Brain death is defined as the irreversible cessation of all cerebral and brainstem functions, confirmed through clinical examination and, when necessary, ancillary testing. While the diagnostic criteria are well established, certain spinal reflexes, such as the Lazarus phenomenon, can complicate clinical examinations and lead to diagnostic uncertainty. Most reported cases describe predominant upper-limb movements; however, atypical variants involving truncal or lower-limb responses have rarely been reported. We report the case of a 33-year-old Iranian man with cerebellar hemangioblastoma who developed transtentorial herniation and fulfilled all clinical criteria for brain death. Brain death determination was performed independently by two neurologists 6 h apart after exclusion of sedative exposure, metabolic disturbances, neuromuscular blockade, and hypothermia. Apnea testing demonstrated an increase in PaCO₂ from 39 to 64 mmHg without spontaneous respiratory effort. During examination, reproducible reflex movements were triggered by passive neck flexion and painful stimulation, consisting predominantly of bilateral hip and knee flexion with lower-limb adduction, accompanied by limited upper-extremity flexion. These findings were interpreted as spinal reflex activity consistent with an atypical lower-limb-predominant Lazarus phenomenon. This variation reinforces the importance of recognizing spinal reflexes in brain-dead individuals and underscores the need for awareness of such findings to avoid misinterpretation. Clinicians must distinguish these movements from indicators of residual brain function to ensure accurate and timely determination of brain death.
We present a case of a 4-year-old girl who underwent two planned staged surgical resections of a benign-appearing medium-sized congenital melanocytic nevus (CMN) on the right buttock. The nevus was 4 cm in diameter, medium brown in color, and exhibited central hypertrichosis with mild cobblestoning. Ten days after the first excision, a striking depigmented halo was noted around the residual nevus, which over time progressed to complete clinical regression of the residual CMN. While spontaneous development of the halo phenomenon in CMNs has been previously reported, no cases of this immune response occurring immediately after surgical excision have been documented in the pediatric population.
Distal adding-on phenomenon remains a common complication following corrective surgery for adolescent idiopathic scoliosis (AIS). This study aimed to characterize the spatial distribution of vertebral bone mineral density (BMD) across the scoliotic spine and to examine whether preoperative BMD asymmetry at the vertebra immediately distal to the lowest instrumented vertebra (LIV + 1) may serve as a complementary biomechanical risk marker for postoperative distal adding-on within existing LIV-selection frameworks. This retrospective cohort study included 90 patients with AIS who underwent posterior spinal fusion and had preoperative full-spine computed tomography scans. Patient-specific three-dimensional finite element analysis (3D-FEA) models were constructed to quantify bilateral vertebral BMD along simulated pedicle-screw trajectories. Patients were grouped by Cobb-angle strata and by postoperative adding-on status. ROC analysis was used to evaluate the predictive performance of LIV + 1 BMD asymmetry. Multivariable and Firth penalized logistic regression analyses were performed to assess its association with distal adding-on. The mean whole-spine BMD was 0.85 ± 0.14 g/cm2. No significant difference was observed between the overall concave and convex sides (p = 0.510), although region-specific asymmetry patterns were identified. Distal adding-on occurred in 15 patients (16.7%). Patients with adding-on showed greater LIV + 1 BMD asymmetry than those without adding-on (0.14 ± 0.06 vs. 0.11 ± 0.03 g/cm2, p = 0.006). LIV + 1 BMD asymmetry demonstrated good discrimination (AUC = 0.865, 95% CI 0.77-0.96), with an optimal cutoff value of 0.112 g/cm2. Based on the optimal cutoff, adding-on occurred in 44.8% of patients above this cutoff and 3.3% of patients at or below this cutoff (Fisher's exact OR = 24.0, p < 0.001); the negative predictive value was 96.7%. The between-group effect size was large (Cohen's d = 0.85; Hedges' g = 0.85). In Firth penalized logistic regression, LIV + 1 BMD asymmetry remained associated with adding-on (OR = 1.338 per 0.01 g/cm2 increase, 95% CI 1.077-1.664, p = 0.009). Vertebral BMD in AIS exhibits a region-specific asymmetric distribution pattern. Increased preoperative LIV + 1 BMD asymmetry is associated with postoperative distal adding-on and may provide complementary, hypothesis-generating biomechanical information for risk stratification and distal fusion-level planning. These findings should be validated in larger cohorts before BMD asymmetry is used as a stand-alone determinant of LIV selection.
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trans-Generational immune priming (TGIP), whereby parental pathogen exposure enhances offspring immune performance, is often viewed as an important phenomenon in arthropods. However, recent syntheses suggest that our knowledge of this phenomenon is taxonomically skewed and potentially overestimated due to publication bias, calling for further tests of TGIP in novel taxa. Here, we provide the first experimental test of pre-ovipositional TGIP in Dermaptera using the European earwig, Forficula auricularia, a species characterized by prolonged maternal care and strong sanitary behaviours. Females were immune challenged one to two months before oviposition with either live or heat killed Serratia marcescens, a naturally associated and virulent bacterium, or assigned to control treatments. Resulting offspring were reared under standard conditions until adulthood and then challenged with live S. marcescens, after which survival was monitored for fifteen days. As expected, bacterial challenges strongly reduced offspring survival. However, offspring survival was unaffected by maternal immune challenge, the timing of maternal exposure, or offspring sex, providing no evidence for pre-ovipositional TGIP. Maternal immune challenge also did not influence the likelihood of producing adult offspring, the number of adults produced, or offspring sex ratio. Overall, these results suggest that pre-ovipositional TGIP is absent or undetectable in the F. auricularia-S. marcescens host-pathogen system. We discuss whether this pattern could reflect earwig-specific traits, such as maternal egg and juvenile care and/or their multi-month developmental period. By documenting a robust null result, this study contributes to a more balanced understanding of the evolutionary and ecological constraints shaping TGIP across insects.
Heinz Werner contrasted the consensual preoccupation with hypothesis testing in experimental research and his own emphasis on the process of exploration. In this paper, the type of exploratory process that Werner is referring to is addressed, using his classic study on contour formation to exemplify this. In that study, Werner explored the phenomenon of contour formation, without testing any particular hypothesis. To further consider the distinction between the systematic exploration of a phenomenon, with a study designed to prove or disprove a specific hypothesis, I consider a study exemplifying the latter. I argue that Werner's thinking has relevance for active researchers today and conclude that the present concern regarding the 'replication crisis' and the complementary advocacy of the pre-registration of studies is inherently detrimental to the process of exploration and discovery that Werner promoted for psychological research.
A recent series of studies has demonstrated an unusual effect in which generating deliberate errors benefits memory for complex information-a phenomenon termed the derring effect. However, evidence for this effect is mixed, and theoretical understanding is underdeveloped. Inspired by the pretesting literature, the current work examined the derring effect under carefully controlled experimental conditions before going on to test theoretical explanations for the observed effect. In four preregistered experiments, participants studied weakly related word pairs in errorful and errorless learning conditions before completing a cued-recall test. In Experiment 1, both unintentional and deliberate errors enhanced subsequent memory relative to their respective errorless learning conditions, replicating the well-established pretesting effect and providing preliminary evidence of a derring effect with paired associates. Experiments 2-4 tested two theoretical accounts for the benefits of deliberate error generation: a broad attentional account, which proposes that generating errors boosts attention to the target, and a semantic elaboration account, which proposes that deliberate errors encourage elaboration of related information. Participants generated semantically related or semantically unrelated errors for each target or simply copied the correct answer. Consistent with the semantic elaboration account, deliberate errors only enhanced memory when they were semantically related to the study materials. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The carbon atom engages in both π-hole and σ-hole tetrel bonding, both of which occur in intramolecular and intermolecular manifolds. Select recent examples of the impact of carbon-based π-hole tetrel bonding in a drug discovery setting are summarized, followed by a discussion of carbon-based σ-hole tetrel bonding, with curated examples of intramolecular and intermolecular interactions that highlight the growing appreciation of this phenomenon.
Gastrointestinal basidiobolomycosis (GIB) is a rare invasive fungal infection of immunocompetent hosts that is endemic to Saudi Arabia and the wider Gulf region. Its presentation overlaps with inflammatory bowel disease (IBD), intestinal tuberculosis and malignancy, and many patients reach a definitive diagnosis only after surgery. We report a 39-year-old Saudi woman who presented with a 7-day history of right lower quadrant pain and non-bloody watery diarrhea. Initial bloods showed an elevated C-reactive protein of 21.5 mg/L, an erythrocyte sedimentation rate of 44 mm/hour and an absolute eosinophil count of 0.54 × 103/µL. Contrast-enhanced computed tomography (CT) demonstrated segmental wall thickening of the terminal ileum, cecum and proximal transverse colon, with a 3×5 cm intramural cecal collection. Colonoscopy revealed ulcerated congested mucosa and an ileocecal stricture; targeted biopsies showed an eosinophil-rich granulomatous inflammation with broad, sparsely septate fungal hyphae demonstrating the Splendore-Hoeppli phenomenon, positive on Grocott methenamine silver and periodic acid-Schiff stains; and tissue culture grew Basidiobolus spp. Interventional radiology and surgical drainage were considered but were technically not feasible because of the intramural location, so the patient was managed medically with oral itraconazole at 200 mg every 8 hours for 3 days followed by 200 mg once daily, with monthly liver enzyme monitoring. Surgery was avoided. A repeat CT scan at 2 months showed near complete resolution of wall thickening, and follow-up colonoscopy at 5 months was normal. The patient self-discontinued itraconazole at 9 months because of symptom resolution and remained asymptomatic at follow-up 2 months later. Clinicians working in endemic regions should consider GIB in any patient with an ileocecal mass or abscess, eosinophilia and an IBD-like presentation, because early biopsy with fungal stains and prompt azole therapy can avert surgery.
BackgroundNurses may experience career plateau, a phenomenon that can negatively impact motivation, job satisfaction and intentions to remain in the profession. As a personal resource, psychological resilience may be particularly important in helping nurses cope with the challenges associated with career plateau.ObjectiveTo examine the relationship between psychological resilience and career plateau among nurses.MethodA cross-sectional, descriptive study was conducted with 784 nurses employed at a tertiary university hospital. Data were collected using the Career Plateau Scale, the Brief Resilience Scale and a demographic information form. Descriptive statistics, Pearson correlation, independent samples t-tests, and multiple linear regression analyses were used to analyze the data.ResultsThe mean psychological resilience score was 21.67 (SD = 4.29), and the mean overall career plateau score was 3.10 (SD = 0.72). Psychological resilience was significantly and negatively correlated with career plateau (r = -0.293, p < 0.001). Regression analyses showed that lower levels of psychological resilience (p < 0.001) and not choosing the nursing profession voluntarily (p < 0.001) were significant predictors of higher career plateau scores. Additionally, age, marital status, and years of professional experience were found to influence perceptions of plateau at the dimensional level.ConclusionsPsychological resilience is a key factor shaping nurses' experiences of career plateau. Enhancing resilience through organizational support and targeted individual-level interventions may help reduce perceptions of career plateau and improve professional satisfaction. Future longitudinal and intervention-based studies are needed to further reveal these relationships.
Augmented renal clearance (ARC) is a critical clinical phenomenon characterized by altered renal excretory function in patients. Although ARC has garnered growing clinical and research attention in recent years, notable gaps remain in its investigation. Inadequate recognition of ARC-related risks may lead to underappreciation of this clinically significant condition in practice. This narrative review synthesizes current evidence on ARC. Current evidence on ARC was narratively reviewed, including pathophysiological hypotheses, diagnostic criteria, predictive models, drug-dosing implications and emerging monitoring techniques. Compared with earlier summaries, we place particular emphasis on recent changes in kidney-function assessment for drug dosing, including the distinction between measured glomerular filtration rate (GFR), measured creatinine clearance (CrCl), Cockcroft-Gault estimated CrCl, and contemporary estimated GFR equations. We discuss the limitations of predictive equations in unstable kidney function, the potential role of repeated short-interval CrCl, bedside hemodynamic assessment, standardized experimental models and multi-omics approaches. ARC should be regarded as a dynamic pharmacokinetic phenotype requiring timely recognition, drug-specific interpretation, therapeutic drug monitoring and direct or repeated assessment of renal clearance in high-risk patients.
It was recently discovered that supercurrents flowing through thin superconducting nanowires can be quenched by applying a gate voltage to a nearby gate electrode. This gate control of supercurrents, known as the GCS effect, could enable superconducting transistor logic. Here, we report that the GCS also manifests in a suppression of Meissner screening, establishing the phenomenon as a genuine feature of superconductivity that is not restricted to transport. Using a scanning nitrogen-vacancy (NV) magnetometer at sub-Kelvin temperatures, we image the nanoscale spatial region of GCS suppression in micron-size niobium islands. Our observations are compatible with a microscopic hot-spot model of quasiparticle generation and diffusion, and in conflict with other candidate mechanisms such as Joule heating or an electric field effect. Our work introduces an alternative means for studying quasiparticle dynamics in superconducting nanostructures, and showcases the power of local imaging techniques for understanding emergent condensed matter phenomena.
Astrocytes are among the first cellular responders to central nervous system injury, yet the mechanisms governing their earliest responses remain incompletely understood. Here, we investigated astrocyte dynamics during the first hours after focal cortical injury induced by cortical devascularization in rats. We observed a rapid and spatially restricted increase in glial fibrillary acidic protein (GFAP) and aquaporin-4 (AQP4) immunoreactivity surrounding the ischemic core as early as 1.5-3.5 h post-lesion, in association with blood-brain barrier disruption and edema-related changes. Within the injury core, astrocytes displayed differential GFAP detection by monoclonal and polyclonal antibodies, together with the appearance of lower-molecular-weight GFAP fragments both in vivo and after oxygen-glucose deprivation in vitro, suggesting GFAP cleavage in severely damaged astrocytes. At the chromatin level, astrocytes proximal to the lesion exhibited reduced histone H3 acetylation, particularly histone 3 acetylation at lysine 9 (H3K9ac), a phenomenon recapitulated in cultured astrocytes exposed to hypo-osmolar stress. This reduction was transient, reversible upon recovery, and prevented by histone deacetylase (HDAC) inhibition. Functionally, hypo-osmolar stress conditioned astrocyte responses to subsequent stimuli, attenuating nuclear factor kappa B (NF-κB) activation and complement 3 (C3) induction after lipopolysaccharide exposure while enhancing proliferative capacity during recovery. Together, these findings identify edema-associated osmotic stress as an early regulator of astrocyte epigenetic state and functional plasticity, suggesting that astrocytes exposed to edema are primed to adopt distinct responses that may contribute to tissue repair and scar formation following brain injury.
Molecular orientation transition is a key determinant of charge transport efficiency in thin-film transistors (TFTs). Conventional strategies to induce such transitions often result in increased molecular disorder, which leads to device performance degradation. Herein, an organic-inorganic hybrid network was proposed to modulate the structure-performance relationship via the incorporation of specific inorganic metal oxides (e.g., In2O3), leading to a marked enhancement in device and sensing performance by nearly 20-fold. This phenomenon may be associated with a triple-condition mechanistic framework involving strong interfacial adsorption, thermodynamic driving force, and abundant oxygen vacancies. The proposed triple-condition mechanistic framework not only transforms molecular orientation from observation into a predictable rule for selecting inorganic additives in organic-inorganic hybrid networks, but also establishes a practical route for improving biosensing performance through molecular orientation in life and health monitoring.
Teicoplanin (TEIC) is widely used in clinical settings to treat serious bacterial infections. This lipoglycopeptide antimicrobial is characterized by a long elimination half-life because of high protein binding owing to its lipophilic side chain. We recently found that the blood concentration of TEIC was significantly decreased when posaconazole was concomitantly administered intravenously rather than orally. We hypothesized that sulfobutylether-β-cyclodextrin (SBE-β-CD), a pharmaceutical excipient contained in posaconazole injectable formulation, may be the potential contributor to this phenomenon. Here, we investigated the molecular interaction between TEIC and SBE-β-CD by theoretical and experimental strategies to examine this possibility and elucidate the underlying mechanisms. Nuclear magnetic resonance analysis confirmed the encapsulation of the TEIC hydrophobic tail by the SBE-β-CD hydrophobic cavity, thereby forming a complex with 1:1 stoichiometry and appreciable binding affinity. These findings were further supported by docking simulations and subsequent quantum chemical calculations. Non-covalent interaction analysis visualized the regions and features of their supramolecular interactions. Computational and in vitro studies highlighted the significant contribution of the TEIC hydrophobic side chain in its binding to human serum albumin. Our results collectively indicate that the direct molecular interaction, whereby the hydrophobic cavity of SBE-β-CD encapsulates most of the hydrophobic side chain of TEIC, can reduce TEIC protein binding and may consequently affect its pharmacokinetics.
The rapid integration of artificial intelligence (AI) in ophthalmology has produced remarkable diagnostic accuracy while simultaneously raising significant ethical and epistemic concerns. This article argues that the prevailing AI paradigm fosters a form of data-fetishism: the tendency to treat datasets and algorithmic outputs as objective truth, privileging measurable metrics over the patient's lived experience and clinical context. Inspired by Marx's concept of commodity fetishism, the analysis demonstrates how this phenomenon produces "algorithmic substitution": a process through which the clinical encounter is converted from an ethically engaged encounter into a data-centric transaction, subordinating beneficence to statistical optimization. Four interconnected manifestations are examined: (1) dataset bias, where the marginalization of rare diseases and non-Western populations constitutes an epistemic injustice; (2) citation bias, which reinforces academic power structures; (3) the "covidization" of research, illustrating metric distortion; and (4) language hegemony, resulting in the epistemic erasure of regional medical knowledge. Clinical evidence reveals that these biases produce systematic errors in high-stakes domains such as ocular oncology and retinal surgery. The analysis concludes that data-fetishism enables a "moral deskilling" of ophthalmologists, redirecting professional fidelity from the suffering patient to the optimized dataset. Preserving the fiduciary essence of medicine requires a reorientation towards epistemic justice, emphasizing representativeness, ethical design, and the maintenance of the clinical gaze.
The discounting of delayed rewards plays an important role in everyday decision making, and steep discounting is associated with numerous behavioral problems. Most tasks used to assess delay discounting, however, are far simpler than many everyday decisions in which outcomes are both probabilistic and delayed. Probability, not delay, has been suggested to be the more salient attribute, a phenomenon we term delay-probability asymmetry. In two experiments, we compared preference on two-attribute (amount and either delay or probability) tasks designed to result in equivalent discounting with preference on three-attribute (amount, delay, and probability) tasks that included the same delay and probability conditions as well as interleaved three-attribute conditions. Although three prominent models of choice (Białaszek et al., 2020; Killeen, 2023a; Vanderveldt et al., 2015) accurately described preference on the three-attribute tasks, they failed to predict the asymmetry. Our results showed that the asymmetry resulted primarily from a decrease in delay discounting rather than from an increase in the salience of probability discounting. This decrease in degree of delay discounting may lead to more patient decisions in everyday choice situations and could reflect a shift to a better long-term decision-making strategy when outcomes are both probabilistic and delayed.
Insect migration is a massive and broad phenomenon, yet there are major knowledge gaps regarding the migration properties of this group. Many dragonfly species are considered migrants but only a few have been thoroughly studied, none of which migrate from Europe to other areas. The red-veined darter Sympetrum fonscolombii (Insecta: Odonata) is a common and widespread species which has recently expanded its range northwards in Europe and Asia. Recently, stable hydrogen isotope analysis showed that individuals from the Levant migrate north during spring, but no concrete evidence of a return southward autumn migration exists. To clarify the migratory status of S. fonscolombii in Israel, we collected observations from various sources (experts, citizen science and social media platforms), spanning all seasons and multiple years, and provide a first phenological description for the species in the area. Natal origins of individuals appearing on the Israeli coastline during autumn were inferred using stable hydrogen isotope analysis from wing samples in a spatially explicit probabilistic assignment. We found that the phenological pattern, with a peak in abundance between August and November, fits a migratory influx. The wing stable isotopes analysis resulted in a broad potential natal origin zone, covering a substantial part of the species' Eurasian range. These results provide the first direct evidence for a southward migration out of Europe and West Asia of S. fonscolombii or any other dragonfly species, with some individuals likely originating from the extreme northern parts of the species' known range.
The emergency consultation process is a high-stakes interface between emergency and specialist physicians, yet systematic differences in how each party perceives this process remain poorly characterized. This study aimed to quantify the perception gap between emergency physicians (EPs) and consultants (CNs) across multiple consultation domains and to identify distinct perception profiles and dyadic conflict risk patterns. A cross-sectional survey was administered to 186 physicians (81 EPs, 105 CNs) in Türkiye between January 2024 and January 2026, using parallel EP- and CN-specific questionnaires. Group comparisons were performed using the Mann-Whitney U test with rank-biserial effect sizes. Perception gap analysis, latent class analysis (LCA), and Monte Carlo dyadic conflict risk simulation (n = 10,000 dyads per combination) were conducted. Statistically significant between-group differences were identified in six of eight domains. The largest perception gaps were observed for frequency of unnecessary consultation requests (r = 0.723), clarity of expectations stated in requests (r = 0.658), and timeliness of responses (r = 0.624). LCA identified two latent classes: "Dissatisfied Requesters" (88.1% EPs) and "Overwhelmed Responders" (94.0% CNs; χ² = 110.49, p < 0.001). Dyadic simulation revealed the highest conflict risk in conflictual × conflictual pairings (mean risk score 3.46; 24.8% high-risk dyads), with no asymmetry between mixed-profile combinations (Δ = 0.02). Emergency physicians and consultants exhibit systematically divergent perceptions of the consultation process, converging only in their shared perception of workflow burden. The absence of asymmetric conflict risk in mixed profiles in this exploratory simulation may be consistent with interprofessional conflict being a bidirectional phenomenon, suggesting that system-level rather than individual-level approaches may warrant consideration. Structured consultation training and shared expectation frameworks are proposed as directions for future investigation. Not applicable.
Mood-congruent memory is a well-established phenomenon that occurs when emotional memory is biased toward content affectively congruent with a past or current mood. To date, however, a majority of research in this area has examined how mood directly impacts the encoding or retrieval of emotional memories, with comparatively less work examining the offline effects of mood during early consolidation. To address this gap in the literature, here we induced happy and sad moods after participants encoded emotional stimuli and then tested memory at least a day later with both recall and recognition tests. Across multiple experiments (performed 2020-2023) using different stimuli, induction techniques, and memory tasks, we demonstrate that a change in postencoding mood is associated with mood-congruent shifts in memory for the affective tone of an emotional experience, while also biasing recognition accuracy toward mood-congruent stimuli. These effects were moderated by subjective arousal and self-relevance ratings of the stimuli at encoding, suggesting that phenomenological appraisals of a stimulus shape the influence of mood during consolidation. Our findings propose that mood-congruent memory can arise from moods dissociated from the initial encoding or subsequent retrieval of emotional material, such that mood retroactively facilitates mood-congruent memory even after an emotional experience has already occurred. (PsycInfo Database Record (c) 2026 APA, all rights reserved).