In this study, we investigated the contribution of verbal working memory (WM) and semantic organization resources in poor and good reading comprehenders (age range: 7.5-11 years). From an initial sample of 151 children, 20 poor and 18 good reading comprehenders were selected and administered a battery of WM tasks -ranging from low to high attentional demands (forward span, backward span, selective word span, and dual task word span)- as well as a semantic WM task involving the manipulation of taxonomic and thematic semantic organization. The findings support the role of working memory (WM) attentional resources, particularly those implicated in the backward span task, in differentiating between skilled and less-skilled reading comprehenders. In addition, a specific contribution of taxonomic and thematic semantic resources emerged. Notably, we observed a correlation between good reading comprehension and stronger taxonomic associations, whereas this relationship was absent in poor comprehenders. Taken together, these findings suggest that specific semantic memory resources contribute to reading comprehension over and above general working memory capacities.
This Viewpoint discusses potential consequences of large language model use for long-term cognitive health and risk of dementia and suggests strategies for gathering evidence to study this topic.
Social categorization is a fundamental aspect of social perception, enabling individuals to process vast amounts of information efficiently. This exploratory fMRI study investigated whether different types of social groups are represented in the brain as stable memory representations. We used repetition suppression as a proxy-measurement for such stable representation, examining four groups categorized by their warmth and competence into the quadrants of the Stereotype Content Model (SCM). Participants judged the typicality of behavioral sentences associated with these groups, presented in pairs that either repeated the same group, or not. A repetition suppression pattern was observed in the posterior temporal sulcus (pSTS) for groups with mixed warmth and competence; specifically the rich (low warmth, high competence) and the poor (high warmth, low competence). By contrast, no suppression was detected for non-mixed groups (military people and welfare recipients). We theorize that mixed groups elicit greater ambiguity, which may prompt the brain to form more robust representations to quickly assess their functional relevance. These findings suggest that stable group representations are not uniformly applied across all group types and may reflect social complexity and motivational salience. The results highlight the pSTS as a key node in group representation and invite further research into its functional role.
Whether comprehensive prestroke risk factor (RF) management-defined by the extent to which existing major RFs meet prespecified treatment and biomarker criteria-is associated with 3-month functional outcomes after ischemic stroke remains unclear. We analyzed patients with ischemic stroke from the CRCS-K-NIH (Clinical Research Collaborations for Stroke in Korea-National Institutes for Health) registry (2011-2022), a multicenter stroke registry in Korea. Hypertension, diabetes, dyslipidemia, and atrial fibrillation were considered as major RFs for ischemic stroke. Comprehensive prestroke RF management was categorized as well controlled (all present RFs meeting study-defined control criteria), partially controlled (some RFs meeting this criteria), or poorly controlled (no RFs meeting this criteria). The primary outcome was 3-month modified Rankin Scale score of 0 to 2, indicating functional independence (good outcome). Among 63 570 patients with ≥1 major RFs, 28.6% were poorly controlled, 35.6% partially controlled, and 35.8% well controlled. The rate of 3-month good outcome was 66.0% among those with 1 RF, 60.8% in 2, and 55.0% in ≥3. After multivariable adjustment, both well-controlled and partially controlled groups had significantly higher odds of achieving good 3-month outcomes compared with poorly controlled patients, consistently across RF burden strata(well controlled: adjusted odds ratio, 1.16 [95% CI, 1.08-1.25] for 1 RF, 1.34 [95% CI, 1.21-1.48] for 2, and 1.23 [95% CI, 1.03-1.48] for ≥3; partially controlled: 1.16 [95% CI, 1.06-1.26] for 2; 1.22 [95% CI, 1.05-1.42] for ≥3) and in the overall cohort (well controlled: 1.22 [95% CI, 1.15-1.29], partially controlled: 1.14 [95% CI, 1.07-1.22]). Comprehensive prestroke RF management, defined by study-specific treatment- and biomarker-based criteria, was independently associated with a higher likelihood of favorable 3-month outcomes across levels of RF burden. These findings suggest that effective prestroke management of existing RFs may improve poststroke functional outcomes, regardless of the number of RFs present.
To investigate factors associated with achieving both postoperative knee flexion range of motion (ROM) ≥ 125° and Numerical Rating Scale (NRS) pain score ≤ 1 at one year after posterior cruciate-retaining total knee arthroplasty (CR-TKA). This retrospective cohort study included 100 patients who underwent CR-TKA between 2018 and 2021. Patients were divided into a good outcome group (G group; n = 43), defined as achieving both postoperative one year knee flexion ROM ≥ 125° and NRS ≤ 1, and a non-good outcome group (NG group; n = 57). Baseline demographic and clinical variables, including age, sex, operative side, body mass index (BMI), preoperative ROM, preoperative NRS, Oxford Knee Score (OKS), and surgical technique, were compared between groups. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with favourable postoperative outcomes. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the discriminative ability of BMI. In the univariate analysis, BMI was significantly lower in the G group than in the NG group (24.54 ± 3.50 vs. 26.35 ± 3.90 kg/m2, p = 0.045). No significant differences were observed for age, sex, operative side, surgical technique, preoperative ROM, preoperative NRS, body weight, height, or OKS. Multivariable logistic regression analysis demonstrated that lower BMI was significantly associated with achieving favourable postoperative outcomes (odds ratio 0.828, 95% confidence interval 0.708-0.968, p = 0.017). ROC curve analysis demonstrated only modest discriminative ability of BMI, with an area under the curve of 0.614 (95% confidence interval 0.510-0.772). The optimal BMI cutoff value was approximately 26 kg/m2. Lower BMI was associated with achieving both good knee flexion and pain-free recovery at one year after CR-TKA. However, because the discriminative ability of BMI alone was modest and residual confounding cannot be excluded, BMI should be interpreted as one associated factor rather than a standalone predictor of postoperative success.
Frailty increases the risk of medication-related harm in older adults, emphasising the importance of early detection of drug-related problems during medication reviews. A new frailty screening tool, using electronic pharmacy data on age, sex, preferential reimbursement of medical expenses, number of chronic medications and medication use, offers a practical solution for community pharmacists to identify this risk group. In this study, we aimed to externally validate this tool. For this external validation, data of community-dwelling participants with available frailty status from the HISLink project were used. This database contains data from the national Health Interview Survey 2018, a cross-sectional population survey conducted by Sciensano, linked to health insurance data (i.e. claims data from the Belgian Compulsory Health Insurance, which includes records on reimbursed healthcare utilisation and medication, and level of reimbursement of medical expenses). The Health Interview Survey 2018 database also contains frailty status assessed using SHARE-FI, which was used to evaluate the frailty screening tool's model performance and predictive accuracy. Logistic recalibration was applied to account for differences in baseline risk and predictor effects, between the development and validation cohorts. A subgroup sensitivity analysis was conducted. Of the 2191 (mean age 74.4 ± 7.2 years, 53.5% female) participants, 20.7% were frail according to SHARE-FI. The screening tool detected 31.6% as frail. Discrimination was good with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.74-0.79), sensitivity of 63.9% and specificity of 76.8% (positive predictive value 41.8% and negative predictive value 89.1%). Calibration was initially modest (Brier score of 0.17) but improved substantially after logistic recalibration (Brier score of 0.13). In the subgroup of individuals with polypharmacy, an area under the receiver operating characteristic curve of 0.72 (95% confidence interval 0.68-0.76) was reported with sensitivity of 76.6% and specificity of 55.6% (positive predictive value 49.3%; negative predictive value 80.8%). The frailty screening tool provides a valid and reliable method for identifying older adults at risk for being frail in the community pharmacy. Its previously observed good performance is confirmed through external validation using data from the HISLink project.
Morality is central to human nature. Being morally accountable requires an understanding of oneself as existing through time and space and an ability to remember past events. We present the first series of studies systematically examining the frequency and characteristics of autobiographical memories for morally themed events using open-ended sampling of autobiographical memories followed by independent coding for morality, following a predefined coding scheme. Overall, the findings show that autobiographical memory plays a central role in relation to morality. Across three studies, using different cueing methods, a substantial proportion of memories referred to a moral theme, with the theme of caring (vs. harming) being especially pronounced. The frequency of memories with moral content increased with greater self-relevance of the memory cue. Across cueing conditions, we found a predominance of memories referring to events in which the person was the agent for a morally good act. Personal misdeeds, being the target for misdeeds, and the target for good deeds were remembered less frequently and dated to have taken place more distant in time. Analyses of self-rated memory characteristics showed a tendency to downplay the narrative importance and self-relevance of memories for personal misdeeds but yielded little support for the idea of impaired memory for such events. The findings are related to evolutionary theory of the development of complex social systems and integrate the study of autobiographical memory with the growing field of moral psychology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Early detection of colon cancer through screening is critical for improving long-term survival outcomes; however, only 54 % of the United States (U.S.) population that is eligible to have a colon cancer screening receive one. Previous research found that people who participate in physical activity (PA) are less likely to get screened due perception of having low risk. However, health organizations have lowered the age to initiate screening as more cases are being reported among younger U.S. residents. This study aimed to examine the association between colon cancer screening and self-reported health status for individuals meeting aerobic PA guidelines among individuals aged 45-54. We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We included all participants between the ages of 45 and 54 who responded to the questionnaire regarding colonoscopy and sigmoidoscopy examinations, and the supplementary module that features PA and sedentary behaviors. Among 1118 respondents, 503 (45.5 %) reported having undergone colon cancer screening via colonoscopy or sigmoidoscopy, whereas 615 (54.5 %) had not. Screening prevalence differed by insurance status (p=0.002), with higher rates among insured individuals (483/1034; 47.2 %) compared with uninsured individuals (11/65; 19.2 %). Screening also varied by race/ethnicity (p=0.022); rates were highest among White respondents (353/732; 49.9 %) and lowest among Asian respondents (16/60; 27.3 %). Screening did not significantly differ by education, sex, overweight/obesity status, transportation access, place of residence, or PA status (all p>0.05). Among respondents meeting aerobic PA guidelines (n=1048), 489 (47.0 %) reported screening. Neither cardiovascular disease (CVD) risk (adjusted odds ratio [AOR]=1.22, 95 % confidence interval [CI]: 0.87-1.70) nor self-reported good health (AOR=0.89, 95 % CI: 0.52-1.51) was associated with screening. Among those meeting both aerobic and strength training guidelines (n=541), 255 (48.8 %) reported screening. In this group, reporting good or better health was associated with lower odds of screening (AOR=0.37, 95 % CI: 0.15-0.90), while CVD risk remained nonsignificant (AOR=1.33, 95 % CI: 0.80-2.23). Our analysis found no link between colon cancer screening and self-reported health status for those meeting aerobic guidelines, but those who met both aerobic and strength training guidelines were less likely to get screened. Uninsured individuals and Asian Americans also had lower screening rates. These findings highlight the need for targeted public health campaigns to address screening disparities, particularly among active individuals and underserved communities.
We report a combined experimental and theoretical investigation of the structural, electronic, elastic, and vibrational properties of triclinic Li2W2O7. The crystal structure was confirmed through Rietveld refinement, in good agreement with the reported triclinic model. Density functional theory (DFT) calculations within the DFT-GGA/PBE framework reproduce the experimental lattice parameters with deviations below 5%. Bader charge analysis reveals predominantly ionic Li-O interactions (Li ≈ +0.90e) combined with significant W-O covalency (W ≈ +2.98e), and electronic structure calculations show a wide O 2p → W 5d charge-transfer band gap characteristic of d0 tungstates. Elastic constant calculations confirm mechanical stability with moderate anisotropy. Raman spectroscopy supported by DFT phonon calculations enables reliable mode assignment, revealing pronounced Li atomic motion in many WO6 vibrations. Hirshfeld surface analysis indicates that Li···O/O···Li contacts dominate the crystal packing (≈55.7%), with a 22.15% void fraction in the framework. High-pressure Raman measurements up to 9.3 GPa show predominantly positive pressure coefficients and clear spectral modifications between 6.3 and 7.5 GPa, providing evidence for a pressure-induced structural phase transition driven by octahedral tilting and symmetry reduction. The pressure response is governed by the interplay between rigid WO6 octahedra and a more compressible Li-O sublattice.
Middle meningeal artery embolization (MMAE) is a minimally invasive adjunctive treatment for chronic subdural hematoma (cSDH). The TRUFILL n-butyl cyanoacrylate (n-BCA) liquid embolic system is indicated for embolization of cerebral arteriovenous malformations for presurgical devascularization and may be appropriate for MMAE in patients with cSDH. To evaluate safety and effectiveness of the study device for MMAE plus standard of care vs standard of care alone in patients with cSDH. The Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n-BCA (MEMBRANE) trial was a prospective, multicenter, open-label, randomized clinical trial conducted from May 27, 2021, to February 6, 2024, at 30 hospitals (28 in the United States and 2 in China). Participants aged 18 to 90 years with symptomatic cSDH and a modified Rankin Scale score of 3 or less were enrolled. Site physicians determined whether each patient required surgical or nonsurgical management. Participants in the surgical and nonsurgical cohorts were then randomized 1:1 to receive MMAE plus standard of care or standard of care alone. The primary effectiveness end point was residual or re-accumulation of hematoma (>10 mm; assessed by an independent core laboratory) at 6 months or requiring a surgical procedure on the cSDH within 6 months (conducted as an intention-to-treat analysis). The primary safety end point was incidence of adverse events through 6 months (conducted as an as-treated analysis). A total of 376 participants (188 in MMAE plus standard of care and 188 in standard of care alone) were included. In the MMAE plus standard of care and standard of care alone groups, the mean (SD) age was 70.9 (10.6) and 70.3 (12.1) years, and 45 (23.9%) and 49 (26.1%) were female, respectively. Primary effectiveness end point events occurred in 17 of 146 participants receiving MMAE plus standard of care (11.6%) and 29 of 131 receiving standard of care alone (22.1%) (final estimate of common odds ratio: 0.53 [90% CI, 0.31-0.91]; P = .04), indicating statistically significant benefit for MMAE plus standard of care vs standard of care alone. Adverse events occurred in 130 of 181 participants in the MMAE plus standard of care group (71.8%) and 124 of 190 in the standard of care alone group (65.3%) through 6 months. MMAE plus standard of care treatment was noninferior to standard of care alone based on analysis of good functional outcome at 3 months, as assessed by the modified Rankin Scale. In this randomized clinical trial, MMAE plus standard of care significantly reduced rates of recurrence and reoperation vs standard of care alone, without a significant increase in adverse events. ClinicalTrials.gov Identifier, NCT04816591.
Chronic kidney disease (CKD) constitutes a significant global health challenge due to its association with elevated morbidity and mortality rates. Diabetic nephropathy is a primary contributor to CKD progression, predominantly resulting from persistent inflammatory and fibrotic processes. CXCL12 is a multifunctional chemokine that has been implicated in renal pathology through context-dependent protective and deleterious effects. This study aimed to investigate circulating CXCL12 and CXCR4 levels in patients with diabetic nephropathy, and non-diabetic nephropathy, and to evaluate their association with disease severity. This study included 177 participants comprising 60 patients with diabetic nephropathy, 57 patients with non-diabetic nephropathy, and 60 healthy controls. Plasma CXCL12 and CXCR4 concentrations were measured using ELISA method. The Kruskal-Wallis test and subsequent post hoc analyses were used to compare groups. ROC curve analysis evaluated the diagnostic value of the biomarkers. Also, binary logistic regression identified independent predictors of CKD. CXCL12 concentrations differed significantly between study groups and were highest in patients with diabetic nephropathy. CXCL12 levels increased with advancing CKD stage in the overall cohort. While no significant stage-related variation was observed in diabetic nephropathy, a pronounced stage-dependent increase was evident in non-diabetic nephropathy. CXCR4 levels showed minimal variation and weaker associations with disease stage. CXCL12 demonstrated good discriminatory performance and independently predicted CKD presence. Elevated CXCL12 levels are strongly associated with CKD irrespective of underlying etiology and may represent a valuable biomarker for disease detection and progression, particularly in non-diabetic CKD.
The nonlinear dynamics of transverse and polarization modes of a broad-area vertical-cavity surface-emitting laser (BA-VCSEL) exhibit, without any external perturbation, chaos with high correlation dimension, large bandwidth (BW), and good spectral flatness over a wide range of currents. We leverage this for high bit-rate entropy generation and random number generation (RNG), passing the NIST tests with rates up to 150 Gb/s, and observe a correlation between the correlation dimension and the number of passed NIST tests. The RNG shows consistent performance across a wide range of parameters. In contrast to other setups, our system does not require optical feedback or optical injection to generate chaos, making it simple, compact, and robust.
The need for sustainable synthesis of bioactive silver nanoparticles (AgNPs) has driven interest in plant-mediated nanotechnology. The synthesis of silver nanoparticles using the aqueous extract of Crataegus songarica K. Koch was investigated in this study. To determine the formation, size, surface morphology, and composition of the synthesized AgNPs, various techniques were used, such as UV-Vis spectroscopy, FTIR, XRD, SEM, EDX, and DLS, to validate the formation of AgNPs. A typical absorption peak (447 nm) in the UV-Vis spectrum indicated the formation of spherical AgNPs, and FTIR analysis revealed the presence of phenolic compounds in the reduction and stabilization of nanoparticles (NPs). XRD was used to determine that the crystallite size was 28.01 nm on average to ensure that the AgNPs were crystalline. SEM images showed clearly defined rounded particles with a size ranging from 20 to 60 nm, and EDX analysis revealed the presence of metallic silver. The produced AgNPs exhibited high biological activity, as demonstrated by their strong antibacterial effect against both gram-positive and gram-negative bacteria, with the largest linear fungal growth inhibition observed against Staphylococcus epidermidis. In addition, AgNPs were effective as antifungal agents against Candida albicans and Aspergillus niger and as dose-dependent anticancer agents against HepG2 cancer cells. As demonstrated in their antioxidant tests, the DPPH and FRAP assays showed good radical scavenging and ferric ion reduction potentials, which are similar to those of ascorbic acid. This study demonstrates that AgNPs mediated by C. songarica are a promising bioactive product that is safe for use in biomedical research and has potential in antimicrobial, anticancer, and antioxidant therapies.
Physical function frequently declines after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the influence of disease status and general condition at the time of transplantation on longitudinal functional changes remains unclear. This retrospective study included 135 adult patients with hematological malignancies who underwent their first allo-HSCT and completed physical function assessments before transplantation and at discharge. Handgrip strength and 6-min walk distance (6MWD) were evaluated. Patients were stratified according to disease status (complete remission [CR] vs. non-CR) and general condition (performance status [PS]). Both handgrip strength and 6MWD decreased significantly after transplantation in all groups. No significant differences in functional changes were observed between the CR and non-CR groups. In contrast, patients with poor PS at transplantation tended to show a greater decline in 6MWD than those with good PS. Multiple regression analysis identified PS at transplantation, age, sex, and change in the hemoglobin level as significant factors associated with changes in 6MWD. Pre-transplant PS was associated with a greater post-transplant decline in endurance capacity, regardless of disease status. PS may serve as a practical clinical indicator for identifying patients at higher risk of physical function deterioration and guiding early targeted rehabilitation interventions.
Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country’s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.
Reliable authentication of high-value edible oils remains challenging when adulterants are unknown and sample heterogeneity affects model robustness. In this study, gas chromatography-ion mobility spectrometry (GC-IMS) fingerprinting was integrated with an origin-assisted one-class chemometric strategy for non-targeted authentication of camellia oil (CAO) adulteration. Volatile organic compound fingerprints of authentic CAO from seven geographical origins and their adulterated samples were systematically characterized. A two-step framework was developed in which geographical origin was first identified using PLS-DA, followed by origin-specific adulteration authentication using one-class classification algorithms (DD-SIMCA and OC-PLS). This strategy reduced origin-induced variability and improves model reliability compared with conventional one-step modeling. DD-SIMCA achieved authentication accuracies above 94% across all adulteration systems and showed strong sensitivity to low-level adulteration. In addition, PLS regression enabled accurate quantification of adulteration levels for four edible oils (Rp2 > 0.96, RPD > 4). These results demonstrate that GC-IMS fingerprinting combined with origin-assisted one-class chemometric modeling provides a rapid, reliable, and non-targeted analytical framework for edible oil authentication, with good potential for extension to other high-value oils.
Erythromycin (ERY) residues have emerged as a critical global concern to food safety and environmental security in recent years. Detecting ERY in food and environment is important for safeguarding public health. In this study, a metal-organic framework [Me2NH2][Eu(TCBPEF)(HCOO)(DMF)]·2.5DMF Eu-TCBPEF, H4TCBPEF = 4',4‴,4‴″,4‴″″-(ethene-1,1,2,2-tetrayl)tetrakis(3-fluoro-[1,1'-biphenyl]-4-carboxylic acid) was synthesized and utilized as a fluorescence "turn-on" sensor for real-time visual monitoring of ERY, which demonstrated the first TPE-based MOF for ERY detection. Eu-TCBPEF could selectively detect ERY in water with a limit of detection (LOD) of 0.327 μM and exhibited excellent detection performance for ERY in seawater and chicken samples with good recovery percentage ranging from 96.9% to 105.4%. Furthermore, a portable Eu-TCBPEF@PVA was fabricated, enabling real-time and on-site monitoring of ERY in combination with a smartphone-assisted platform. In addition, Eu-TCBPEF exhibited a remarkable mechanofluorochromism: the fluorescent color can be reversibly switched between cyan and yellow upon grinding and exposure to acetonitrile. This study presents a dual-function MOF that provides new insights into the function of TPE-based MOFs and meanwhile offers an effective solution for on-site monitoring of antibiotic residues in food and environment, with promising applications in advanced anticounterfeiting security materials.
To describe the perinatal and neurological outcomes of fetuses with occipital encephalocele treated with intrauterine repair by open microneurosurgery. Between 2021 and 2025, a consecutive cohort of fetuses with occipital encephalocele referred to two fetal surgery centers in Nicaragua and Mexico were selected for intrauterine correction by open fetal microneurosurgery. Inclusion criteria were fetuses at less than 28 weeks with isolated occipital encephalocele, Chiari III malformation (obliteration of the cisterna magna with protrusion of cerebral tissue), and microcephaly. We report the procedure-related characteristics, perinatal and neurological outcomes (hydrocephalus, meningitis, seizures, cognitive delay, motor dysfunction, and visual impairment) within the first 12 months of age. Twelve cases were evaluated during the study period but only 6 cases were selected for fetal intervention. Open fetal microneurosurgery was successfully performed in all cases at a median gestational age (GA) of 25+2 weeks+days, with a median surgical time of 93 minutes. Regression of Chiari and reversal of microcephaly was observed in 4/6 and 6/6 cases, respectively. The median GA at birth was 36+5 weeks+days. Preterm rupture of the membranes and preterm delivery was reported in 3/6 cases. No cases of perinatal death were reported. Within the first 12 months of age, none of the children developed meningitis, cognitive delay, or hydrocephalus requiring ventriculoperitoneal shunting. Motor dysfunction, seizures and visual disorders were reported in 1/6, 1/6 and 3/6 cases, respectively. In fetuses with occipital encephalocele, open fetal microneurosurgery is feasible and is associated with good perinatal and neurological outcomes.
The goal was to identify risk factors for postoperative lower extremity deep vein thrombosis (DVT) in traumatic lower limb fracture patients and establish a nomogram prediction model for clinical risk assessment and management. A total of 136 lower extremity traumatic fracture (LETF) patients admitted to the emergency surgery department were enrolled. Patients were divided into DVT and non-DVT groups based on postoperative color Doppler ultrasonography. Univariate and multivariable logistic regression analyses were performed to determine independent risk factors for DVT. A nomogram prediction model was constructed and validated using receiver operating characteristic curve analysis, calibration curve, and decision curve analysis (DCA). Among 136 patients, 52 developed DVT, while 84 did not. No significant differences were observed in age, gender, BMI, hypertension, coronary artery disease, time from injury to surgery, operative duration, or American Society of Anesthesiologists score (all p > 0.05). However, diabetes prevalence, intraoperative transfusion rate, hip versus tibiofibular fracture distribution, injury severity score (ISS) score ≥ 25, hemoglobin, hematocrit, fibrinogen (FIB), and D-Dimer (D-D) levels differed significantly (all p < 0.05). Thromboelastography (TEG) revealed significantly higher maximum amplitude (MA) and α-angle, but lower clot formation time (K) value in the DVT group (all p < 0.001). Multivariable analysis identified hip fracture, ISS ≥ 25, elevated FIB, elevated D-D, increased MA, and decreased K as independent risk factors (all p < 0.05). The nomogram demonstrated excellent predictive performance (area under the curve = 0.89, 95% confidence interval: 0.77 - 1.00), good calibration (Hosmer-Lemeshow test p > 0.05), and clinical utility on DCA. The TEG-based nomogram incorporating clinical features effectively predicts postoperative DVT risk in traumatic fracture patients, facilitating early identification of high-risk individuals and personalized pro-phylaxis to mitigate DVT incidence and improve outcomes.
Treatment options for patients with immunoglobulin light chain (AL) amyloidosis and advanced cardiac involvement remain limited. The prospective, phase 2 EMN22 trial included previously untreated patients with AL amyloidosis, measurable hematologic disease, and Mayo2004/European cardiac stage IIIB to receive daratumumab monotherapy at the standard dose and schedule for up to two years (28-day cycles); patients with inadequate response after three cycles could additionally receive bortezomib weekly and dexamethasone. The primary endpoint was 6-month overall survival (OS) rate. Of 40 enrolled patients, ten (25.0%) received additional treatment with bortezomib and dexamethasone. The 6-month OS rate was 65.0% (95% CI, 48.2-77.6) and median OS was 10.4 months. The best hematologic response rate (partial response or better) up to six months was 75.0% (very good partial response or better: 47.5%; complete response: 12.5%), the median time to the first and best hematologic response being one week and 2.3 months, respectively. The cardiac response rate at six months was 30.0%. Common serious adverse events were cardiac failure (25.0%), sudden cardiac death (10.0%), and acute kidney injury (7.5%). The patients' quality of life remained stable throughout the trial treatment and observation. In patients with high-risk, advanced (stage IIIB) AL amyloidosis, daratumumab monotherapy was feasible and well-tolerated, achieving rapid hematologic responses and associated with prolonged survival relative to historical cohorts. Cardiac response rates at 6 months were significant, considering the advanced cardiac disease. These findings support daratumumab as the backbone of anti-clonal therapy in advanced cardiac AL amyloidosis. This trial was registered at www.clinicaltrials.gov as #NCT04131309.