Minimally invasive neurosurgical techniques have emerged as a transformative paradigm, offering alternatives to conventional open approaches. The demand for safer, less invasive procedures accelerated the development of laser interstitial thermal therapy (LITT), focused ultrasound (FUS), and radiofrequency ablation (RFA), each employing a distinct mechanism with unique clinical implications. The objective was to critically evaluate and contextualize LITT, FUS, and RFA with emphasis on their comparative efficacy, safety, and roles as competing or complementary technologies in minimally invasive neurosurgery. Literature published between 2005 and 2025 was identified through PubMed, Scopus, and Web of Science, using keywords "LITT," "FUS," "RFA," "minimally invasive neurosurgery," "epilepsy," "glioma," and "movement disorders." Eligible English studies included clinical trials, systematic reviews, meta-analyses, and large observational studies. The extracted data were synthesized narratively, focusing on clinical indications, efficacy, safety, and patient-centered outcomes. Evidence highlights the roles of LITT, FUS, and RFA across tumors, epilepsy, and movement disorders with differing efficacy and safety indications. LITT is most effective in gliomas and metastases, FUS shows its strongest evidence in movement disorders, whereas LITT and RFA via stereo-electroencephalography-guided thermocoagulation remain relevant in epilepsy. Reported safety outcomes include edema with LITT, skull heating with FUS, and hemorrhage with RFA. Patient-centered outcomes across modalities suggest shorter recovery periods, improved cosmesis and quality of life, and favorable cost-effectiveness. LITT, FUS, and RFA represent complementary rather than competitive modalities in minimally invasive neurosurgery. Advances in imaging, navigation, thermal technologies, and patient-centered approaches are likely to accelerate their integration into cohesive, multimodal neurosurgical strategies.
Unhealthy lifestyle may influence semen quality. This research aimed to investigate the association of unhealthy lifestyle with the risk of low semen quality and further to examine the causal relationship by Mendelian randomization (MR) method. The association of six unhealthy lifestyle habits (smoking, alcohol consumption, coffee consumption, sedentary behavior, obesity, and sleep disturbance) with semen quality was assessed using binary logistic regression analysis including 508 participants. A two-sample MR analysis for seven unhealthy lifestyle habits (smoking, alcohol consumption, caffeine consumption, cannabis consumption, sedentary behavior, obesity, and sleep disturbance) and semen quality was conducted. The principal analysis employed the inverse-variance-weighted (IVW) approach. The MR-pleiotropy residual sum and outlier (MR-PRESSO) tests and MR-Egger regression were implemented to evaluate horizontal pleiotropy. Sensitivity analyses were performed with Cochran's Q test, leave-one-out analysis, and the funnel plot. During the cross-sectional study, smoking, heavy alcohol and coffee consumption, and sedentary behavior were found to be significantly correlated with an elevated prevalence of low semen quality in the two models (P < 0.05). In the IVW of MR analyses, a causal relationship between smoking/alcohol consumption/caffeine consumption/cannabis use/sedentary behavior and the semen quality-related genetic aspects (WFDC3, PATE1, CFAP45, SPEF1, CREM, SPATA20, SPATA9, SPATA46, CCDC103, CRISP2, EQTN, and SPAG11A) was observed (P < 0.05). The robustness of the above results was found to be reliable with no pleiotropy. MR sensitivity analyses yielded consistent results. Our cross-sectional study indicated that smoking, heavy alcohol and coffee consumption, and sedentary behavior were significantly correlated with low semen quality. The MR study supported a causal association between smoking/alcohol consumption/caffeine consumption/cannabis use/sedentary behavior and low semen quality.
Neural stem cell (NSC) therapeutics have emerged as a promising approach for addressing neurological disorders due to their inherent ability to self-renew, differentiate into neural lineages, and secrete neurotrophic factors. This narrative review explores the evolving clinical landscape of NSC applications, highlighting their therapeutic potential in neurodegenerative diseases, ischemic stroke, and spinal cord injuries. Recent clinical advancements demonstrate the safety and preliminary efficacy of NSC-based therapies in conditions like Parkinson's disease and amyotrophic lateral sclerosis. NSCs' capacity to promote neuroplasticity and tissue restoration underscores their potential in reversing synaptic and neuronal damage. Despite these advancements, significant challenges remain. Ethical considerations, particularly concerning cell sourcing and patient consent, must be carefully navigated. Technical barriers, including cell delivery, survival, and long-term integration, require innovative solutions. Furthermore, safety concerns such as tumor formation and immune rejection necessitate rigorous preclinical and clinical assessments. Regulatory challenges, including the standardization of manufacturing processes and international harmonization, are essential for widespread adoption. Looking ahead, the integration of precision medicine, advanced biomaterials, and patient-specific-induced pluripotent stem cells offers promising approaches to enhance NSC therapeutics. Collaborative efforts between researchers, clinicians, and regulatory agencies are crucial for overcoming existing barriers and translating NSC research into clinical practice, offering new hope for patients with complex neurological conditions.
ST-segment elevation myocardial infarction (STEMI) continues to be a leading cause of cardiovascular (CV) morbidity and mortality worldwide, posing an ongoing clinical and public health burden. Although angiotensin-converting enzyme inhibitors (ACEIs) remain integral to guideline-recommended therapy following STEMI, recent evidence indicates that sacubitril/valsartan may offer superior cardioprotective benefits. This meta-analysis aims to systematically evaluate and compare the efficacy and safety of sacubitril/valsartan versus ACEIs in the management of patients with STEMI. PubMed and Cochrane databases were systematically searched from inception to July 2024 to identify randomized controlled trials (RCTs) comparing sacubitril/valsartan and ACEIs in patients with STEMI. Data were synthesized using a random-effects model to calculate risk ratios (RRs) and weighted mean differences (WMDs), each with 95% confidence intervals (CIs). A P-value < 0.05 was considered statistically significant. A total of five RCTs comprising 4915 participants were included in the final analysis. Sacubitril/valsartan therapy was associated with a significant reduction in major adverse cardiovascular events (MACE) [RR: 0.66 (0.50, 0.86); P = 0.002] and hospitalizations for heart failure (HHF) [RR: 0.67 (0.49, 0.92); P = 0.01]. Treatment with sacubitril/valsartan also significantly improved left ventricular ejection fraction (LVEF) [WMD: 2.60 (1.53, 3.68); P < 0.00001] and reduced NT-proB-type natriuretic peptide (NT-proBNP) levels (WMD: -268.89 [-422.35, -115.42]; P = 0.0006). No significant differences were observed in the risk of recurrent myocardial infarction [RR: 1.02 (0.39, 2.71); P = 0.96), CV death [RR: 0.78 (0.61, 1.01); P = 0.06], or all-cause mortality [RR: 0.85 (0.68, 1.06); P = 0.15]. Safety analyses revealed no significant differences in the risk of cough [RR: 0.63 (0.15, 2.72); P = 0.54], hypotension [RR: 1.68 (0.97, 2.91); P = 0.06], worsening renal function [RR: 0.51 (0.22, 1.21); P = 0.13], or hyperkalemia [RR: 0.59 (0.17, 2.01); P = 0.40]. Sacubitril/valsartan therapy significantly reduces MACE and HHF and improves LVEF in patients with STEMI, without increasing the risk of adverse safety outcomes. Future well-powered randomized trials are needed to confirm these results and support clinical guideline recommendations.
Sclerocarya birrea is used in traditional medicine for the treatment of many diseases, including gastritis, diarrhea, dysentery, and hemorrhoids. The objective of this study was to evaluate the efficacy of Sclerocarya birrea aqueous extract on acetic acid-induced ulcerative colitis in rats. Thirty-six male rats were fasted for 18 hours with free access to water. Colitis was induced by rectal administration of 1 ml of acetic acid (5%) after anesthesia. After the onset of disease symptoms, the rats were treated for 6 days with aqueous extract of Sclerocarya birrea at 150, 300, and 600 mg/kg. After the sixth day of treatment, the animals were fasted for 12 hours, weighed, anesthetized by intraperitoneal injection of the valium (10 mg/kg)/ketamine (50 mg/kg) mixture, and then sacrificed. Blood, colon, liver, and spleen were collected for complete blood count and for biochemical and histological analyses. The extract at 300 and 600 mg/kg increased (P ≤ 0.01) the reduced glutathione level and the superoxidismutase and catalase activities. This extract significantly reduced the levels of tumor necrosis factor, malondialdehyde, nitric oxide, interleukin 6, and myeloperoxidase compared to the colitis control. Our extract regenerated the damaged colonic mucosa. Sclerocarya birrea appears to act on colitis by modulating anti-inflammatory and oxidative stress activity.
Lung cancer remains the most common cause of global cancer-related deaths. With the rapid advancement of artificial intelligence (AI) in medicine, this study aims to review publications on AI applications in lung cancer and identify key research trends and hotspots. Publications from 1997 to 2022 on AI and lung cancer were retrieved from the Web of Science Core Collection. CiteSpace (5.7.R5) and VOSviewer (1.6.16) were used to analyze publication metrics, collaboration patterns, keyword clusters, and research trends. National cooperation was further assessed via the Bibliometric Online Analysis Platform. Our results showed that the USA is the leading country in AI and lung cancer from all aspects. Followed by China, with the publication growing in recent years, and the cooperation between the USA and China is the most frequent. The USA expert Wenya Linda Bi has the most citations of 379, and Harvard Medical School has the most citations as institution of 959. However, Maastricht University has the most publications when it comes to the institution. During the past 25 years, the keywords of this field have changed a lot. In the past, the experts mainly focused on the "DNA." With the maturity of AI, the research hotspot evolved to "survival" and "diagnosis." AI and lung cancer research are integrating deeply, with areas like "AI + radiomics" advancing precise diagnosis and personalized treatment. This progress is expected to transform early screening and therapy while requiring continued improvements in technology and ethics.
Allgrove syndrome (AS) is a rare autosomal recessive disorder caused by triple A syndrome gene mutations, characterized by alacrima, achalasia, and adrenocorticotropic hormone (ACTH)-resistant adrenal insufficiency, with potential neurological complications. Early signs include absent tears, feeding difficulties, vomiting, and growth issues, while adrenal crises and neurological symptoms may appear later. Diagnosis is often delayed when only one feature is present. We report a 13-year-old boy with AS on oral hydrocortisone who presented with recurrent vomiting for 1 month. Neurological examination revealed below-average intellectual function, decreased muscle bulk, mild weakness, bilateral hyperreflexia, wide-based ataxic gait, intention tremor, dysarthria, and positive finger-nose test. Cranial nerves and sensation were intact. Laboratory investigations showed elevated ACTH due to poor hydrocortisone absorption, and endoscopy confirmed achalasia. He was switched to intravenous hydrocortisone and underwent Heller myotomy with Nissen fundoplication, resulting in resolution of vomiting and normalization of ACTH, though neurological symptoms persisted. AS often presents first with alacrima, followed by achalasia, causing dysphagia and vomiting, and adrenal insufficiency developing in childhood, which can be life-threatening. Neurological manifestations may include ataxia, tremor, hyperreflexia, and cognitive impairment. Our case highlights the impact of achalasia on hydrocortisone absorption and the need for early multidisciplinary intervention. Early recognition, long-term follow-up, and proper care are crucial to prevent adrenal crises and manage neurological complications, improving outcomes and quality of life in affected patients.
Penile strangulation is an uncommon urological emergency in which an external constricting object initially impedes venous and lymphatic outflow and, if prolonged, leads to arterial insufficiency and tissue necrosis. A 16-year-old male presented after approximately 2 weeks of progressive penile swelling and pain following self-application of a metallic key holder at the midshaft. Examination revealed marked distal edema, coronal congestion, shaft erythema, focal ulceration, and areas of skin necrosis, with preserved distal sensation and no urinary retention. Clinical assessment suggested adequate distal perfusion without deep structural compromise. Under general anesthesia, the constrictor was divided and removed, necrotic tissue was debrided, a drain was placed, and prophylactic antibiotics were administered. At the 2-week follow-up, the wound had healed without infection; voiding and erectile function were preserved, and a psychiatric referral was arranged. Injury severity is shaped by the duration of constriction, the device used, and the degree of preserved perfusion. Stepwise management from bedside techniques to operative or high-power cutting tools guides safe removal. Early decompression typically maintains urinary and sexual function, whereas delayed intervention increases the risk of stricture, erectile dysfunction, and gangrene. Coordinated surgical management and psychiatric follow-up are essential to optimize outcomes and reduce recurrence. Penile strangulation demands urgent, device-specific intervention guided by assessment of constriction duration, perfusion status, and object composition. Adherence to graded management algorithms and early psychiatric evaluation are recommended to minimize long-term morbidity and address contributory behavioral factors.
Intestinal failure is a severe condition that requires complex, multidisciplinary management and long-term nutritional support. Despite its clinical relevance, no previous bibliometric analyses have mapped the global research landscape on intestinal failure, nor have they explored geographic or socioeconomic disparities in evidence production. This study aimed to characterize the evolution, distribution, and thematic focus of global research on intestinal failure. A scientometrics study was conducted using Scopus, Web of Science, and PubMed. Publications were included if they addressed intestinal failure as defined by the MeSH term "Intestinal Failure" (Unique ID: D00090124). Quantitative indicators were calculated using R and Python. Countries were classified by income level and geographic region according to the World Bank. Collaboration networks, keyword trends, and thematic evolution were analyzed through network and visual mapping. A total of 3513 articles were included. Research output was dominated by high-income countries (90.2%), particularly the United States (32.4%), the United Kingdom (12.6%), and Western Europe. Latin America, Africa, and South Asia were markedly underrepresented. Thematic concentration centered on parenteral nutrition, short bowel syndrome, and intestinal transplantation, while emerging topics included catheter infections, sarcopenia, and microbiota. Temporal analyses revealed increased output and impact since 2010, peaking in 2022. Global research on intestinal failure is growing, but remains geographically and economically inequitable. This analysis reveals structural gaps in evidence generation and underscores the need to foster inclusive, context-relevant research agendas to advance scientific equity in the field of intestinal failure.
Type 2 diabetes mellitus (T2DM) often progresses to require basal insulin therapy. Despite the efficacy of once-daily basal insulins such as glargine and degludec, daily injections remain a barrier to adherence. Insulin efsitora alfa, a novel once-weekly fragment crystallizable (Fc)-fusion basal insulin, may improve treatment convenience while maintaining glycemic control. To evaluate the efficacy and safety of once-weekly insulin efsitora alfa compared with once-daily basal insulin analogs in adults with T2DM. An updated systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251118205). PubMed, Embase, and CENTRAL were searched up to 30 July 2025 for randomized controlled trials (RCTs) comparing insulin efsitora alfa with once-daily basal insulins. Pooled analyses were performed using a random-effects model in RevMan 5.4. Risk of bias was assessed with the Cochrane RoB-2 tool, and evidence certainty with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Six RCTs comprising 4115 participants were included. Once-weekly insulin efsitora showed non-inferior HbA1c reduction compared with daily basal insulin (mean difference = -0.04; 95% confidence interval: -0.13 to 0.05; P = 0.35). No significant differences were observed in fasting serum glucose or body weight change. Incidents of level 1, level 2 (clinically significant), and level 3 (severe) hypoglycemia, as well as adverse and serious adverse events, were comparable between groups. Once-weekly insulin efsitora alfa demonstrates comparable efficacy and safety to daily basal insulin. However, further large-scale, long-term trials are warranted to confirm its durability, safety, and real-world effectiveness.
Drug-resistant solid tumors represent a major challenge in oncology, with resistance mechanisms, including efflux pump overexpression, apoptotic pathway alterations, and adaptive survival signaling, contributing to poor outcomes despite multimodal therapy. Conventional chemotherapy and first-generation antibody-drug conjugates (ADCs), such as ado-trastuzumab emtansine (T-DM1), were limited by non-specific cytotoxicity, heterogeneous drug-antibody ratios, linker instability, and insufficient bystander killing, yielding modest efficacy in heavily pretreated populations. Next-generation ADCs address these shortcomings through site-specific conjugation, advanced cleavable linkers, and novel payloads, such as topoisomerase I inhibitors, enabling robust bystander killing and circumvention of efflux-mediated resistance. Clinically, trastuzumab deruxtecan demonstrated meaningful progression-free survival benefit in HER2-low metastatic breast cancer, while enfortumab vedotin reduced mortality risk in platinum- and immunotherapy-refractory urothelial carcinoma, establishing ADC efficacy across solid tumor histologies. However, significant toxicity concerns persist. Trastuzumab deruxtecan carries a 15.4% incidence of interstitial lung disease, including fatal events, and sacituzumab govitecan is associated with grade 3 or higher neutropenia in approximately 51% of patients. Furthermore, next-generation ADCs are not resistance-proof, with antigen downregulation, payload efflux, and impaired internalization emerging as clinically relevant escape mechanisms. Biomarker-driven patient selection, rigorous toxicity monitoring, and prospective trials addressing resistance will be essential to realizing the full and durable potential of this drug class.
Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases and remains a leading cause of cancer mortality worldwide. Pathophysiologically, NSCLC arises from genetic alterations such as EGFR, KRAS, and ALK mutations, which drive dysregulated signaling, uncontrolled proliferation, and immune evasion. Standard treatments include surgery, radiotherapy, platinum-based chemotherapy, and immunotherapy with PD-1/PD-L1 inhibitors, yet survival outcomes remain suboptimal. Emerging evidence suggests that circadian biology influences therapeutic efficacy, with time-of-day (ToD) immunochemotherapy offering a novel approach to optimize outcomes. Mechanistically, circadian rhythms regulate immune cell trafficking, cytokine release, and drug metabolism, thereby modulating treatment response and toxicity. Clinical trials in NSCLC demonstrate that early-day administration of immunochemotherapy improves progression-free and overall survival compared to late dosing. Similar chronotherapy benefits have been reported in colorectal, breast, pancreatic, and hepatocellular cancers, underscoring broad translational relevance. Despite promise, challenges include patient heterogeneity in circadian rhythms, logistical barriers in oncology clinics, and limited biomarker validation. Future strategies should prioritize multicenter validation, integration of chronobiological profiling, and exploration of combination therapies. Cost-effectiveness analyses, awareness campaigns, and clinical drives to evaluate safety and adherence will be essential to establish trust and optimize outcomes.
An overlap syndrome is a condition when there is coexistence of two or more autoimmune connective tissue disease, which is very rare and diagnostically challenging. Dermatomyositis is an autoimmune condition that presents with skin manifestations, progressive muscular weakness, and inflammation. Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune condition mainly affecting skin, joints, kidneys, and brain. Early recognition and therapeutic intervention are necessary in overlap syndromes to prevent the patient from having severe cardiopulmonary problems. This is a case of a 32-year-old woman diagnosed with SLE who developed progressive muscle weakness (3/5 strength proximally) and a distinctive rash, classic signs of dermatomyositis from last 2 months. Laboratory tests have shown elevated creatine kinase (3500 U/l), positive ANA (1:640), anti-dsDNA, and anti-Jo-1 antibodies, along with visible myopathic alterations on electromyographs; unique results on muscle and skin biopsies were all confirmed by investigations. After confirming the diagnosis of dermatomyositis, the patient condition was managed by high dose corticosteroids (prednisolone 1 mg/kg/day), intravenous immunoglobulin for severe muscle weakness, methotrexate, high-dose corticosteroids, and physical therapy. This case highlights the complexity of diagnosis in distinguishing the true dermatomyositis from SLE associated inflammatory myopathy in young adults. It emphasizes the importance of early recognition of DM-SLE overlap syndrome through targeted investigations integrating clinical, serological, and histopathological assessment; that can alter the disease trajectory. The case emphasizes the importance of maintaining high clinical suspicion in patients with autoimmune diseases while guiding the immunosuppressive therapy.
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease in infants, with the highest burden in those under 6 months of age. Global RSV epidemics occur seasonally and nearly all children are infected within the age of 2 years, resulting in significant hospitalizations, morbidity, and healthcare costs. Enflonsia™ (clesrovimab-cfor), recently approved by the U.S. Food and Drug Administration, is a long-acting recombinant monoclonal antibody targeting the prefusion F protein of RSV, preventing viral entry and replication. A single intramuscular dose provides protection across the RSV season, eliminating the need for monthly injections. Clinical trials indicate that clesrovimab reduces RSV-related hospitalizations by up to 76% and medically attended RSV disease by over 70%, with a safety profile comparable to existing antibodies like palivizumab and nirsevimab. Common adverse events include mild injection-site reactions and rare hypersensitivity. While its high cost and cold-chain requirements may limit accessibility in low- and middle-income countries, the single-dose, season-long protection offers logistical advantages and potential cost-effectiveness in high-burden settings. Enflonsia represents a significant advance in infant RSV prophylaxis, with implications for global health strategies, integration into immunization programs, and equitable access to reduce RSV morbidity worldwide.
The unprecedented rise of antimicrobial resistance has substantially compromised the efficacy of β-lactam antibiotics, once the cornerstone of bacterial infection management, posing a major challenge to modern medicine. β-Lactams exert their antibacterial effect by inhibiting penicillin-binding proteins (PBPs) involved in cell wall synthesis; however, resistance mechanisms including porin alterations, PBP mutations, β-lactamase production, and efflux systems increasingly limit their clinical utility. In response, the development of β-lactamase inhibitors (BLIs) has become a critical strategy, with diazabicyclooctanes such as nacubactam (NAC) representing a mechanistically distinct advancement. NAC is a non-β-lactam BLI that exhibits a unique multi-modal mechanism of action encompassing inhibition of serine β-lactamases (Ambler classes A, C, and selected D), direct binding to penicillin-binding protein 2 (PBP2), and enhancement of partner β-lactam activity, including in certain β-lactamase-negative strains. Preclinical in vitro and in vivo studies demonstrate that NAC, when combined with β-lactams such as cefepime, aztreonam, or meropenem, produces substantial reductions in minimum inhibitory concentrations against multidrug-resistant Gram-negative pathogens, including carbapenemase-producing and metallo-β-lactamase (MBL)-coexpressing Enterobacterales. PBP2 targeting contributes to characteristic morphological changes and intrinsic antibacterial activity, resulting in synergistic cell wall disruption when used in combination regimens. Early clinical data from phase I studies indicate that NAC is generally well tolerated, with favorable pharmacokinetic properties and no serious safety concerns reported to date. Nevertheless, NAC lacks direct activity against class B MBLs and exhibits limited efficacy against certain non-fermenting Gram-negative organisms. Moreover, resistance mediated by β-lactamase or PBP2 alterations remains a potential concern. Importantly, robust human efficacy data from phase II and III clinical trials are currently limited. NAC represents a promising investigational BLI with a mechanistically innovative profile and broad β-lactam-potentiating capacity. While preclinical and early clinical findings support its translational potential, further clinical validation is required to define its therapeutic role, optimal combinations, and long-term impact in the management of multidrug-resistant Gram-negative infections.
Soft tissue sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Sarcomas constitute a rare subgroup that usually affects younger age groups. We report the case of a 70-year-old female who presented with a right axillary mass that had gradually increased in size over the last 8 months. Imaging revealed a heterogeneously enhancing mass that was free from the underlying muscle and joint capsule but was splaying the axillary vessels. Upfront resection of the mass was planned in the multidisciplinary meeting. Mass was excised with an intact capsule, sparing the neurovascular bundle. The patient developed transient right wrist and arm paresis with swift recovery in 3 days. The histopathology of the excised mass was leiomyosarcoma. The workup for whole-body primaries was inconclusive; therefore, the diagnosis of primary axillary leiomyosarcoma was made. Adjuvant radiation therapy (50 Gy in 20 fractions) was given, with no recurrence at 16-month follow-up. There is a wide range of differential diagnoses of axillary masses because the axilla contains both lymph nodes and non-lymphatic tissue such as accessory breast tissue, skin, fat, muscles, nerves, blood vessels, and bone. Clinicians should be familiar with the axillary anatomy and imaging features of different axillary lesions. Current guidelines recommend multidisciplinary discussion with radiologists, surgeons, and oncologists who can collaborate in the management of soft-tissue sarcomas in specialized centers. This case signifies the surgical management of atypical anatomical locations of leiomyosarcoma. Complete surgical resection with adequate resection margins should be the optimum treatment protocol wherever possible, with adjuvant radiation, reducing the recurrence.
Neurocysticercosis is an infection of the central nervous system (CNS) caused by the larvae of the tapeworm Taenia solium. Spinal neurocysticercosis is a very uncommon form of neurocysticercosis, among which intradural extramedullary is the most common, intramedullary is less common, and extradural is very rare. A 28-year-old woman presented to the center with complaints of back pain for 2 years; gradual-onset bilateral lower limb weakness associated with a loss of sensation and stiffness of the lower limbs for 2 months; intermittent fever with a maximum recorded temperature of 101 °F; and involuntary passage of urine and stool for 3 days, with no history of trauma or any other comorbidities. Extradural spinal neurocysticercosis is a very rare form of neurocysticercosis, presenting with very vague symptoms that may mimic other infectious conditions of the spinal cord. The patient was diagnosed with an epidural abscess, underwent decompression surgery, and was treated accordingly in the initial phase, as MRI findings suggested infective pathology. However, the histological diagnosis of the tissue after surgery was suggestive of neurocysticercosis, and medical therapy for the same was then introduced, with the patient continuing rehabilitation. This multidisciplinary approach to treatment is important for the proper management of the patient. In summary, this case highlights a rare presentation of extradural spinal neurocysticercosis. It sheds light on the diagnostic challenges and treatment, emphasizing the importance of considering neurocysticercosis in patients with spinal symptoms mimicking infective pathology.
Growing evidence suggests that bacterial infectious diseases contribute substantially to morbidity and mortality among individuals with malignant neoplasms. However, data regarding mortality related to the co-occurrence of malignant neoplasms and other bacterial diseases is limited. This study analyzes the national mortality trends for the co-occurrence of malignant neoplasms and other bacterial diseases in the United States from 1999 to 2023. A retrospective study was conducted using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for individuals aged 15+ to calculate age-adjusted mortality rates (AAMRs) per 100 000 and annual percent change (APC) using joinpoint regression, stratified by year, sex, age, race/ethnicity, urbanization, and geographic regions. From 1999 to 2023, 726 510 deaths were recorded involving malignant neoplasms co-occurring with bacterial diseases. The AAMR slightly declined from 8.14 in 1999 to 7.63 in 2012, followed by a rise to 10.02 in 2023 with an APC of 2.51 (95% confidence interval: 2.14-2.89, P < 0.05). Males had higher mortality rates than females, declining until 2012, then increasing, while female rates were stable before rising after 2013. West exhibited the greatest increase in AAMR. Non-Hispanic Black individuals had the highest absolute AAMRs throughout the study period. Nonmetropolitan areas showed greater increases in AAMRs compared to metropolitan areas. Older age groups, especially those 65 years and above, predominantly contributed to mortality. Despite improvements, mortality from bacterial diseases and malignant neoplasms has increased, particularly affecting older adults, men, racial minorities, and the western region, requiring targeted interventions to reduce disease burden in vulnerable communities.
Rosette-forming glioneuronal tumor (RGNT) is a rare World Health Organization grade I tumor of the central nervous system, most commonly found in the fourth ventricle. Preoperative diagnosis is challenging, and optimal management for incompletely resected tumors is not well-established. An 8-year-old boy presented with headaches and declining vision due to obstructive hydrocephalus caused by a large fourth ventricle tumor with extension into the cerebellopontine angle. After an endoscopic third ventriculostomy, the patient underwent maximal safe subtotal resection. Histopathological examination confirmed RGNT. Given the residual tumor, adjuvant radiotherapy was administered. Following treatment, the patient's symptoms resolved, and follow-up imaging demonstrated stable residual disease. Although RGNTs are indolent tumors, their location in the fourth ventricle often precludes complete resection. Subtotal resection followed by adjuvant radiotherapy may represent a valid option in selected cases where complete resection is not feasible, with the aim of balancing tumor control and neurological preservation. This case adds to the limited pediatric experience and emphasizes the importance of a personalized, multidisciplinary approach with careful long-term surveillance. This case highlights the importance of individualized, multidisciplinary decision-making in the management of pediatric RGNTs of the fourth ventricle when complete resection is not feasible.
Rotavirus enteritis is the main cause of hospitalization and death in patients with diarrhea. There is no specific drug. Vaccine prevention is effective, but the oral route has safety concerns in developing countries. A safe and effective treatment is urgently needed. To systematically evaluate the clinical analysis of conventional therapy combined with probiotics in patients with rotavirus enteritis. We retrieved a total of 14 randomized controlled trials (RCTs) involving 1709 patients from multiple databases. Results showed that probiotics significantly shortened recovery times for defecation frequency [mean difference (MD) = 1.18, 95% confidence interval (CI): 0.76-1.60, P < 0.00001], antidiarrheal time (MD = 1.17, 95% CI: 1.02-1.32, P < 0.00001), body temperature recovery (MD = 0.83, 95% CI: 0.58-1.08, P < 0.00001), and vomiting cessation (MD = 1.00, 95% CI: 0.61-1.39, P < 0.00001). Immunoglobulin levels (IgA and IgG) also improved significantly. The experimental group demonstrated a higher total effective rate [relative risk (RR) = 0.85, 95% CI: 0.82-0.88, P < 0.00001] and comparable safety (RR = 1.38, 95% CI: 0.74-2.56, P > 0.05). Probiotics, by regulating gut microbiota and enhancing mucosal immunity, offer a safe and effective adjunct to conventional therapy for rotavirus enteritis.