The increasing frequency and severity of wildfires has necessitated assessing fire effects on soil systems. Variation in fuel loads and fire effects create landscape mosaics with distinct abiotic properties, a heterogeneity that has been dubbed pyrodiversity. Expanding on the pyrodiversity framework, the pyrodiversity-biodiversity hypothesis posits that pyrodiversity increases niche diversity, thereby promoting biodiversity. This hypothesis, however, has remained untested for soil microbes and microeukaryotes. We explored this hypothesis for soil fungal communities using pre- and post-fire data from three empirical fuel load manipulations and across a total of five different vegetation contexts. We first compared pre- and post-fire abiotic heterogeneity to test whether fuel load manipulations would lead to greater environmental heterogeneity, particularly in soil properties. We then tested whether such manipulations led to greater fungal biodiversity as measured by fungal richness, β-diversity, and community dispersion. Labile abiotic soil resource (e.g. plant available phosphorus and inorganic nitrogen) heterogeneity increased post-fire, but this effect depended on the experimental context. In contrast, we observed little evidence for pyrodiversity-associated increases in post-fire fungal richness or diversity; community dispersion increased only in the study with the most extreme fuel load manipulations. Although our analyses did not clearly answer whether pyrodiversity begets biodiversity, our results highlight the nuances of soil responses to fire. Pyrodiversity-biodiversity linkages appear to depend on the system and on the diversity metric: the hypothesis had no support based on fungal richness, but community dispersion provided some support, even if only in one experiment. Understanding system-specific responses may be particularly important as fires increase in systems where they have been suppressed or have been historically rare.
Chronic nonspecific cough in children is a common and challenging clinical problem. Flexible bronchoscopy plays a crucial role in identifying underlying etiologies when non-invasive investigations are inconclusive. This study aimed to assess bronchoscopy and related diagnostic findings in children presenting with chronic cough. This prospective cross-sectional study included 64 children aged 3 months to 18 years who presented with chronic nonspecific cough lasting more than four weeks. All patients underwent a standardized evaluation that included clinical assessment, laboratory tests, chest X-ray, and high-resolution CT. Pulmonary function testing was performed in children older than five years. Flexible bronchoscopy was conducted, and bronchoalveolar lavage samples were examined for cytological and microbiological analysis. This prospective study included 64 children (32 males) with a median age of 8 months (IQR 36-84) with chronic cough, classified as dry (n = 38), wet (n = 21), or barking (n = 5) cough. Bronchoscopy revealed abnormalities in 87.5% of cases, most commonly purulent secretions and congenital airway anomalies. BAL showed neutrophilia in 95.3%, and cultures were positive in 20.3%, mainly for Haemophilus influenzae and Streptococcus pneumoniae. For predicting PBB, the combined multivariable model demonstrated good discriminative ability (AUC = 0.809, P = 0.004). Increasing age (OR = 1.038, P = 0.024) and tobacco smoke exposure (OR = 4.15, P = 0.04) were significant independent predictors. For congenital airway anomalies, the combined model demonstrated excellent predictive performance (AUC = 0.912, P < 0.001), outperforming individual clinical variables. Flexible bronchoscopy demonstrated a high diagnostic yield in children with chronic cough that remained unexplained following comprehensive noninvasive evaluation. However, a definitive assessment of its clinical utility requires direct comparison with other diagnostic modalities, which is addressed in the subsequent analysis.
Multimodal perception can often evoke performance that is greater than the sum of its unimodal parts in cognitive tasks. For example, choice reaction time research has found responses to multimodal stimuli that are faster than could be explained by responses to its individual unimodal components. This has led to a growth in multimodal perceptual research to explain behavioural observations, but less is known about multimodal influences on more cognitively demanding tasks such as semantic activation and memory. Across 3 well-powered pre-registered memory experiments (total n = 792), this study tested if multimodal encoding could reduce perceptual demands, evoke semantic processing, and encourage episodic recollection. In Experiment 1 the presence of congruent visual information aided later unimodal auditory retrieval (e.g., a dog picture and a barking sound), but multimodal manipulations had similar effects across young and older adults. Experiment 2 equated auditory only and visual only memory for picture-sound items by utilising blurring of the visual pictures, generating a novel shared stimulus set. Here there was no benefit to multimodal encoding, and identifiability of a given stimulus was more strongly related to memory following multimodal encoding than memory following unimodal encoding. Experiment 3 utilised the remember-know paradigm and found no specific multimodal encoding effects on episodic remembering, but did find that item identifiability was more strongly linked to recollection than to familiarity. Our data highlight how multimodal processing is nuanced and supports a general need for multimodal research to explain wholistic sensory processing.
To demonstrate the effectiveness of surgical treatment for complicated expiratory tracheal stenosis. The authors present anamnestic data, symptoms, diagnostic approaches, surgical features and outcomes in a patient with expiratory tracheal stenosis and syncopal episodes. Expiratory tracheal stenosis remains an underdiagnosed and underestimated condition. Primary etiopathogenetic factor is excessive intrathoracic pressure during exhalation. The gold standard for diagnosis is tracheobronchoscopy. Imaging techniques are useful only in dynamic formats. Conservative therapy (anti-inflammatory, mucolytic and bronchodilators), including positive end-expiratory pressure (PEEP) ventilation, is effective for most patients, but should be considered as a palliative measure. Surgical treatment aimed at posterior tracheal wall reinforcement is indicated for complications such as syncopal episodes, severe barking cough, and impaired social functioning. Minimally invasive techniques are available and appropriate for expiratory tracheal stenosis. Long-term outcomes depend on consistent lifelong pulmonological care. Иллюстрация эффективности хирургического лечения при осложненном экспираторном стенозе трахеи (ЭСТ). Представлены описание анамнеза, клинических проявлений и методов диагностики, а также особенности хирургического лечения и его результаты у пациента с ЭСТ, приводящим к синкопальным состояниям. ЭСТ остается недооцененным заболеванием. Основным патофизиологическим механизмом ЭСТ является чрезмерное давление в грудной клетке на выдохе. Основным вариантом диагностики остается фибротрахеобронхоскопия. Лучевые способы визуализации имеют смысл только при их динамических вариантах. Консервативная терапия (противовоспалительная, муколитическая, бронходилататационная), включая дыхание с положительным давлением в конце выдоха, у большинства пациентов с ЭСТ эффективна, но ее следует относить к паллиативному варианту. Хирургическое лечение, направленное на укрепление задней стенки трахеи, показано в тяжелых случаях, при развитии таких осложнений, как синкопальные состояния, сильный лающий кашель, ограничивающий социальную адаптацию. При лечении больных с ЭСТ доступны и приемлемы миниинвазивные технологии. Отдаленный результат лечения зависит от адекватной пожизненной терапии под наблюдением пульмонолога.
Human activities increasingly reshape wildlife diel activity patterns, yet species-specific adjustments across land-use gradients with varying levels of human pressure and protection remain poorly understood. Nepal's 2020 COVID-19 lockdown created a quasi-experimental reduction in human mobility, allowing clearer attribution of temporal responses to human pressure. Using camera trap data from matched 30-day windows (March 24-April 24) in 2019 (pre-lockdown) and 2020 (lockdown) across the Bardia complex, representing a mosaic of human pressure and protection gradients, including Bardia National Park (NP), its buffer zone (BZ), and adjacent human-dominated areas outside of buffer zone (OBZ). NP-2020 treated as the baseline and quantified species-specific activity patterns with kernel densities, coefficients of overlap (Δ, 95% CIs), circular mean peak-time shifts (hours, 95% CIs), and a nocturnality index (% detections between 19:00-05:00 h, 95% bootstrap CIs). We analyzed four contrasts and reported overlap and peak-time shifts within species, contrasting NP-2020 with the same species in BZ and OBZ during survey periods 2019 and 2020. Relative to the NP-2020, herbivores -especially chital, barking deer, hog deer, and wild boar shifted activity peaks by ~ 6-11 h toward night and showed reduced overlap within-species in BZ and OBZ, with several near anti-phase schedules in OBZ. Sambar remained comparatively stable and crepuscular, while tigers exhibited low NP-BZ overlap and near 12 h offsets in their activity peaks. Lockdown conditions increased overlap and attenuated nocturnal displacement for several species (notably chital and sambar), evidencing rapid behavioral relaxation. The dominant pattern is a gradient of increasing nocturnality and declining overlap in activity patterns as human pressure increases from NP to BZ to OBZ, with persistent nocturnality in hog deer and wild boar indicating chronic constraints. We emphasize integrating temporal refugia into management by limiting high-intensity human activities during crepuscular periods and reducing nighttime noise and lighting at forest-agriculture interfaces, so wildlife need not rely on extreme nocturnality to coexist with humans. Long-term monitoring that couples activity metrics (overlap, peak-time shifts) with environmental factors and physiological indicators is needed to evaluate demographic and fitness consequences and to inform temporal ecology in multi-use landscapes.
Magnetic Resonance Imaging can be a challenging experience for many, despite improvements in scanner design and acquisition speed. A key area of importance to patients is communication about what is happening throughout their scan experience, which can be overlooked in increasingly busy departments. With the new scanner technology available in this community diagnostic centre, there is an updated autovoice function that automatically provides the patient with an update on the expected scan duration. A post-scan survey was administered to patients attending for MRI scanning. Open and closed questions were used to explore patients' views on the usefulness of this autovoice functionality and to better understand how it was received and how it influenced their experience. A total of 313 questionnaires were collected during the two-month period. Most participants perceived the autovoice prompt as useful, with one in five patients preferring the auto prompt over that of a radiographer, and the majority having no preference either way (68%). Entry into the scanner and preference for the delivery of information during the scan were not significant (p = 0.054), with no strong preference one way or the other, although a greater number of headfirst opted for autovoice. Age was not significant (p = 0.063), but those aged 50 years or less showed a greater preference for autovoice than those over 50. Those reporting heightened perceived anxiety on the day suggested greater benefit from the autovoice during the examination. Content analysis of the survey responses indicates a generally positive experience and response towards the autovoice, with some criticisms and suggestions for improvement highlighted. The feedback underscores the importance of clear communication, time awareness, and supportive staff in improving the patient experience during scans. For many, automated systems seem to be perceived as beneficial, offering consistent information, helping them anticipate what to expect, and reducing the likelihood of miscommunication or omission. Findings from this evaluation indicate that patients generally report a positive MRI experience, with the integration of autovoice prompts contributing meaningfully to their sense of communication and reassurance. MRI scans can be stressful, and clear communication during the scan is important for patient comfort. This study asked people to complete a survey after their MRI scan to understand their views on an automated voice system that gives updates about scan timing. This study found that most people felt the automated messages were helpful, especially those who felt more anxious, and many had no strong preference between automated messages and staff communication. This matters because improving how information is shared during scans can help people feel more reassured and improve their overall experience.
The classification of harmful radiation-induced effects into 'stochastic' and 'deterministic' or 'cancer/heritable effects' and 'tissue reactions' has played a significant role in the recommendations of the International Commission on Radiological Protection (ICRP) over a number of decades. More recently, however, there has been a debate regarding the adequacy of the current scheme for classification of health effects with current scientific evidence. While these scientific aspects are discussed in greater detail in a parallel article, we will emphasise the practical importance of the classification itself here. The setting of dose limits is quite different for 'deterministic' and 'stochastic' effects. In the first case, provided reliable data regarding the threshold doses for radiation effects on a particular tissue are available, the dose limit is supposed to avoid harm altogether. With 'stochastic effects', the expected risks at the dose limit are supposed to be 'tolerable'. Below the dose limit, optimisation must be aimed for based on the 'prudent' assumption that the stochastic risks linearly depend on the dose and that there is no threshold. If the distinction between the two kinds of harmful effects is drawn into question, possible consequences for the system of radiological protection need to be considered, especially in the context of its aims as they currently apply, namely, 'to manage and control exposures to ionising radiation so that deterministic effects are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable'. It may be necessary, moreover, to discuss if and how the terminology used by ICRP (and others), in particular the terms 'deterministic effects' and 'tissue reactions', should continue to be used for the classification of radiation effects.
Ambrosia beetles (Coleoptera: Curculionidae: Scolytinae) are economically important pests of ornamental nursery crops because the presence of <5 attacks can render thin-barked deciduous trees unmarketable. In North America, Xylosandrus crassiusculus (Motschulsky), Xylosandrus germanus (Blandford), Xylosandrus compactus (Eichhoff), and Cnestus mutilatus (Blandford) are among the most destructive ambrosia beetle pest species in nursery systems. Anisandrus maiche (Stark) is a new emerging pest in North America. These species preferentially colonize physiologically stressed hosts by orienting to ethanol emitted from plant tissues, creating a strong linkage between host stress, beetle behavior, and management risk. Despite the widespread use of ethanol-baited traps and preventative insecticide applications, ambrosia beetle management remains challenging due to variability in phenology, species-specific cryptic and social behaviors, and continual pressure from surrounding woodlots. The objective of this review was to synthesize current knowledge on the natural history and landscape ecology of beetles in the tribe Xyleborini and to discuss how this information can be applied to improve integrated pest management in nursery systems. Mechanisms of host selection and ethanol-mediated attraction, a review of monitoring tools and their interpretation, and an examination of species-specific differences in flight activity, dispersal capacity, overwintering biology, and reproductive behavior are biologically relevant to management. Landscape context, including proximity to woodlots and the spatial distribution of hosts, influences the risk of beetle infestations. Management tactics, including cultural, chemical, biological, and behavioral, are discussed in the context of ambrosia beetle biology, ecology, and movement across nursery-woodlot interfaces.
To assess current perceptions of training in adolescent and young adult healthcare among UK resident doctors and educational supervisors (ES), and to identify barriers and opportunities for improvement. Cross-sectional national survey of resident doctors and ES, followed by qualitative focus group discussions. UK-wide, involving medical specialties participating in internal medicine training (IMT) and higher specialty training programmes. 670 resident doctors and 64 ES across 29 specialties. A subset of nine participants (four ES, five resident doctors) took part in focus groups. Exposure to training, confidence in managing adolescent medicine, awareness of transition care tools and policies, perceived barriers and suggestions for improvement. 18% of resident doctors had attended transition clinics and 38% reported no formal training in adolescent medicine. 5% of respondents were aware of national training guidance. Confidence and preparedness were low, with significant variation across specialties. ES confirmed the importance of adolescent medicine training but noted systemic limitations. Key barriers included limited clinical opportunities, lack of curricular emphasis and poor interdepartmental coordination. Training in adolescent medicine remains inconsistent across UK specialties. System-wide reforms are needed to improve preparedness and care quality. This may include mandating adolescent care competencies, structured clinic access and integration into curricula.
 Hemostasis in chronic kidney disease (CKD) is currently becoming a complicated and disturbed process, not a simple bleeding disorder. Recent evidence suggests that the combination of elevated mean platelet volume (MPV) and bleeding, particularly during the initial phases of the disease, is a discordant hemostatic profile.  To examine the association between mean platelet volume (MPV) and bleeding symptoms among patients with chronic kidney disease (CKD) and to evaluate the utility of platelet indices in characterizing a discordant hemostatic profile.  This analytical cross-sectional study recruited 527 patients with CKD from tertiary care centers. Bleeding was measured on a questionnaire that included typical bleeding symptoms and a bleeding score. Platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet count, were provided in the medical records. Data were evaluated using nonparametric tests, logistic regression, and receiver operating characteristic (ROC) curves.  Bleeding symptoms were observed in 298 patients (56.5%). Bleeding participants had increased MPV, which increased with increasing CKD stages. Multivariate analysis showed MPV was significantly associated with bleeding symptoms (OR = 2.88, p < 0.001). ROC curves indicated moderate discriminative ability (area under the curve (AUC) = 0.730), but poor performance of PDW and non-predictive value of platelet count. CKD is associated with a discordant hemostatic profile of elevated MPV alongside bleeding symptoms. MPV may serve as a potential marker associated with bleeding symptoms in patients with CKD.
Intraoperative neurophysiological monitoring (IONM) has evolved from a novel technique into an evidence-based standard treatment method for high-risk neurosurgical and spinal surgeries. Its effectiveness is based on two interrelated pillars: optimized multimodal monitoring, mainly including motor and somatosensory evoked potentials (MEPs/SSEPs) as well as electromyography (EMG), and total intravenous anesthesia (TIVA) combined with a precise neuromuscular blockade-based anesthesia protocol. IONM significantly reduces neurological function damage during surgeries for spinal deformities, intramedullary tumors, acoustic neuromas, and gliomas in the brain functional area, redefining the standards of safe surgical practice. However, there are still certain challenges, including the difficulty in converting signal changes into clinical actions, controlling high false alarm rates, and overcoming technical/logistical obstacles in complex and lengthy surgeries. These objectively existing problems further highlight the importance of clinical judgment. Looking to the future, a key developmental direction involves transforming intraoperative neurophysiological monitoring (IONM) from a passive monitoring tool into a system capable of predictive guidance and comprehensive neuroprotection. Emerging models include artificial intelligence (AI) technologies for real-time analysis and technologies for fusing multimodal data into surgical "dashboards", but they still face significant obstacles in data quality, clinical validation, and human-centered design. Closed-loop systems and the application of neurobiomarker recognition to achieve neuroprotection remain enduring research topics. In summary, the development of IONM technology towards a more mature direction requires a coordinated planning scheme: establishing evidence-based standards, promoting data-driven discoveries through large-scale collaborative research, and achieving deep multidisciplinary integration within the surgical team. The ultimate goal is to make IONM an intelligent guiding tool that not only monitors but also actively optimizes surgical strategies to ensure the preservation of neural function.
The optimal management of nondisplaced femoral neck fractures (FNFs) in elderly patients remains debated. Internal fixation (IF) offers shorter operative time and reduced blood loss but carries risks of nonunion and reoperation, whereas hemiarthroplasty (HA) may reduce these failures at the expense of greater operative burden. We conducted a systematic search of PubMed, MEDLINE, and Embase (completed in September 2025) to identify randomized controlled trials comparing IF and HA in patients aged ≥65 years with Garden I-II FNFs. Four RCTs were included, enrolling 454 patients (230 IF; 224 HA). Outcomes included implant-related complications, reoperation, mortality, functional outcomes, perioperative variables, and quality of life. IF was associated with significantly higher implant-related complications (19.1% vs. 3.1%; odds ratio (OR) = 4.12, 95% confidence interval (CI) = 2.12-8.00; P < 0.0001) and reoperations (OR = 4.10, 95% CI = 2.12-7.95; P < 0.0001). Osteonecrosis was more frequent following IF (OR = 5.97, 95% CI = 1.54-23.14; P = 0.01), as was nonunion/fixation failure (OR = 13.43, 95% CI = 3.66-49.33; P < 0.0001). Deep infection rates were comparable between the groups (OR = 0.52, 95% CI = 0.14-1.92; P = 0.33). In contrast, HA was associated with greater blood loss (mean difference (MD) = -143.11 mL, 95% CI = -204.53 to -81.69; P < 0.0001) and longer operative time (MD = -23.07 minutes, 95% CI = -41.14 to -4.99; P = 0.01). Mortality was comparable between the groups up to 36 months (risk ratio = 0.93, 95% CI = 0.50-1.73; P = 0.81). Early functional outcomes favored HA, although long-term scores were similar. This meta-analysis suggests that HA reduces complications and reoperations without increasing mortality and may represent a preferable option for many frail elderly patients, while treatment decisions should remain individualized based on operative risk and comorbidity.
To summarize current evidence on Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) applications and outcomes in facial plastic surgery. PRP and PRF are autologous platelet concentrates with regenerative potential. They release growth factors that promote tissue repair, angiogenesis, extracellular matrix remodeling, graft integration, and scar remodeling, making them increasingly relevant in facial plastic surgery. A narrative review of clinical studies, meta-analyses, and systematic reviews was conducted. Key outcomes included wound healing, graft retention, postoperative edema and ecchymosis, scar improvement, and patient satisfaction. PRP improved wound healing, reduced crusting, and enhanced patient satisfaction in rhinoplasty, while PRF decreased cartilage resorption and improved graft stability. In rhytidectomy, PRP offered modest reductions in edema and ecchymosis. Both agents enhanced scar revision and fat graft outcomes, with PRF showing superior remodeling and long-term graft retention. In periorbital rejuvenation, PRP improved pigmentation and satisfaction, whereas PRF improved skin texture and wrinkles. Both were safe with minimal adverse events. PRP and PRF are effective biologic adjuncts in facial plastic surgery, supporting tissue regeneration, graft integration, and aesthetic outcomes. Efficacy is influenced by patient factors and technique. High-quality, procedure-specific trials are needed to optimize protocols.
Traumatic injury in older people is a significant health burden with higher mortality rates than younger cohorts. Survival following older trauma may be complicated by the patients pre-injury state and clinical uncertainty. Timely identification of palliative and end-of-life care needs may be challenging for acute clinical teams, and treatment escalation planning is not routinely embedded in trauma care. This point prevalence snap-shot aimed to evaluate treatment escalation discussions and palliative/end of life care (EoLC) practice in older major trauma patients at a national level. A one-day point prevalence "flash-mob" audit was conducted across Major Trauma Centres (MTCs) and Trauma Units (TUs) in England, Wales and Scotland. All trauma patients aged ≥ 65 years in hospital were eligible for inclusion. Patients with and without treatment escalation plans (TEPs) and those on care pathways were analysed. Data from 957 patients in 49 hospitals were included and median time from injury was 11 days (interquartile range 4-24). A TEP or equivalent was documented in 393 patients (41.0%). Among patients with a TEP, there were more aged > 85 years (165/393 (41.9%), than in those without a TEP (167/564 (29.6%), p < 0.001). Clinical frailty scoring was performed in 657 patients (68.6%), and where recorded, TEPs were associated with increased frailty (CFS ≥5 TEP: 68% [207/304] vs. No TEP: 46.4% [164/353], p < 0.001). Polytrauma predominated over any single site injury (TEP: 140/393, 35.6% vs. No TEP: 197/564, 34.9%). Admitting specialty teams differed between groups and those with a TEP were more likely to be under the care of a medical consultant (92/393, 23.4%) compared to only 60/564, 10.6% of the no-TEP patients (p < 0.001). A fifth of those with a TEP were on a documented palliative, time-limited or end-of-life care pathway (20.3%). Care pathways were more likely in those with older age (p < 0.001) and severe frailty (CFS≥7) (p = 0.03) rather than injury type, clinical specialty or advance care plans. This national snapshot demonstrates limited and variable use of treatment escalation planning with low rates of recorded palliative and EoLC need discussions in older major trauma patients. Greater integration of frailty assessment and early goals-of-care discussions are required to improve care for this growing population.
Acute ischemic stroke (AIS) due to M2 middle cerebral artery (MCA) occlusion represents the most frequent medium vessel occlusion (MeVO), yet the benefit of EVT in these patients remains uncertain. The perfusion parameter Tmax >4 seconds reflects delayed contrast arrival and captures regions of hemodynamic compromise that may include both potentially salvageable tissue and areas at risk of infarction if reperfusion is delayed or incomplete. This study therefore aims to evaluate whether the Tmax > 4s volume perfusion deficit predicts functional outcomes in patients with M2 occlusions who undergo EVT. For this retrospective multinational study, AIS patients with M2 MCA occlusion who underwent EVT were included. We performed univariable and multivariable logistic regression analysis to predict the mRS outcomes 90 days after the stroke (90-day mRS), based on the Tmax > 4s volume and adjusting for age, admission NIHSS, ASPECTS, intravenous thrombolysis (IVT), and modified thrombolysis in cerebral infarction grading (mTICI). 130 M2 AIS patients were included, with a median age of 75.5 (65-81.75). The model based on Tmax > 4s volume had an area under the curve (AUC) of 0.81 (95% CI, 0.73-0.88). The optimal Tmax >4s volume threshold was 113 mL, which demonstrated the highest performance for discriminating between outcomes. Among the participants, ASPECTS (p = 0.03) was significantly lower and 90-day mRS (p = 0.05) was significantly higher in the Tmax > 4s greater than 113 ml volume patient cohort. In the multivariable logistic regression analysis, higher Tmax > 4s volume (OR: 0.24; 95% CI: 0.08-0.70) and higher admission NIHSS (OR: 0.88; 95% CI: 0.81-0.96) were independently associated with lower odds of favorable outcome (mRS 0-2), while successful EVT was a protective factor (OR: 6.10; 95% CI: 1.80-20.64). Our results demonstrate that Tmax > 4s serves as a quantitative marker for predicting mRS outcomes in M2 AIS patients who underwent EVT. When considered alongside established clinical variables, this metric may provide complementary prognostic information.
Middle meningeal artery embolization (MMAE) has emerged as a treatment for chronic subdural hematoma (cSDH), but comprehensive real-world safety data remain limited. We performed a multicenter retrospective analysis of 1781 consecutive patients undergoing MMAE for cSDH (2019-2025). The primary outcome was any procedure-related complication within 30 days. Inverse probability of treatment weighting (IPTW) assessed the association between technical success and complications, adjusting for demographic, clinical, and procedural confounders. Mean age was 72.8 ± 12.4 years; 68.1% were male. The 30-day complication rate was 5.1% (91/1781; 95% CI, 4.1-6.2). In-hospital mortality was 2.9% (47/1625). Technical success was achieved in 97.5% (1505/1543). Among documented complications, thromboembolic events were most common (37.2%; 32/86), followed by hemorrhagic complications (23.8%; 20/84) and access-site hematoma (10.4%; 8/77). Among patients with classifiable symptom status, 80.6% of complications were symptomatic, yielding an overall symptomatic complication rate of 3.0%. Neurological deterioration occurred in 27.1% (248/915). Among 1552 patients with documented surgical approach, complication rates were similar between surgery plus embolization (4.9%; 34/690) and embolization alone (5.2%; 45/860; OR, 0.94; 95% CI, 0.59-1.48; p = 0.79). After IPTW adjustment, technical success was associated with an 86% reduction in complication odds (OR, 0.14; 95% CI, 0.05-0.40; p < 0.001). In this large multicenter cohort, MMAE was associated with a 5.1% complication rate. Technical success was the strongest protective factor. Embolization with or without surgery showed equivalent safety profiles.
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, requires consistent high-quality care to reduce variation in patient experience and improve outcomes. The IBD Standards previously published in 2009, 2013 and 2019 have provided an aspirational framework for best practice. Since 2019, two rounds of national benchmarking with patient engagement, healthcare professional (HCP) consultation and new evidence have highlighted areas for quality improvement (QI). We aimed to develop the 2026 IBD UK Standards of healthcare for adults and children, ensuring they reflect current and aspirational best practice and to support future QI initiatives. A multidisciplinary working group of 18 HCPs and 4 people with lived experience assessed the 59 IBD standards from 2019, categorising them as needing no change, minor or major amendment or deletion. New standards were developed through iterative drafting and consensus review, with feedback incorporated from 47 external HCPs and a patient workshop. The 2026 standards remain aspirational, structured across seven domains: the IBD service, pre-diagnosis, newly diagnosed, flare management, surgery, inpatient care and ongoing care. The 2026 IBD UK Standards comprise 60 statements: 6 unchanged from 2019, 48 updated, 7 deleted and 6 new. Key themes include multidisciplinary, coordinated care with defined leadership; age-appropriate transition pathways; timely referral from primary care, access to diagnostic tests, treatments and surgery; patient-centred care, including better communication, personalised care plans, shared decision-making and support for self-management; holistic assessment and management of physical, nutritional and psychological need; QI and audit supported by electronic systems; research participation and innovation. The 2026 IBD UK Standards provide a contemporary aspirational framework to drive consistent, high-quality, personalised care across the UK. They aim to reduce inequality, improve experience and outcomes through support for patient-centred shared decision-making, national benchmarking, service development, patient involvement and QI.
Metaplastic breast cancer (MpBC) is a rare and aggressive breast cancer subtype characterised by marked histological heterogeneity, therapeutic resistance and poor clinical outcomes. Despite increasing molecular research, existing evidence remains fragmented, heterogeneous and poorly integrated, limiting clinical translation and biomarker validation. We developed an integrative analytical framework combining systematic review, quantitative meta-analysis, transcriptomic profiling and interpretable machine learning to identify and prioritise molecular markers in MpBC. A Preferred Reporting Items for Systematic Reviews and Meta Analyses-guided systematic review was conducted across PubMed, arXiv and Semantic Scholar. Effect sizes were standardised to Cohen's d and synthesised using a random-effects model. Transcriptomic analysis was performed on the GSE165407 dataset using DESeq2 in R (RStudio version 1.1.463), with differentially expressed genes cross-referenced against literature-derived biomarkers. Supervised models including a multi-layer perceptron and boosted random forest were applied, with performance evaluated using receiver operating characteristic analysis. Model interpretability was assessed using SHapley Additive exPlanations. Eleven studies met inclusion criteria. Meta-analysis demonstrated low heterogeneity and a pooled effect size of d = 0.74 (95% CI 0.59-0.88), indicating a consistent moderate-to-large biomarker signal across studies. Pathway enrichment revealed convergence on PI3K/AKT/mTOR signalling, immune modulation and epithelial -mesenchymal transition. Transcriptomic profiling demonstrated concordance with literature-derived markers. The random forest model achieved strong classification performance (AUC = 0.91), with high specificity and minimal misclassification. SHapley Additive exPlanations analysis identified both canonical (PI3KCA, RPL39, EXO1) and non-canonical (CD55, LARGE2) contributors to model prediction. This study provides an integrated synthesis linking systematic evidence, transcriptomic validation and interpretable machine learning in MpBC. By reconciling fragmented literature with data-driven modelling, we identify a biologically coherent and clinically tractable molecular signature, offering a foundation for biomarker-driven stratification and translational validation.
This study investigated context-associated variation in vocalizations in Malinois dogs through acoustic parameter analysis. Vocalizations from thirty adult Malinois dogs (15 males, 15 females) aged 2 to 3 years were recorded across 11 behaviourally defined contexts. Using Praat software, key acoustic parameters-fundamental frequency (F0), harmonic-to-noise ratio (HNR), and formant frequencies-were extracted and analyzed. Results indicated that different vocalization types (barking, whimpering, growling, snarling, howling) exhibited distinct acoustic profiles. Whimpering and howling showed significantly higher F0 values than barking (p < 0.05), with whimpering uniquely displaying both low and high F0 components. Dogs in contexts expected to be positively valenced (e.g., food anticipation) showed lower HNR than those in contexts expected to be negatively valenced (e.g., separation) (p < 0.05). However, the actual internal states were not independently verified. Formant analysis revealed that snarling and howling had lower Formant 1 (F1) values (p < 0.05), while formant dispersion varied with emotional state. These findings suggest that acoustic analysis of dog vocalizations can provide objective insights into dogs' motivational and arousal changes, thereby improving our understanding of canine vocal communication, social behavior, and the human-dog bond. This approach has potential applications for working-line Malinois breeding programs and for enhancing human-working dog interactions.
Thyroid eye disease (TED) is a serious medical condition observed in patients with thyroid disorders, and patients often present in emergencies, threatening their vision. This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients. This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes. Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.