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Differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, exhibits marked regional variations in epidemiology worldwide, with management strategies evolving in response to evidence-based advances in diagnosticsand therapeutic protocols.This article synthesizes global and China-specific epidemiological patterns in DTC, evaluates temporal trends in disease-specific survival across populations, and reviews the evolution of evidence-based guidelines. Building on emerging clinical evidence, it analyzes the rationale for therapeutic de-escalation and critically assesses its implications for clinical practice and patient outcomes.Drawing on adverse outcomes observed in international de-escalation protocols, this study advocates the principle of early detection, early diagnosis, and early treatment (the "three earlies"), establishes a surgery-led multidisciplinary team (MDT) for full-cycle management, and gradually advances to precision diagnosis and treatment, aiming to consolidate and enhance China's DTC care outcomes. 分化型甲状腺癌（DTC）作为甲状腺癌的主要病理类型，其全球流行病学特征呈现明显地域差异，诊疗理念也随循证医学证据积累不断革新。该文系统梳理国际及我国DTC的流行病学现状，对比其他国家与我国DTC生存率的变化趋势，并聚焦国内外权威指南中DTC诊疗策略的变化倾向，结合最新研究证据分析诊疗模式转变的核心逻辑，对DTC诊疗降级管理的策略进行理性思考。笔者参考国外DTC降级管理后预后变差的教训，提出应坚持“三早”原则，建立以外科为核心的多学科诊疗团队（MDT）进行全流程管理，以此为基础逐步实现精准诊疗，为巩固与提升我国DTC的诊疗成果提供保障。.
Remimazolam tosylate is an ultra-short-acting benzodiazepine sedative and anaesthetic. The related drug, midazolam, is associated with delirium but it remains unclear whether remimazolam also promotes delirium. We tested the primary hypothesis that remimazolam is non-inferior to propofol for delirium in patients during the initial 3 days after lung resection surgery. Secondary outcomes were the proportion of delirium-positive assessments; duration of stay in the post-anaesthesia care unit; and hospital and Mini-mental State Examination scores at 30 days. We randomly allocated patients aged ≥ 65 y to remimazolam or propofol anaesthesia for lung resection surgery. Delirium was assessed by trained assessors blinded to trial treatment using the Confusion Assessment Method in the post-anaesthesia care unit and twice daily for 3 postoperative days. Our non-inferiority margin was a 10% absolute difference in the incidence of postoperative delirium. The modified intent-to-treat population included 455 patients. Delirium occurred in 108/227 (48%) patients allocated to the remimazolam group and 71/228 (31%) in those allocated to the propofol group (risk ratio 1.53, 95%CI 1.21-1.94). The absolute risk difference was 16.5% (95%CI 7.7-25.3%) which considerably exceeded our non-inferiority margin; therefore, non-inferiority was not established. Emergence delirium was more frequent in patients allocated to remimazolam (105/227 (46%) vs. 64/228 (28%); risk ratio 1.65, 95%CI 1.28-2.12), whereas delirium after post-anaesthesia care unit discharge was uncommon and similar between groups (9/227 (4%) vs. 12/228 (5%); risk ratio 0.75, 95%CI 0.32-1.75). Delirium-positive assessments occurred in 129/1377 (9%) patients allocated to the remimazolam group and 102/1440 (7%) in those allocated to the propofol group (risk ratio 1.36, 95%CI 0.96-1.91). Remimazolam was not non-inferior to propofol for postoperative delirium in older patients having lung resection surgery and provoked more emergence delirium. We studied older adults having lung surgery and compared two anaesthetic drugs: remimazolam and propofol. Patients were randomly given one of the two drugs during their operation. After surgery, trained researchers checked for signs of delirium, a condition that can cause confusion and difficulty thinking clearly. A similar drug called midazolam has been linked to delirium after surgery. Remimazolam is a newer drug, and doctors wanted to know if it was as safe as propofol when it came to the risk of delirium in older patients. We found that delirium was more common in patients who received remimazolam than in those who received propofol. Nearly half of the patients given remimazolam experienced delirium, compared with about one‐third of those given propofol. The biggest difference was seen soon after waking up from anaesthesia, when confusion was more common with remimazolam. However, the two groups had similar lengths of hospital stay and similar memory and thinking test scores one month later. Overall, the study suggests that propofol may be a better choice than remimazolam for reducing confusion after lung surgery in older adults.
We propose a semi-supervised semantic segmentation framework based on a novel self-training method with Ambiguity-Driven Online Refinement (ADOR). Compared to recent methods based on consistency regularization that only use a limited amount of unlabeled data due to the need to filter noisy pseudo-labels, our approach leverages a larger amount of unlabeled data for training while being able to dynamically refine pseudo-labels to mitigate noise. To achieve this, we introduce Spatial Ambiguity Resolution (SAR) that selectively filters and refines the ambiguous regions in pseudo-labels produced by CNNs and ViTs. The proposed method leverages both local and global confidence as a robust estimate for label quality, and a stochastic correction disrupts the accumulation of errors. In addition, we present Semantic Ambiguity Learning (SAL) to adaptively enhance class separability based on varying levels of pairwise class confusion. Specifically, we adjust the pairwise similarity between a query feature and its positive and negative class prototypes, in order to place more emphasis on classes that are prone to confusion. Experimental results on both the Pascal VOC and Cityscapes datasets demonstrate the efficacy of our method with both CNNs and ViTs. Code will be made publicly available at https://github.com/LlistenL/ADOR.
BackgroundThe comet assay is a sensitive and widely used technique for assessing DNA damage at the single-cell level. Despite its advantages, traditional manual scoring methods remain time-consuming, subjective and limited in scalability, posing challenges for high-throughput and standardized analysis.ObjectiveThis study aims to develop and evaluate a deep learning-based system for automated comet assay image classification, addressing limitations of manual and semi-automated approaches while enhancing accuracy, reproducibility and processing efficiency.MethodA YOLOv5-based object detection model was trained on a dataset of 875 annotated comet assay images, curated through a three-step expert-reviewed process. Various hyperparameters and data augmentation techniques were optimized to improve performance. The dataset was split into training, validation and test sets, and model performance was evaluated using mAP, precision, recall and confusion matrix analysis.ResultsThe model achieved strong performance, with mAP@0.5 reaching 0.98 and recall exceeding 0.8. Detailed analyses revealed robust learning behavior and generalization capacity. Visual outputs, including precision-recall curves and class-wise confusion matrices, confirmed high classification accuracy, although overlapping comet structures and class imbalance posed challenges. The model demonstrated improved scalability and processing speed compared to traditional tools, supporting its integration into web-based applications.ConclusionThe proposed YOLOv5-based system offers a scalable and accurate solution for automating comet assay analysis. It significantly enhances throughput and reduces human error, supporting its application in genotoxicity testing, biomonitoring and molecular epidemiology. Future work will focus on handling overlapping structures, benchmarking against existing tools and optimizing deployment in real-world laboratory settings.
Plant diseases significantly affect agricultural productivity and global food security, while accurate disease identification remains challenging because of uncertain and overlapping visual symptoms in leaf images. Existing deep learning approaches often require large annotated datasets and suffer from limited interpretability in practical agricultural environments. This study presents a multi-parameter improved fuzzy soft set-based framework for plant disease classification using tomato leaf images from the PlantVillage dataset. The objective is to develop an interpretable and reliable classification model capable of handling uncertainty in plant disease patterns through feature-driven fuzzy similarity analysis. The methodology integrates image preprocessing, color and texture feature extraction, variance-based feature weighting, prototype generation using K-means clustering, and fuzzy similarity computation using Mahalanobis distance and Gaussian membership functions. RGB, HSV, and Gray-Level Co-occurrence Matrix (GLCM) features are extracted from standardized leaf images and evaluated within an improved fuzzy soft classification framework. Performance comparison is carried out using machine learning models including Support Vector Machine (SVM), Random Forest (RF), Linear Discriminant Analysis (LDA), and Naive Bayes (NB) implemented in Python using Scikit-learn libraries. Experimental simulation results demonstrate that the proposed framework achieves competitive classification performance while preserving interpretability and robustness under uncertain feature distributions. Performance evaluation is conducted through accuracy analysis, ROC-AUC curves, confusion matrices, ablation studies, and Wilcoxon Signed-Rank statistical testing. The proposed Improved Fuzzy Soft model achieved an accuracy of 88.57% which is less than LDA (94.92%), Random Forest (97.78%) and SVM (97.94%) classifiers. However, in the cross data set validation, the proposed Improved Fuzzy Soft model achieved an accuracy of 67.35% which is greater than LDA (51.02%), Random Forest (51.02%) and SVM (55.10%) classifiers. Statistical validation using the Wilcoxon Signed-Rank Test produced a p-value of [Formula: see text], confirming that the performance difference between the Improved Fuzzy Soft framework and the Random Forest classifier is statistically significant under the current experimental setting.
To examine global research trends in delirium prevention through a bibliometric analysis and provide a structured overview of its development and emerging directions. A bibliometric analysis. Data were retrieved from the Web of Science Core Collection, focusing on publications between January 1, 2015, and December 31, 2024. The analysis utilized VOSviewer, CiteSpace, and the Bibliometrix R package to evaluate publication trends, contributing countries, institutions, authors, and research focus areas. Annual publication output increased steadily from 2015 to 2024, indicating a growing research interest in postoperative delirium. The United States contributed the largest share of publications (26.8%), followed by China (12.1%), Japan (8.5%), and Australia (6.7%). Harvard University and Harvard Medical School were the most productive institutions. Inouye SK and Ely EW were the most prolific authors. International collaboration was centered on a network involving the United States, China, and Germany. The most-cited article was by Su X et al in The Lancet (2016; 512 citations), and the most locally cited reference was Inouye SK's Confusion Assessment Method (1990; 268 citations). Keyword analysis identified 11 major research themes, including postoperative delirium, cognitive impairment, dexmedetomidine, nursing-led nonpharmacological interventions, dementia, advanced age, machine learning, electroencephalogram monitoring, neuroinflammation, intensive care unit, cardiac surgery, and hip fracture. Research on postoperative delirium prevention has increased steadily over the past decade, with the United States and leading academic institutions contributing substantially to the field. Current research has focused on major risk factors and preventive interventions, while emerging topics such as machine learning, electroencephalogram monitoring, and neuroinflammation suggest new directions for future studies. Further research should address nonsurgical populations, integrated intervention strategies, long-term outcomes, and mechanistic pathways to support more precise and multidisciplinary prevention approaches.
Traditional detection methods often rely on fixed thresholding or machine-learning models, which can be computationally expensive. This study introduces a double-sliding-window technique to detect anomalies in ECG signals through adaptive-signal analysis. This method uses two independent sliding windows to dynamically track signal variations, enabling real-time identification of deviations in heart rhythm without prior knowledge of data distribution. The detection module achieved an average execution-time of 0.03 seconds with using less than 16 MB of memory, supporting its suitability for real-time systems. Furthermore, confusion matrix analysis yielded an accuracy of 95.33%, a sensitivity of 95.00%, a precision of 100.00%, and a specificity of 100.00%.
In older adults, bipolar disorder (BD) frequently presents atypically, with manic symptoms manifesting as irritability or confusion rather than euphoria. Cognitive impairments, including mild cognitive impairment and dementia, can obscure or mimic bipolar symptoms, complicating accurate diagnosis. Depressive episodes tend to be more frequent and prolonged, increasing misdiagnosis risk as unipolar depression. Pharmacological management requires careful consideration of age-related pharmacokinetic and pharmacodynamic alterations. Mood stabilizers including lithium, valproate, and lamotrigine are commonly employed but necessitate vigilant monitoring for adverse effects and drug interactions. Atypical antipsychotics such as quetiapine and aripiprazole are generally preferred for their tolerability profiles, though comorbidity burden and polypharmacy substantially elevate risks of adverse drug reactions and interactions. Late-onset and early onset bipolar disorder in older adults (LOBD and EOBD) represent clinically relevant subgroups with differing diagnostic considerations. However, current evidence does not clearly support major differences in pharmacologic management. The purpose of this narrative review is to address this gap by comprehensively exploring the clinical presentations and diagnostic challenges in older-age BD (OABD) as well as the pharmacological treatment patterns worldwide. We also outlined clinically focused synthesis of special considerations and tailored approaches, and finally critically appraise the literature to determine future directions and research needs. Addressing the multifaceted diagnostic and pharmacotherapeutic challenges of OABD through dedicated age-specific clinical trials, comparative effectiveness studies, systematic evaluation of deprescribing strategies, and enhanced clinician awareness will be fundamental to improve outcomes for this understudied and expanding population.
To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic and the 2022 formula crisis on the Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Qualitative study using in-depth key informant interviews. The Connecticut WIC Nutrition and Breastfeeding Peer Counseling programs between December 2022 and June 2023. Twelve WIC staff members: administrators (n = 2), peer counselors (n = 6), nutritionists/International Board-Certified Lactation Consultants (n = 3), and a breastfeeding coordinator (n = 1). The effect of the COVID-19 pandemic on (1) perinatal care for WIC mothers, (2) the provision of nutrition and breastfeeding peer counseling services in Connecticut, and (3) the effect of the 2022 formula crisis on peer counseling services and participants. An inductive, iterative approach was used to identify themes from the interviews. Braun and Clarke's 6-step approach was used to analyze transcripts. The pandemic caused disruptions to perinatal care that affected the peer counseling process and required a rapid shift in WIC structure, workflow, and communication approaches. The formula crisis led to uncertainty, confusion, and increased interest in breastfeeding. The WIC program adapted quickly by providing remote/virtual services and flexible service hours. These findings support the continued use of remote/virtual breastfeeding peer counseling services and operations in the state of Connecticut WIC program.
Stomatognathic movement disorders (SMDs) are uncommon but clinically significant neurological conditions that frequently present with orofacial manifestations. Because affected patients may initially seek care from dental practitioners, limited awareness of these disorders could contribute to diagnostic confusion with temporomandibular disorders (TMDs) and may have implications for timely referral and appropriate patient management. This study evaluated dental practitioners' knowledge, diagnostic confidence, and educational preparedness regarding SMDs. A cross-sectional survey was conducted among dental practitioners using a validated self-administered online questionnaire. Knowledge scores were calculated out of 25 points and expressed as percentages. Comparative analyses were performed across educational levels using one-way ANOVA, chi-square tests, and multivariable logistic regression. A total of 156 dental practitioners participated. Mean knowledge scores differed significantly across academic level (Bachelor: 44.05%, Master: 48.95%, Doctorate: 63.71%; p < 0.001). Doctoral-level education independently predicted adequate knowledge (OR = 8.54, 95% CI: 2.09-34.97; p = 0.003), whereas master's-level showed no significant effect. Knowledge gaps were observed in several domains, particularly in distinguishing SMDs from TMDs and in the management of oromandibular dystonia. Only a minority of participants correctly recognized that temporomandibular joint radiographs are not routinely required prior to treatment. Self-reported clinical confidence was generally low, with only 1.1% of general dentists reporting the ability to independently manage suspected SMD cases. Nevertheless, 94.9% of participants supported integrating SMD-related content into dental curricula. The surveyed dental practitioners demonstrated important knowledge gaps regarding SMDs. These findings highlight opportunities to strengthen undergraduate and continuing dental education in the recognition, differentiation from TMDs, and appropriate referral of patients with suspected SMDs.
Dorsal preservation rhinoplasty (DPR) has attracted significant attention in recent years. However, the rapid dissemination of diverse techniques and terminology has generated confusion regarding definition, indications, methodology, and outcomes. A unified conceptual framework remains lacking. We retrospectively reviewed 1,191 consecutive primary rhinoplasties performed by a single senior surgeon between 2010 and 2024. Three chronological series were analyzed. Series 1 (2010-2014; n = 320) introduced push-down and let-down osteotomies in selected cases. Series 2 (2015-2019; n = 352) expanded indications to more complex morphologies, exposing limitations. Series 3 (2020-2024; n = 519) applied a unified framework developed from the previous series. Revision rates and clinical lessons were compared. : Series 1 reported 11 revisions (3.4%), confirming feasibility in favorable cases. Series 2 recorded 35 revisions (9.9%) during the uncontrolled expansion of indications. Series 3 demonstrated 17 revisions (3.3%) after refinement of patient selection and operative decision-making informed by earlier experience, with revision rates differing significantly across the three series (χ²(2) = 21.61, p < 0.001). The third series validated that systematic application of a dorsal preservation framework produced reliable outcomes, minimized revisions, and helped formulate a pyramidal classification with named septoplasty modulators. The evolution of DP rhinoplasty follows a U-shaped learning curve, characterized by initial proof-of-concept, uncontrolled expansion, and subsequent consolidation through classification. Integration of the pyramidal framework with W-point septoplasty clarifies terminology, standardizes methodology, and establishes DP rhinoplasty as a reproducible and mature approach in contemporary practice.
Caseous calcification of the mitral annulus is a rare entity, often unrecognised by clinicians and radiologists alike. It can be difficult to diagnose on echocardiography, with the risk of confusion with cardiac tumours or pseudomasses. In this context, we report the case of a 40-year-old female patient with a notable medical history of arterial hypertension and chronic renal failure, admitted to the hospital with infectious pneumonitis complicated by right-sided chest pain. An echocardiogram performed as part of the work-up revealed severe aortic narrowing, calcification of the mitral annulus, moderate mitral insufficiency and severe tricuspid insufficiency. For pre-operative assessment, a coroscan was performed, demonstrating a hypodense formation in the aortomitral trigone, consistent with caseous calcification of the mitral annulus. This case illustrates the diagnostic complexity of multiple valve anomalies associated with cardiovascular and metabolic risk factors. It also highlights the crucial importance of multimodal imaging in refining the differential diagnosis and optimising the therapeutic strategy. This case thus contributes to the medical literature on the management of annular and caseous calcifications. La calcification caséeuse de l'anneau mitral est une entité rare et souvent méconnue des cliniciens, y compris des radiologues. Son diagnostic peut s'avérer difficile en échocardiographie, avec un risque de confusion avec des tumeurs ou pseudomasses cardiaques. Dans ce contexte, nous rapportons le cas d'une patiente de 40 ans, aux antécédents médicaux notables d'hypertension artérielle et d'insuffisance rénale chronique, hospitalisée pour une pneumopathie infectieuse compliquée de douleurs thoraciques droites. Une échocardiographie réalisée dans le cadre du bilan a révélé un rétrécissement aortique serré, une calcification de l'anneau mitral, une insuffisance mitrale modérée et une insuffisance tricuspide sévère. En vue d'une évaluation préopératoire, un coroscanner a été effectué, mettant en évidence une formation hypodense au niveau du trigone aortomitral, compatible avec une calcification caséeuse de l'anneau mitral. Ce cas illustre la complexité diagnostique en présence d'anomalies valvulaires multiples associées à des facteurs de risque cardiovasculaires et métaboliques. Il souligne également l'intérêt crucial d'une imagerie multimodale pour affiner le diagnostic différentiel et optimiser la stratégie thérapeutique. Ce cas contribue ainsi à enrichir la littérature médicale sur la prise en charge des calcifications annulaire et caséeuse.
Hip fractures significantly impact the physiological and psychological well-being of elderly patients. Post-operative delirium (POD) is a common complication after hip fractures in this population, severely affecting treatment outcomes and recovery. Effective pain management during the peri-operative period is crucial for reducing POD, yet the best analgesic approach remains debated. A retrospective study (from January 2015 to December 2020) included 198 elderly hip fracture patients who received preoperative (PO-) or intraoperative (IO-) fascia iliaca compartment block (FICB) with 50 mL of 0.25% ropivacaine. Over the first 3 days (assessed every 24 h), cognitive function (Mini-Mental State Examination [MMSE]), pain intensity (Visual Analog Scale [VAS]), and systemic inflammatory mediators (CRP, IL-1, IL-6, TNF-α) were evaluated. Postoperative delirium (POD) incidence was daily assessed via the Confusion Assessment Method (CAM) for 72 h by a trained surgeon. Statistical analyses included intergroup comparisons of MMSE/VAS scores and inflammatory markers; cumulative POD incidence was analyzed using Kaplan-Meier curves. Normally distributed data were compared via independent-samples t-test, and categorical data (expressed as percentages) via chi-square (χ²) test. Patients were allocated to two groups: PO-FICB (n = 100) and IO-FICB (n = 98). Postoperatively, the PO-FICB group had significantly higher MMSE scores on days 1-3 (27.85 ± 1.923, 27.49 ± 2.807, 27.23 ± 1.698 vs. 25.80 ± 1.864, 25.73 ± 2.197, 22.57 ± 2.128; all P < 0.01) and lower levels of inflammatory mediators (CRP, IL-1, IL-6, TNF-α; all P < 0.05). VAS pain scores were lower in the PO-FICB group (1.58 ± 0.702, 2.26 ± 0.647, 2.40 ± 0.492 vs. 2.70 ± 0.659, 3.02 ± 0.853, 2.33 ± 0.620), with significant differences on days 1-2 (P < 0.0001) but not day 3 (P = 0.068). POD incidence was significantly lower in the PO-FICB group (5% [5/100]) than in the IO-FICB group (15.3% [15/98]; P = 0.0168). No severe complications or mortality were observed during 12-month follow-up. Compared with IO-FICB, PO-FICB may confer more targeted analgesia and is associated with a lower incidence of POD in elderly hip fracture patients. These associations might relate to PO-FICB's potential early effects of inhibiting inflammation and exerting putative neuroprotective-like actions, which are consistent with current multimodal perioperative management strategies and geriatric neuroprotective concepts. This finding provides preliminary support for considering PO-FICB as a viable option in perioperative regional anesthesia selection for this patient population.
This paper critiques the use of the term "mysticism" in psychedelic research, arguing its continued use is outdated and misleading. It highlights the confusion stemming from the historical context of "mysticism," particularly through the works of Walter Stace and Walter Pahnke, whose ideas have shaped the psychedelic discourse despite being flawed and largely unexamined. The paper is divided into two parts: the first is an archaeology that re-evaluates these foundational texts that misled psychedelic discourse; the second is a genealogy that traces how the concept of "mysticism", with its religious roots, became attached to "psychedelics" and became normalised in second generation psychedelic research. It advocates for rebranding the Mystical Experience Questionnaire (MEQ) to the Psychedelic Experience Questionnaire (PEQ), emphasising that this change accords nicely with the idea of Psychedelic Experience which Walter Pahnke developed in his later research, as a five-part typology, and liberates the instrument from the hangover of a dubious legacy in which the correlation between therapeutic outcomes and mystical experiences invites psychedelic experiences to be shoehorned into a very particular and peculiar quasi-religious construct.
Pyogenic ventriculitis is a rare and potentially fatal infection of the ventricular system. While most reported cases are nosocomial and catheter-associated, ventriculitis as a complication of community-acquired bacterial meningitis is uncommon, particularly in adults, and carries a poor prognosis. We report the case of an 82-year-old previously healthy and unvaccinated woman who presented with a one-day history of fever, confusion, and purulent left-sided otorrhea on a 2-week background of flu-like symptoms. Cranial computed tomography was consistent with otogenic meningitis complicated by pneumocephalus, and lumbar puncture confirmed purulent meningitis. Empirical therapy for meningitis with ceftriaxone, amoxicillin, metronidazole, and dexamethasone was initiated, and surgical source control of the otogenic focus was performed. Both blood and cerebrospinal fluid cultures grew Streptococcus pneumoniae with a penicillin minimum inhibitory concentration of < 0.03 mg/L. Serotyping by multiplex PCR with confirmatory Quellung reaction, performed at the Swiss National Reference Center for Invasive Pneumococci, identified Serotype 3. Despite penicillin G monotherapy, fever and impaired consciousness persisted, and repeat imaging revealed meningitis-associated pyogenic ventriculitis with intraventricular debris. Adjunctive rifampicin and a series of cerebrospinal fluid drainage interventions (lumbar drain followed by external ventricular drain) failed to substantially improve neurological outcome. Antibiotic therapy was continued for 9 weeks, after which the patient was transferred to long-term institutional care with severe residual neurological impairment. This case illustrates the diagnostic and therapeutic challenges of meningitis-associated pyogenic ventriculitis in adults and the disproportionate severity of disease caused by Serotype 3 S. pneumoniae, whose unusually thick mucoid capsule promotes immune evasion and the formation of viscous purulent debris that hampers source control. The case is consistent with Swiss surveillance data showing that Serotype 3 remains a leading cause of invasive pneumococcal disease in older adults and serves as a sentinel event highlighting persistent gaps in adult pneumococcal immunization.
Tuberculosis (TB) preventive treatment (TPT) is effective in preventing TB among people living with HIV (PLHIV). Patient experiences and preferences contribute to optimising the delivery cascade for TPT among PLHIV. We describe patient-level reasons for initiation, completion, refusal and discontinuation of 3HP (high-dose rifapentine (RPT) 900 mg plus isoniazid (INH) 900 mg weekly for 3 months) and INH in Ethiopia, South Africa and Zimbabwe. We conducted a total of 141 45-60 min in-depth interviews (IDIs) with adult PLHIV in Ethiopia (n=45), South Africa (n=45) Zimbabwe (n=51) between March and June 2022. Participants were attending routine HIV care in nine healthcare facilities and interviewed using a study-designed interview guide. The guide explored three categories: TB and TPT knowledge, reasons for TPT initiation and experiences of taking TPT and antiretroviral therapy (ART). Recordings were transcribed verbatim, translated and thematically analysed on MAXQDA using an abductive coding scheme incorporating the information-motivation-behavioural (IMB) skills model to understand reasons behind TPT uptake patterns. Of the 141 participants, 28 were still on TPT, 66 completed, 22 discontinued and 25 refused to initiate TPT. The majority were female (88%, 124/141), with an average of 36 years. IMB constructs were reflected in participants' TPT uptake patterns, with illustrative quotes highlighting key patterns across the dataset. In relation to information, participants demonstrated knowledge of TPT and its benefits; however, there was confusion about the role of TPT in the absence of TB disease. Prior TB experiences, social support and engagements with healthcare workers were motivations for uptake. The main behaviours found included adoption of adherence strategies and use of medication reminders. Side effects, fears of pill burden and contraindications had negative outcomes for TPT uptake and completion. The findings underscore the need to enhance the understanding of TPT through targeted interventions at clinic and community levels. Strengthening these efforts may improve TPT uptake and completion rates.
Polycystic ovary syndrome (PCOS) was recently renamed polyendocrine metabolic ovarian syndrome (PMOS). We review the renaming process, the potential advantages, and the challenges associated with this global effort. A large consortium of experts and patient representatives debated whether renaming was justified, what principles should guide a new name, and how such a change could be implemented without disrupting clinical care, research, education, or patient communication. Surveys indicated that awareness of the broader features of the syndrome improved in the last years after dissemination strategies and patient advocacy initiatives, but important gaps remained, particularly around the risk of comorbidities. New perspectives emerge with renaming PCOS into PMOS after a carefully planned effort to improve scientific accuracy, patient understanding, and clinical communication while minimizing confusion during implementation. The new terminology emphasizes the syndrome's endocrine and metabolic nature and removes the misleading reference to 'polycystic' ovaries. Similar to previous successful nomenclature updates in gynecology, this gradual transition aims to enhance education, interdisciplinary care, research, and long-term management, ultimately supporting more accurate diagnosis and improved patient outcomes.
Lichen sclerosus (LS) and morphea are chronic inflammatory sclerosing dermatoses that occasionally exhibit overlap. While their coexistence within the same lesion is increasingly recognized, nodular presentations remain exceptionally rare. We report a 50-year-old woman with a strikingly distinctive presentation of a solitary, well-circumscribed, exophytic nodule on the left posterior thigh, characterized by an ivory-colored peripheral rim, and an erythematous central zone. Histopathological examination revealed features of both lichen sclerosus (epidermal atrophy, basal vacuolar alteration, and homogenized upper dermal collagen with a subjacent band-like lymphocytic infiltrate) and keloidal morphea (deep dermal sclerosis with keloidal collagen fibers extending into subcutaneous septa, entrapped adnexal structures, and lymphoplasmacytic infiltrate). The exophytic nodular morphology with keloidal features expands the known clinical spectrum of LS-morphea overlap. Recognition of this unusual variant may prevent diagnostic confusion with other nodular dermal proliferations.
This retrospective study aimed to investigate inadvertent intraoperative hypothermia (IIH) in patients undergoing laparoscopic radical resection for colorectal cancer (CRC) and to compare predictive models for short-term prognosis. Among 296 CRC patients (January 2022 to June 2024), univariate and multivariate logistic regression identified independent risk factors. Based on these, five models (nomogram, neural network, decision tree, random forest, gradient boosting machine) were constructed and evaluated using ROC, calibration curves, decision curves, and confusion matrices, with an additional 102 patients (July 2024 to July 2025) for clinical validation. Of the 296 patients, 72 (24.32%) had poor short-term prognosis, and 102 (34.46%) experienced IIH. Restricted cubic spline analysis showed IIH duration >55 minutes significantly increased poor prognosis risk. IIH was an independent risk factor (OR=4.498, P<0.001), remaining significant after adjusting for tumor location, TNM stage, and CEA (OR=4.245, P<0.001). Rectal tumor location, TNM stage III, and CEA ≥5 ng/mL were also risk factors. Except for the decision tree, the four other models showed good predictive performance in both sets. In the independent validation (102 cases), prediction accuracies were 83.33%, 78.43%, 78.43%, 77.45%, and 75.49%, respectively. In conclusion, IIH is an independent risk factor for poor short-term prognosis after laparoscopic CRC resection, with significantly increased risk when duration exceeds 55 minutes. Logistic regression, neural network, random forest, and gradient boosting machine all demonstrate excellent predictive performance.
Identifying the origin of perforating lesions on fossil bone is often difficult, and many are considered tooth traces, in spite of more likely and more parsimonious etiologies. Much of this confusion stems from tooth trace criteria that are ambiguous when the context for the lesions is not considered. Mistaken identification of tooth traces has led to misleading interpretations of animal behavior. This study of tooth traces on fossil bones critically reviews previous criteria and applies them to assessing bones from an Edmontosaurus annectens bonebed within the Lance Formation, Wyoming, USA. Of the 3013 bones examined, thirteen bones had features indicative of tooth traces based on gross appearance. Of these, one bone had perforations determined to have a different etiology. Twelve bones had traces attributed to tooth marks, including four bones with Knethichnus parallelum and Linichnus serratus ichnotaxa. Tyrannosaurus rex was identified as the likely inflictor of traces attributable to both ichnotaxa, by comparison of denticle density of carnivore teeth within the bonebed with striation/serration density of the traces. The importance of context in the analysis of perforating lesions on fossil bones is shown through the mistaken identification of features such as neurovasculature foramina and lesions associated with pathology as tooth traces. This study contributes to the literature on biting behavior and refines the criteria used to identify perforations caused by bite marks. The application of these refined criteria also proved useful in accurately identifying tooth traces on bone. This, in turn, enhances the guidelines for recognizing perforations as tooth traces and encourages further research on this topic.