently when using the structured report template compared to free text, e.g., arterial hyperenhancement 100% vs. 92.5% (p < 0.01) and washout 93.4% vs. 79.7% (p < 0.01). Only the documentation of threshold growth was not significantly improved, but absolute lesion size was reported significantly more often within the structured reports. The diagnostic accuracy of the LI-RADS category was higher for the structured reports than for the free-text reports (82.3% vs. 63.9%).Structured reporting improves LI-RADS documentation in MRI reports of patients at risk for HCC and may help with multidisciplinary communication and patient management. · Structured reporting showed improved documentation of key features for LI-RADS classification compared to nonstructured MRI reports.. · Structured reports improve the categorization of liver lesions according to LI-RADS in patients at risk for HCC.. · Nelles C, Wagner A, Lennartz S et al. Clinical Benefit of Structured Reporting Using the Liver Imaging Reporting and Data System (LI-RADS) in MRI in Patients at Risk for Hepatocellular Carcinoma. Rofo 2025; DOI 10.1055/a-2553-1392.

Project ECHO (Extension for Community Healthcare Outcomes) links experts with community providers through video teleconferences that include both didactics and case discussions. We piloted the first ECHO with a specific focus on reproductive rheumatology intended to increase rheumatologists' knowledge and self-efficacy in providing reproductive health care.

The Project ECHO guides informed ReproRheum ECHO curriculum development, provider recruitment, logistics, and assessment. Assessments included interviews and pre/post surveys to assess knowledge, self-efficacy, and identify program strengths and weaknesses.

Eight rheumatology providers (5 physicians, 2 nurse practitioners, 1 rheumatology fellow) and 4 experts (2 reproductive rheumatologists, 2 maternal-fetal medicine physicians) participated in six 1-hour ReproRheum ECHO sessions from January to March 2023. All but one provider attended all sessions, demonstrating feasibility. Knowledge of the rate of birth defects after exposure to both azathioprine and mycophenolate significantly increased in participating physicians. Provider self-efficacy also increased significantly (6.8 ± 1.2 pre-ECHO to 8.1 ± 0.5 post-ECHO, p = 0.03). All participants "agreed" or "strongly agreed" that they had increased confidence in their ability to answer colleagues' questions and guide patients' choices in contraception and medication in pregnancy. In interviews, providers reported satisfaction with and appreciation of both didactic and case discussions, the multidisciplinary approach, and connecting with other providers. They reported improved comfort and increased frequency of discussing reproductive health in practice.

The pilot ReproRheum ECHO was feasible and improved knowledge and self-efficacy among rheumatologists in reproductive health. This model is a promising approach to improving reproductive health care for women with rheumatic disease.

Many longitudinal Alzheimer's disease studies fail to retain Black American adults once enrolled. This limits the generalizability of research findings.

The Community-Engaged Digital Alzheimer's Research (CEDAR) study developed digital, culturally-informed, community-engaged efforts to increase longitudinal registry task completion of Black American Brain Health Registry (BHR) participants. Difference-in-differences analysis was conducted to compare longitudinal registry task completion rates within groups (before vs. after CEDAR referral) and between groups (enrolled in CEDAR vs. not enrolled).

Of 3888 invited Black American BHR participants, 420 (10.8%) enrolled in CEDAR. For CEDAR participants, we found significant increases in enrollment rate into referral studies and BHR timepoint completion rate after enrollment into CEDAR. Compared to those not enrolled, CEDAR participants had higher rates of: enrollment in referral studies, timepoint completion, initial questionnaire completion, and neuropsychological test completion.

The results provide preliminary evidence that CEDAR's culturally-informed, community-engaged research efforts were effective at improving engagement of Black American adults in an online longitudinal study. This is evidenced by increased registry engagement before and after enrollment and in comparison to Black American BHR participants not enrolled in CEDAR. These results need to be interpreted cautiously due to selection biases. This strategy can be adapted to other studies and settings.

CEDAR is an online AD/ADRD registry engagement intervention for Black participants.The intervention is community-engaged, digital, culturally-informed, and multifaceted.Engagement rates increased before versus during the intervention for enrollees.Engagement rates decreased over the same time period for non-enrolled participants.Results need to be interpreted with caution due to selection biases.

Scalp-EEG incompletely covers the frontal lobe cortex. Underrepresentation of frontobasal or frontomesial structures, fast ictal spreading, and false lateralization impede scalp-EEG interpretation. Hence, we investigated the significance of scalp-EEG in the presurgical workup of frontal lobe epilepsy.

Using descriptive statistical methods and Pearson chi-squared test for group comparisons, we retrospectively investigated postsurgical outcome, interictal epileptiform discharges (iiEDs), and electrographic seizure patterns on scalp-EEG in 81 consecutive patients undergoing resective epilepsy surgery within the margins of the frontal lobe.

Postoperatively, patients with frontopolar iiEDs ( n = 7) or concordant frontopolar iiED focus and seizure-onset ( n = 2) were seizure free ( n = 7/7, Engel Ia). MRI-positive patients with frontopolar iiEDs or frontopolar seizure-onset ( n = 1/8 Engel Id, n = 7/8 Engel Ia) underwent surgery without stereo-EEG. Thirteen of 16 patients with frontolateral ( n = 8/10, Engel Ia), or left frontobasal ( n = 5/6, Engel Ia) seizure-onset undergoing further stereo-EEG, were seizure-free postoperatively. Seizure-onset prevalent over one electrode ( n = 37/44 Engel I, p = 0.02), fast activity (FA)/flattening at seizure-onset ( n = 29/33 Engel I, p = 0.02), FA/flattening during the seizure ( n = 38/46 Engel I, p = 0.05), or focal rhythmic sharp-/spike-/polyspike-and-slow waves during the seizure ( n = 24/31, Engel Ia, p = 0.05) were favorable prognostic markers. Interictal polyspike waves ( p = 0.006 for Engel Ia) and interictal paroxysmal FA ( p = 0.02 for Engel I) were unfavorable prognostic markers.

Frontopolar scalp-EEG findings serve as biomarkers for predicting favorable surgical outcome in lesional frontal lobe epilepsy. Consequently, careful analysis of scalp-EEG assists in bypassing stereo-EEG in these patients.

The objectives of this study were to i) provide population-level prevalence rates of pregnancy, birth, elective termination, and miscarriage among females treated for SUDs and their demographic counterparts and ii) examine associations between SUD treatment and pregnancy and elective terminations.

Data were analyzed from a prospective registry-linkage study of all females (15-45 years) recorded as treated for SUDs in the Norwegian Patient Registry over a 2-year period (n = 6470) and a non-treated frequency-matched cohort of females from the general population (n = 6286). Pregnancy and pregnancy outcomes over a 4-year follow-up were retrieved from the Norwegian Patient Registry. Multivariable logistic regression models tested for associations of SUD treatment with pregnancy and with elective termination among pregnant females.

Annual pregnancy and elective termination rates per 1000 females were significantly higher for the SUD cohort than the non-treated cohort (94.2 vs 71.3 for pregnancy, P < 0.001; 54.7 vs 17.8 for elective termination, P < 0.001), the annual birth rate was lower for the SUD cohort (25.3 vs 41.8, P < 0.001), and the rate of miscarriage did not differ across cohorts. Multivariable analysis showed that SUD treatment was associated with a significant increase in the odds of pregnancy (adjusted Odds Ratio 1.34, Confidence Interval [1.18-1.54]) and the odds of an elective termination, conditional on pregnancy (aOR 2.55, Confidence Interval [1.97-3.29]).

Females treated for SUDs had substantially higher odds of pregnancy and elective terminations than the non-treated cohort. To improve their reproductive health, targeted interventions such as free long-acting contraception and integration of family planning guidance into substance use treatment should be considered.

Rencofilstat inhibits cyclophilin to reduce hepatic inflammation and fibrosis, which, in turn, could improve liver function and reduce portal-systemic shunting. Since HepQuant quantifies liver function and portal-systemic shunting, it was used to measure the hepatic effects of rencofilstat treatment of MASH with advanced fibrosis.

Seventy subjects with suspected ≥ F3 MASH, defined from liver biopsy or AGILE 3+ ≥ 0.53, were randomised to rencofilstat 75 mg/d (n = 24), 150 mg/d (n = 23) or 225 mg/d (n = 23), and tested by HepQuant at baseline, 60 and 120 days. The DuO version included oral dosing of d4-cholate and two blood samples (20 and 60 min). DuO's disease severity index (DSI) and portal-systemic shunting fraction (SHUNT%) were evaluated for changes from baseline at 60 and 120 days of rencofilstat treatment.

Across all subjects, there was a significant decrease in SHUNT% both at Day 60 (-1.67%, p = 0.0156) and Day 120 (-1.55%, p = 0.0441). In the 225 mg rencofilstat arm, 56% of subjects (10/18) were responders by Day 120 (p = 0.0549), and their DSIs improved with a mean change of -1.61 (p = 0.0190). Across all treatment arms, subjects with DSI > 18.3 at baseline had the greatest improvement with treatment (ΔDSI = -2.59, p = 0.0053).

Although further studies are warranted, the decreases in DSI and SHUNT% suggest that rencofilstat 225 mg/d improves hepatic function and portal-systemic shunting. HepQuant DuO is simple to administer, well-tolerated and a useful tool for detecting the hepatic effects of treatment.

The study was registered at ClinicalTrials.gov, NCT05461105.

A number of immunohistochemical stains have been examined for utility in establishing the site of origin for metastatic well-differentiated neuroendocrine tumors (NETs). In the gastrointestinal (GI) tract, distinguishing metastatic duodenal NETs from jejunoileal and other GI NETs is important for clinical work-up, prognosis, and therapy. A recent study indicated that prohormone convertase 2 (PCSK2 or PC2) had broad expression in small intestine and appendiceal NETs. Because the study did not include duodenal NETs, we examined PCSK2 expression in duodenal and other GI NETs.

GI NETs (n = 69) and 13 corresponding lymph node metastases from stomach, duodenum, pancreas, ileum, appendix, and rectum were evaluated for the expression of PCSK2, along with ISL1, NKX2.2, CDX2, SATB2, and PAX8. Expression of each stain was evaluated using the H-score system, and differences in expression by site were evaluated by the chi square test.

PCSK2 was expressed at similar frequency in duodenal (50%), pancreatic (59%), and ileal NETs (40%). PCSK2 was infrequently expressed in stomach (0%), appendiceal (8%), and rectal (25%) NETs. However, incorporating PCSK2 into a panel including ISL1, NKX2.2, CDX2, and SATB2 allowed development of an algorithm which had 87% sensitivity and 93% specificity for classification of ileal NETs; and 68% sensitivity and 98% specificity for pancreaticoduodenal NETs.

In contrast to previous findings, PCSK2 does not show specificity for any particular GI site. An algorithmic approach incorporating the expression of PCSK2 with that of ISL1, NKX2.2, CDX2, and SATB2 is useful in discriminating pancreatic, duodenal, ileal, appendiceal, and rectal NETs.

The World Health Organization (WHO) recommended cryptococcal antigen (CrAg) screening for people presenting with advanced HIV disease (AHD) and for those with positive CrAg without evidence of meningitis to initiate preemptive antifungal medication. Data on the implementation of WHO recommendations regarding CrAg screening is limited. We estimated pooled prevalence of CrAg screening uptake, cryptococcal antigenemia, lumbar puncture, cryptococcal meningitis and initiation of preemptive antifungal medication from available eligible published studies conducted in Africa.

PubMed, Cochrane Library and Embase were searched for articles published between January 2011 and December 2023. CrAg uptake was defined as percentage of eligible people (CD4 ≤ 200 cells/mm3 or WHO stage III/IV) who received cryptococcal antigen testing. Stratified analysis to compare uptake and cryptococcal antigenemia between studies that involved multiple vs single sites was performed. Using random effects models, we computed the pooled estimate of CrAg screening uptake, cryptococcal antigenemia, lumbar puncture, cryptococcal meningitis, preemptive antifungals treatment and 95% confidence intervals (CIs).

Ten studies with 18,820 individuals with AHD were analyzed. Overall, the pooled estimate of CrAg screening uptake was 57.1% (95% CI: 41.4-72.7). CrAg screening uptake was significantly lower among studies that involved multiple sites compared to those that involved single site, (47.3% vs 73.3%; p<0.001). Overall, the pooled prevalence of cryptococcal antigenemia was 9.6% (95% CI:6.4-12.9). Cryptococcal antigenemia was significantly lower among studies that involved multiple sites compared to those that involved single site, (9.1% vs 10.4%; p<0.001). Among those who tested positive for CrAg, 84.6% (95% CI: 54.1-99.0) received preemptive antifungal treatment, though nearly 25% did not undergo lumbar puncture, highlighting gaps in diagnostic follow-up. Six studies evaluated CrAg positive patients with lumbar puncture and the overall prevalence of lumbar puncture was 74.9% (48.0-94.8). The overall prevalence of cryptococcal meningitis was 58.1% (46.6-69.6).

Not screening for CrAg among people with AHD and failure to initiate antifungal medications among eligible patients with cryptococcal antigenemia presents a significant missed opportunity. Emphasis on improving CrAg screening is critical given its proven cost-effective benefits.

Clean intermittent catheterization (CIC) has significant advantages over indwelling catheters. To facilitate CIC, a continent catheterizable channel (CCC) to the bladder is required in some cases. The Mitrofanoff appendicovesicostomy (APV) is considered the gold standard for pediatric CCC creation. However, when the appendix is unavailable or unsuitable for the creation of a CCC alternatives are required.

This study aims to share our single-center experience with using a spare ureter as a CCC in pediatric patients and compare its advantages and complications to those of APV and the use of bowel segments.

A retrospective review of the medical records of all pediatric patients who underwent CCC creation between 2001 and 2023 was performed. The inclusion criteria were age younger than 18 years at surgery and the use of an appendix, ileal segment, or ureter for CCC creation.

A total of 108 pediatric patients underwent CCC creation. Of these, 90 had an APV, 5 had an ileal segment CCC, and 13 had a ureteral CCC. Operating times were not significantly different among the groups. The median follow-up was 78 months for the ureter group, 66 months for the APV groups and 13 months for the ileal group. The stomal continence rates were 92 % for the ureter group, 97 % for the APV group, and 100 % for the ileal group. Stomal complications occurred in 15.4 % of ureter CCCs, 25.6 % of APVs, and 40 % of ileal CCCs. No significant differences in complication rates were observed among the groups.

Our findings demonstrate that ureteral CCCs have acceptable complication rates and functional outcomes comparable to those of APVs and ileal CCCs. The limitations of this study include its retrospective design and small sample size, especially in the ureteral and ileal groups. Future prospective studies with larger cohorts are recommended to further validate these findings.

Our study indicates that the utilizazion of a spare ureter for CCC creation is a feasible and effective alternative in pediatric patients with a nonfunctioning kidney.

To determine the prevalence of piriformis syndrome (PS) among undergraduate university health sciences students aged 18 to 25 and assess the significant predictors of PS regardless of its type and severe PS in particular.

A cross-sectional study.

The study was conducted at a tertiary care hospital of a public university in Pakistan from December 2023 to May 2024.

A total of 190 subjects enrolled in the study who met the eligibility criteria, which included being an undergraduate health sciences student (medical and allied health specialities), aged 18 up to 25 years, and willing to participate in the study. Participants were selected using multistage random sampling.

The prevalence of PS in addition to associated risk factors as a primary outcome measures. Secondary outcome measures included the severity of PS.

Of the total, 119 (62.6%) were female, 114 (60.0%) were between 22 and 25 years old, and 125 (65.8%) had standard body mass index. The prevalence of PS was (61.1%), whereas half suffered from severe PS, and the remaining half had mild and moderate PS. We found that factors such as casual sitting positions, sitting duration and International Physical Activity Questionnaire (IPAQ) score (physical activity) were associated with odds of PS in the crude and adjusted regression analyses. When stratified by severity of PS, factors such as writing positions, casual sitting positions, sitting duration and IPAQ score (physical activity) were associated with odds of severe PS in the crude and adjusted regression analyses.

Students have a high prevalence of PS, with an increased likelihood of buttock pain associated with prolonged sitting, poor posture and physical inactivity. Future research that includes several factors related to students' social and psychological backgrounds is required.

Paraguay, an agricultural country in South America, has a high prevalence of tick infestations in its cattle population due to warm temperatures, high humidity, and extensive grazing management practices. Consequently, Babesia infections, which are transmitted by ticks, might have a wide distribution in Paraguay, but the current status of these infections remains uncertain. Therefore, we aimed to assess the infection status of three clinically significant Babesia species, including Babesia bovis, Babesia bigemina, and Babesia naoakii, among cattle populations in Paraguay. Blood samples were collected from a total of 326 cattle across nine departments in Paraguay, and their DNAs were screened with species-specific PCR assays. Of the surveyed cattle, single infections of B. bovis and B. bigemina were detected in 24 (7.4 %) and 127 (39.0 %), respectively, while co-infection with both the parasite species was detected in 38 (11.7 %). In contrast, all of the surveyed cattle were negative for B. naoakii infection. The prevalence of B. bigemina-single infection was higher in the Eastern region (49.0 %) compared to the Western region (34.6 %), in cattle under extensive management (51.3 %) compared to those under semi-intensive management (34.6 %), and in Bos indicus cattle (50.3 %) compared to Bos taurus (15.8 %). Our findings demonstrated a wide distribution of B. bovis and B. bigemina infections among cattle in Paraguay, underscoring the importance of implementing effective control measures to reduce the potential economic losses associated with bovine babesiosis.

To examine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) with Sonazoid (Sonazoid-CEUS) for endometrial lesions.

In this prospective and multicenter study, data were collected from 84 patients with endometrial lesions from 11 hospitals in China. All the patients received a conventional US and Sonazoid-CEUS examination. The lesion characteristics based on US and Sonazoid-CEUS imaging were collected from the case report forms. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined using histopathologic diagnosis as the gold standard.

Of the 79 patients included, 29 were diagnosed with benign lesions and 50 with endometrial carcinoma (EC). The accuracy, sensitivity, specificity, PPV, and NPV for Sonazoid-CEUS and US at differentiating EC from benign endometrial lesions were 82.2%, 94%, 62.1%, 81.0%, and 85.7%, and 79.7%, 96%, 51.7%, 92.3%, and 88.2%, respectively, with no significant differences observed for any of the values. For Sonazoid-CEUS, the best delineators of EC versus benign lesions were early enhancement and hyperenhancement (74% vs 53.3%, P = 0.029, 68% vs 45%, P < 0.001), and lesion size enlargement (76% vs 48%, P = 0.001). Despite finding no significant difference in the enhancement patterns (P = .367), a faster wash-in pattern with the contrast agent entering before the surrounding myometrium was more common in the EC vs benign cases (92% vs 48.3%).

Sonazoid-CEUS has higher accuracy, specificity, and comparable sensitivity for differentiating EC from benign endometrial lesions compared with conventional US. It provides complementary hemodynamics information reflective of tissue vascularization, which may improve the overall diagnostic efficiency.

Oxytocin (OT) is a crucial modulator of social cognition and behavior. Previous work primarily examined effects of acute intranasal oxytocin administration (IN-OT) in younger males on isolated brain regions. Not well understood are (i) chronic IN-OT effects, (ii) in older adults, (iii) on large-scale brain networks, representative of OT's wider-ranging brain mechanisms. To address these research gaps, 60 generally healthy older adults (mean age = 70.12 years, range = 55-83) were randomly assigned to self-administer either IN-OT or placebo twice daily via nasal spray over four weeks. Chronic IN-OT reduced resting-state functional connectivity (rs-FC) of both the right insula and the left middle cingulate cortex with the salience network but enhanced rs-FC of the left medial prefrontal cortex with the default mode network as well as the left thalamus with the basal ganglia-thalamus network. No significant chronic IN-OT effects were observed for between-network rs-FC. However, chronic IN-OT increased selective rs-FC of the basal ganglia-thalamus network with the salience network and the default mode network, indicative of more specialized, efficient communication between these networks. Directly comparing chronic vs. acute IN-OT, reduced rs-FC of the right insula with the salience network and between the default mode network and the basal ganglia-thalamus network, and greater selective rs-FC of the salience network with the default mode network and the basal ganglia-thalamus network, were more pronounced after chronic than acute IN-OT. Our results delineate the modulatory role of IN-OT on large-scale brain networks among older adults.

A community athlete with an anterior cruciate ligament (ACL) injury is 2.5 times more likely to have a family history of ACL injury than an athlete without an ACL injury. The prevalence of family history and its relationship to ACL injury has not been investigated in elite athletes playing a high-risk sport such as Australian rules football.

The purpose of this study was to determine whether there is an association between primary ACL injury and family history in professional male and female Australian Football League (AFL) players. It was hypothesized that players with a history of ACL injury would have greater rates of family history.

Case-control study; Level of evidence, 3.

All AFL players in the state of Victoria, Australia, were invited to complete a survey querying about their history of ACL injury and whether they had any immediate family members with a history of ACL injury. ACL injury history was compared in those with and without a family history of ACL injury according to sex.

Completed surveys were obtained from 615 out of a possible 672 (91.5%) AFL players, of whom 410 were men and 205 were women. Of players with a history of ACL injury, family history was reported in 47% of male players (15 of 32) and 32% of female players (7 of 22). Male players with an ACL injury history were 3.19 times (95% CI, 1.55-6.76; P < .003) more likely to have a positive family history compared with those without ACL injury, and female players with an ACL injury history were 1.7 times (95% CI, 0.66-4.5; P = .2) more likely to report a family history than those without.

A strong association was observed between family history and primary ACL injury history in male Australian rules football players. The same association was not statistically significant in female players.

Leishmania is a genus of the family Trypanosomatidae that unites obligatory parasitic flagellates causing a variety of vector-borne diseases collectively called leishmaniasis. The symptoms range from relatively innocuous skin lesions to complete failures of visceral organs. The disease is exacerbated if a parasite harbors Leishmania RNA viruses (LRVs) of the family Pseudototiviridae. Screening a novel isolate of L. braziliensis, we revealed that it possesses not a toti-, but a bunyavirus of the family Leishbuviridae. To the best of our knowledge, this is a very first discovery of a bunyavirus infecting a representative of the Leishmania subgenus Viannia. We suggest that these viruses may serve as potential factors of virulence in American leishmaniasis and encourage researchers to test leishmanial strains for the presence of not only LRVs, but also other RNA viruses.

The objective of this study was to compare drink driving and related road safety issues in 2 urban areas of 6 countries and develop an equation for estimating the rate of crash underreporting to the police in urban areas of countries that lack this information.

This study is a secondary analysis of 1 to 2 waves of surveys in pairs of matched medium-sized cities in Belgium, Brazil, China, Mexico, South Africa, and Ohio, United States; the surveys supported evaluation of local alcohol harm reduction efforts. Data were from 2017 to 2019 except 2023 for Mexico. Mailed surveys in Ohio and household interviews elsewhere of quota samples matched to census data yielded 23,240 completed interviews. Relevant questions covered drinking, driving under the influence of alcohol (DUI), DUI enforcement, and, except in South Africa, road crashes. GLM regression provided an equation for estimating police reporting rates of urban injury and no-injury crashes from a country's purchasing-power parity-adjusted gross domestic product (GDP) per capita.

The percentage of drivers driving unlicensed was 30% in Mexico and South Africa, 15% in Brazil, 8% in China, and <1% elsewhere. Among adults who both drove and drank, self-reported urban DUI rates ranged from 12% in China to 53% in South Africa, with 4 countries between 18% and 26%. Among those reporting DUI, the percentage stopped by police for doing so was 14% in Belgium, 15% in Brazil, 25% in China, 31% in Mexico, 45% in South Africa, and only 3% in Ohio. The surveys yielded data on 380 urban crashes. Past-year crash involvement was 2% to 3% in Belgium and China and 5% to 6% elsewhere. The 10% injury rate in Ohio crashes was significantly below the 24% to 35% rates elsewhere. Injury crashes were almost universally reported except in Brazil (60% reported). Only 49% to 56% of non-injury crashes were reported, except in Ohio (73%). Perceived alcohol-involved crash rates of 18% to 19% in Belgium and Ohio were significantly lower than the 32% reported in Brazil, 41% in China, and 57% in Mexico. In the regression, GDP per capita and injury involvement were positively associated with police crash reporting.

Our equation more closely approximates urban police crash reporting rates than prior studies that assumed that they matched U.S. data. DUI enforcement is weak/ineffective in urban Ohio. With suggested adjustments, our survey questions should be usable in other international road safety and DUI studies.

Somatostatin receptor positron emission tomography/computed tomography (SSTR-PET/CT) using [68Ga]-labeled tracers is a widely used imaging modality for neuroendocrine tumors (NET). Recently, [18F]SiTATE, a SiFAlin tagged [Tyr3]-octreotate (TATE) PET tracer, has shown great potential due to favorable clinical characteristics. We aimed to evaluate the reproducibility of Somatostatin Receptor-Reporting and Data System 1.0 (SSTR-RADS 1.0) for structured interpretation and treatment planning of NET using [18F]SiTATE.

Four readers assessed [18F]SiTATE-PET/CT of 95 patients according to the SSTR-RADS 1.0 criteria at two different time points. Each reader evaluated up to five target lesions per scan. The overall scan score and the decision on peptide receptor radionuclide therapy (PRRT) were considered. Inter- and intra-reader agreement was determined using the intraclass correlation coefficient (ICC).

The ICC analysis on the inter-reader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 85%), overall scan score (ICC ≥ 90%), and the decision to recommend PRRT (ICC ≥ 85%) showed excellent agreement. However, significant differences were observed in recommending PRRT among experienced readers (ER) (p = 0.020) and inexperienced readers (IR) (p = 0.004). Compartment-based analysis demonstrated good to excellent inter-reader agreement for most organs (ICC ≥ 74%), except for lymph nodes (ICC ≥ 53%).

SSTR-RADS 1.0 represents a highly reproducible and consistent framework system for stratifying SSTR-targeted PET/CT scans, even using the novel SSTR-ligand [18F]SiTATE. Some inter-reader variability was observed regarding the evaluation of uptake intensity prior to PRRT as well as compartment scoring of lymph nodes, indicating that those categories require special attention during further clinical validation and might be refined in a future SSTR-RADS version 1.1.

SSTR-RADS 1.0 is a consistent framework for categorizing somatostatin receptor-targeted PET/CT scans when using [18F]SiTATE. The framework serves as a valuable tool for facilitating and improving the management of patients with NET.

SSTR-RADS 1.0 is a valuable tool for managing patients with NET. SSTR-RADS 1.0 categorizes patients with showing strong agreement across diverse reader expertise. As an alternative to [68Ga]-labeled PET/CT in neuroendocrine tumor imaging, SSTR-RADS 1.0 reliably classifies [18F]SiTATE-PET/CT.

To assess the performance of Chat Generative Pre-Trained Transformer-4 in providing accurate diagnoses to retina teaching cases from OCTCases.

Cross-sectional study.

Retina teaching cases from OCTCases.

We prompted a custom chatbot with 69 retina cases containing multimodal ophthalmic images, asking it to provide the most likely diagnosis. In a sensitivity analysis, we inputted increasing amounts of clinical information pertaining to each case until the chatbot achieved a correct diagnosis. We performed multivariable logistic regressions on Stata v17.0 (StataCorp LLC) to investigate associations between the amount of text-based information inputted per prompt and the odds of the chatbot achieving a correct diagnosis, adjusting for the laterality of cases, number of ophthalmic images inputted, and imaging modalities.

Our primary outcome was the proportion of cases for which the chatbot was able to provide a correct diagnosis. Our secondary outcome was the chatbot's performance in relation to the amount of text-based information accompanying ophthalmic images.

Across 69 retina cases collectively containing 139 ophthalmic images, the chatbot was able to provide a definitive, correct diagnosis for 35 (50.7%) cases. The chatbot needed variable amounts of clinical information to achieve a correct diagnosis, where the entire patient description as presented by OCTCases was required for a majority of correctly diagnosed cases (23 of 35 cases, 65.7%). Relative to when the chatbot was only prompted with a patient's age and sex, the chatbot achieved a higher odds of a correct diagnosis when prompted with an entire patient description (odds ratio = 10.1, 95% confidence interval = 3.3-30.3, P < 0.01). Despite providing an incorrect diagnosis for 34 (49.3%) cases, the chatbot listed the correct diagnosis within its differential diagnosis for 7 (20.6%) of these incorrectly answered cases.

This custom chatbot was able to accurately diagnose approximately half of the retina cases requiring multimodal input, albeit relying heavily on text-based contextual information that accompanied ophthalmic images. The diagnostic ability of the chatbot in interpretation of multimodal imaging without text-based information is currently limited. The appropriate use of the chatbot in this setting is of utmost importance, given bioethical concerns.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Previously, we showed that the germ cell-specific nuclear protein RBMXL2 represses cryptic splicing patterns during meiosis and is required for male fertility (Ehrmann et al., 2019). Here, we show that in somatic cells the similar yet ubiquitously expressed RBMX protein has similar functions. RBMX regulates a distinct class of exons that exceed the median human exon size. RBMX protein-RNA interactions are enriched within ultra-long exons, particularly within genes involved in genome stability, and repress the selection of cryptic splice sites that would compromise gene function. The RBMX gene is silenced during male meiosis due to sex chromosome inactivation. To test whether RBMXL2 might replace the function of RBMX during meiosis we induced expression of RBMXL2 and the more distantly related RBMY protein in somatic cells, finding each could rescue aberrant patterns of RNA processing caused by RBMX depletion. The C-terminal disordered domain of RBMXL2 is sufficient to rescue proper splicing control after RBMX depletion. Our data indicate that RBMX and RBMXL2 have parallel roles in somatic tissues and the germline that must have been conserved for at least 200 million years of mammalian evolution. We propose RBMX family proteins are particularly important for the splicing inclusion of some ultra-long exons with increased intrinsic susceptibility to cryptic splice site selection.

Equine piroplasmosis is caused by Theileria equi and Babesia caballi, which are hemoprotozoan parasites. Understanding the epidemiology and genotypes of T. equi and B. caballi is crucial for developing effective control strategies in endemic countries. However, the endemic status of these two parasite species remains uncertain in Kyrgyzstan due to lack of surveys. Our study, therefore, aimed to detect T. equi and B. caballi infections in Kyrgyzstan and identify their genotypes. Blood samples were collected from 226 horses across all seven provinces of Kyrgyzstan, namely Chuy, Issyk-Kul, Naryn, Talas, Jalal-Abad, Osh, and Batken. These blood samples were subjected to DNA extraction, followed by specific PCR assays targeting T. equi and B. caballi. We found that 56 (24.8%, confidence interval (CI): 19.6-30.8%) and 7 (3.1%, CI: 1.5-6.3%) of the tested horses were positive for T. equi and B. caballi infections, respectively. Theileria equi was detected in all surveyed provinces, whereas B. caballi was found in five provinces, except for Talas and Osh. Subsequent genotype-specific PCR assays showed that T. equi-positive horses harbored all five genotypes: A, B, C (also known as Theileria haneyi), D, and E. On the other hand, phylogenetic analysis of B. caballi rap-1 sequences detected the genotypes A and B1. The prevalence of T. equi and B. caballi suggests a potential risk of clinical equine piroplasmosis among horses in Kyrgyzstan, and the observed genotypic diversity underscores the challenges in managing the disease. Our findings emphasize the need for comprehensive control measures to effectively address equine piroplasmosis in Kyrgyzstan.

Parkinson's Disease (PD) is a clinically diagnosed disease that carries a reported misdiagnosis rate of 10-20%. Recent scientific discoveries have provided evidence of volatile organic compounds in sebum that are unique to patients with PD. The primary objective of this study was to determine if companion dogs could be trained to distinguish between sebum samples provided by PD-positive patients and PD-negative human controls. This was a randomized, handler-blind, controlled study. Twenty-three canines of varying breeds, ages, and environmental backgrounds were included. The study period encompassed 200 total working days from 2021 to 2022. Factors investigated included donor gender and levodopa drug affectivity, as well as canine breed, age, and duration of training time. The findings in this study were compiled from data collected during the final two years of a seven-year research program. For this two-year reporting period, when averaged as a group, the 23 dogs were 89% sensitive and 87% specific to olfactory distinction between PD-positive and PD-negative human donor samples. Ten of the twenty-three dogs averaged 90% or higher in both sensitivity and specificity. In 161 separate trials, a dog was presented with both novel PD-positive and PD-negative samples. For these novel exposures, the dogs collectively averaged 86% sensitivity and 89% specificity. PD medication was also investigated and was found to have no discernible impact on canine sensitivity or specificity results. Study findings support the application of companion dogs, trained with force-free, reward-based methodologies, for the detection of PD-positive and PD-negative samples under controlled conditions.