Autistic monolingual children show heterogeneity in their language abilities in the school-age years. School-age bilingual neurotypical children also show heterogeneity in their second-language (L2) abilities as these are modulated by many factors including cumulative L2 input. This study compared school-age neurotypical and autistic children's L2 vocabulary development, as modulated by cumulative L2 input, to determine the extent to which the autistic children formed a distinct group from the neurotypical children. Participants were autistic (n = 23) and neurotypical (n = 26) bilingual children with English as their L2 and diverse first-language backgrounds, aged 4;7-9;6 (years;months). Children were matched groupwise for age. Children were administered a receptive vocabulary test, and conversational language samples yielded expressive lexical measures: word tokens and types and internal state term tokens and types. Linear regression modeling revealed that the autistic group had lower scores for all but one vocabulary measure and that higher scores were associated with more L2 input for children in both groups. A hierarchical cluster analysis revealed more nuanced results: One cluster, consisting of all but one of the neurotypical and the majority of the autistic children, overlapped in vocabulary abilities, with the autistic group having somewhat more L2 input. A second cluster consisted of all autistic children except for one neurotypical child and had extensive L2 input and very low vocabulary abilities. The autistic bilinguals in this study were not a homogeneous group separate from their neurotypical peers. Instead, only some autistic bilinguals showed distinct L2 profiles from their neurotypical peers.
Duchenne muscular dystrophy (DMD) is the most common pediatric hereditary neuromuscular disorder. While interest in brain involvement in DMD is increasing, neurobehavioral data in steroid-naive children remain limited, often nonstandardized, and derived from small cohorts. The primary objective was to characterize the baseline neurobehavioral profile of young steroid-naive boys with DMD enrolled in a multinational clinical trial. Secondary objectives were to examine associations with developmental features (speech and learning difficulties), motor function, parent respondent type, brain dystrophin isoform, age, and country. We performed a baseline cross-sectional neurobehavioral analysis of steroid-naive boys recruited in the "Finding the Optimum Regimen for Duchenne Muscular Dystrophy" trial. Eligible participants were glucocorticoid-naive boys aged 4 to <8 years with genetically confirmed DMD; boys with severe behavioral problems affecting participation were excluded. Four parent-reported scales were analyzed: Strengths and Difficulties Questionnaire (SDQ), Personal Adjustment and Role Skills Scale (PARS-III), IOWA Conners-Parent Scale, and Revised Rutter Scale. Associations with age, respondent (i.e., the parent who completed the questionnaire), brain dystrophin isoforms, speech-learning difficulties, country, and motor function were explored. The cohort included 196 boys aged 4 to <8 years (mean 5.9 ± 1.0). Speech and learning difficulties were reported in approximately 40% and 25% of participants, respectively, with 20% presenting both. Scores across neurobehavioral scales were strongly correlated, with only 5%-10% of boys exceeding screening cutoffs. Speech and learning difficulties were associated with worse scores across all scales. Among boys with an above-threshold SDQ Impact score, the most frequently reported difficulty was classroom learning. No significant associations were observed with age, brain dystrophin isoforms, or country of origin. Weak correlations were identified between motor function and PARS-III scales, in particular between North Star Ambulatory Assessment total score and PARS-III Total, Peer Relations, and Productivity scores. Mothers more frequently reported inattentive-overactive behaviors than fathers. Although this was a selected cohort, young boys with DMD may experience social, emotional, and learning difficulties that can interfere with everyday life, including schoolwork, despite the absence of a formal neurobehavioral diagnosis. These findings stress the importance of routine early psychosocial screening and targeted interventions. ClinicalTrials.gov: NCT01603407. First submitted: April 3, 2012. First participant enrolled: January 30, 2013. clinicaltrials.gov/study/NCT01603407.
Cardiac auscultation is an essential component of clinical examination but is often challenging to achieve proficiency in. Self-contained, multisensory learning resources that incorporate simultaneous visual and haptic stimuli offer a unique approach to supporting learners in acquiring this core skill. This pilot study of both medical students and clinical educators evaluated the utility of a novel iPhone app, Haptic Heart, which generates haptic vibrations to simulate heart sounds and murmurs. We aimed to explore the perceptions of students and educators when using haptics as a learning resource and the underlying reasons behind these perceptions and to gather lessons that would inform future development of the resource. Clinical-year medical students from the Lincoln Medical School with access to an iPhone were invited to trial Haptic Heart between October 2023 and December 2024. Cardiology specialists involved in clinical education were also invited to take part. After using the app, participants were asked to complete a modified version of the 12-item Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions questionnaire that included additional free-text items. Educators were also asked to comment on the resource's authenticity and perceived usefulness. Quantitative responses were analyzed using descriptive statistics; free-text responses were analyzed for common themes. A total of 21 students and 18 educators completed the evaluation. Both cohorts returned positive responses across nearly all questionnaire items, with students showing near universal agreement that the app was of excellent quality (21/21, 100%), supported their learning needs (21/21, 100%), and would change their clinical practice (20/21, 95.2%). Educators similarly rated the resource highly for learning utility (16/18, 88.9%) and authenticity (13/18, 72.2%). Reported technical difficulties were minimal for students (1/21, 4.8%) and educators (2/18, 11.1%). Analysis of free-text responses suggested that learners valued the ability to "feel" murmurs and to vary heart rate. Educators highlighted the resource's novelty and innovation, although some noted concerns about audio quality when using a stethoscope to auscultate haptic vibrations directly. This pilot evaluation demonstrates the potential of smartphone-based haptic technology as a tool for medical education. Haptic Heart was perceived by both students and educators as an innovative educational tool for cardiac auscultation. Further work should focus on expanding the range of haptic patterns provided and exploring the effectiveness of these resources on learning.
To describe and compare biceps femoris long head (BFlh) muscle architecture between limbs with and without a recent history of T-junction hamstring injury. Case-control study. English Premier League club. Participants were 30 professional male soccer players, including 5 cases with recent history of unilateral T-junction hamstring injury and 25 controls with no recent history of any hamstring injury. Participants had their BFlh fascicle length (FL), pennation angle (PA) and muscle thickness (MT) assessed bilaterally using wide-field-of-view ultrasound. Paired t-tests compared FL, PA and MT between previously injured (left) BFlh and contralateral uninjured (right) BFlh within cases. Un-paired t-tests compared left BFlh - right BFlh (asymmetry) in these measures between the case and control groups. Within cases, MT was significantly less in previously injured compared to contralateral uninjured BFlh (p < 0.01; mean paired difference [95%CI] = -0.48 cm [-0.59 cm to -0.36 cm]). Asymmetry in BFlh muscle thickness was significantly larger in the case group compared to control group (p < 0.01; between-group mean difference [95%CI] = -0.51 cm [-0.64 cm to -0.37 cm]). BFlh FL and PA did not differ significantly within cases, or between the case and control groups. Between-limb deficits in BFlh MT exist following T-junction hamstring injury.
Vamorolone is a dissociative corticosteroid (CS) approved by the US Food and Drug Administration in 2023 for treating Duchenne muscular dystrophy (DMD). This study evaluated the safety, tolerability, and pharmacokinetics (PK) of vamorolone in young boys with DMD; exploratory objectives included efficacy and patient-reported outcomes. A 12-week, phase II, open-label, multiple-dose study (VBP15-006) enrolled CS-naive boys with DMD aged 2-<4 years in Canada. Participants received 2 or 6 mg/kg/d oral vamorolone. An ongoing expanded access protocol (EAP) provided longer-term data. Primary end points were the occurrence of treatment-emergent adverse events (TEAEs) and changes from baseline to week 12 in height, weight, and body mass index (BMI); other end points included PK and effects of vamorolone on muscle function. Twenty boys (mean age [SD] 3.4 [0.39] years) with similar baseline characteristics were enrolled; all completed VBP15-006 and 19 continued to receive vamorolone through EAP Canada. TEAEs were mostly mild, with no deaths, serious TEAEs, or TEAEs leading to drug discontinuation during VBP15-006. TEAEs were more frequent with 6 mg/kg/d vamorolone than with 2 mg/kg/d, with gastrointestinal disorders and infections/infestations, respectively, most reported. Vamorolone use was associated with morning serum cortisol reductions in all patients, more pronounced with 6 mg/kg/d. Stable growth trajectories were observed at both doses throughout VBP15-006 and the EAP Canada follow-up period, with a total median (Q1; Q3) exposure to vamorolone of 2 years (1.7; 2.3). By EAP Canada last visit, 8/19 patients had weight and BMI z-scores changes >0.5, suggestive of excessive weight gain over time. Vamorolone displayed a dose-dependent PK profile with rapid absorption and no accumulation. Dose-dependent improvements in motor function (measured by Bayley-III gross motor scaled score) were observed. Glucose metabolism and bone turnover biomarkers remained stable. Ease of administration was rated favorably. Vamorolone was well tolerated in 2-<4-year-old boys with DMD, with no new safety concerns identified. A dose-dependent PK profile was observed, consistent with previous studies. Exploratory evidence suggested dose-dependent improvements in gross motor function. These findings are consistent with potential therapeutic benefit of vamorolone for young boys with DMD. ClinicalTrials.gov: NCT05185622 (VBP15-006; clinicaltrials.gov/study/NCT05185622), NCT03863119 (EAP; clinicaltrials.gov/study/NCT03863119). First submitted November 9, 2021. First patient enrolled: March 21, 2022. The VBP15-006 study provides Class IV evidence that in boys with DMD aged 2-<4 years, 12-week treatment with vamorolone was not associated with serious adverse events or changes in weight, height, or BMI. Gastrointestinal events and infections were the most reported TEAEs.
Breast cancer is the most common cancer among women worldwide and an increasing concern in India, with incidence rates rising particularly among women under 50 years old. In India, delayed diagnosis and limited access to health care often lead to mastectomy, leaving many women to face complex physical, emotional, and social challenges afterward. External breast prostheses (EBPs) are a cost-effective option for post-mastectomy recovery, but there is limited research on the long-term experiences of Indian women using EBPs. This qualitative study employed a phenomenological approach to explore the lived experiences of 35 women in Gujarat who had undergone mastectomy and used EBPs for at least 5 years. Participants were purposively chosen and interviewed using a semi-structured guide that addressed satisfaction, challenges, user needs, and suggestions for improvement. Thematic analysis was performed to identify key patterns and insights. Most women reported high satisfaction with the adaptability, comfort, and positive impact of EBPs on self-confidence, especially when using silicone prostheses. However, challenges such as heat and perspiration, weight imbalance, durability concerns, limited product awareness, and affordability issues were noted. Participants suggested improvements including lighter, more breathable, and adjustable materials, longer warranties, enhanced counseling, and better financial access. Findings reveal both the psychosocial benefits and practical challenges of long-term EBP use among Indian women, aligning with global literature and emphasizing the need for patient-centered rehabilitation solutions. Although EBPs improve confidence and daily function, enhancements in design, cost, and awareness are needed. Addressing these could significantly improve life quality and rehabilitation for postmastectomy women in India.
Ischemic stroke is a life-threatening neurological condition that frequently leads to severe brain damage and long-term disability. Current therapeutic options remain limited and are largely confined to anticoagulant-based interventions. Despite extensive evidence implicating inflammation in stroke pathogenesis, effective therapies targeting neuroinflammatory mechanisms are still missing. Given that chemokines and their receptors have been successfully targeted in clinical contexts outside stroke, we identified these signaling axes as promising candidates for therapeutic modulation in ischemic injury. We tested the hypothesis that pharmacological modulation of selected chemokine-receptor pathways alters the neuroinflammatory response and tissue viability following ischemia. Using organotypic hippocampal cultures subjected to oxygen-glucose deprivation, we demonstrate that inhibition of CX3CR1, CCR2, and CXCR4 differentially affects tissue viability under ischemic conditions. Owing to the pronounced biological effects observed upon CCR2 inhibition, we further investigated its mechanistic basis using atomic force microscopy. These analyses revealed that Irbesartan treatment is associated with cytoskeletal reorganization and significant alterations in the mechanical properties of ischemic brain tissue. In summary, our study establishes the organotypic hippocampal culture-oxygen-glucose deprivation model as a robust platform for investigating neuroinflammatory processes in ischemic stroke. We identify key chemokine-receptor circuits that modulate ischemic injury and uncover a previously underappreciated contribution of tissue biomechanics to the pathophysiological response to ischemia.
External beam radiation therapy (EBRT) has gained delayed acceptance as a recommended first-line treatment modality for patients with hepatocellular carcinoma (HCC), given limited evidence that it improves overall survival (OS). We analyzed individual patient data (IPD) from an international cohort to assess OS among patients with HCC treated with EBRT. We performed a systematic review of publications that assessed EBRT, met prespecified technical standards for HCC, and reported OS (search date December 15, 2022). Corresponding authors were invited to submit IPD for the study. We performed Kaplan-Meier survival analyses to determine OS and restricted mean survival time (RMST) stratified by Barcelona Clinic Liver Cancer (BCLC) stage and treatment status (ie, treatment-naïve and experienced). We performed random effects Cox proportional hazards modeling to assess clinical characteristics associated with OS. Data were provided on 4,913 patients treated with EBRT with a median follow-up time of 5.0 years. The median OS was 6.8 years (95% CI, 5.7 to 8.7) for BCLC-0 and 4.6 years (95% CI, 4.1 to 5.1) for BCLC-A. Among treatment-naïve patients, the median OS was not reached (95% CI, 8.6 to not reached) for BCLC-0 and was 5.4 years (95% CI, 4.5 to 6.7) for BCLC-A. In multivariable models, more advanced BCLC stage, higher tumor burden, worse performance status, and Child-Pugh class B or C were associated with a higher risk of mortality. Ablative radiation dose and more recent year of treatment were associated with a reduced risk of death. To our knowledge, this study represents the largest multinational cohort of patients with HCC treated with EBRT. OS outcomes with EBRT for very early- and early-stage HCC appear to be comparable with resection, thermal ablation, and other ablative locoregional therapies. These data support the inclusion of EBRT in the BCLC HCC clinical decision-making process.
Postoperative urinary retention (POUR) commonly occurs following elective lumbar spine surgery. POUR can result in prolonged admission, urinary tract infection (UTI), and patient morbidity. Prophylactic α1-antagonist therapy is often used to reduce the risk of this complication. The aim of this study was to identify the incidence of POUR in this population and determine the effect of prophylactic α1-antagonists using a propensity score (PS)-matched model. This retrospective review included patients who underwent elective lumbar spine surgery at a single institution between 2015 and 2021. PSs were generated for the likelihood of receiving prophylactic α1-antagonists immediately after surgery. PS matching was performed using 1:1 nearest-neighbor matching (0.01 caliper) without replacement. From this matched cohort, a random-effects model accounting for variation in surgeon practice was used to assess factors associated with POUR. Overall, 2326 patients were identified and 506 were successfully PS matched. The overall incidence of POUR was 8.8%. Immediately postoperatively, 422 patients (18.1%) received prophylactic α1-antagonist therapy (treatment group) and 1904 patients did not (controls). Prior to matching, there were significant differences between the control and treatment groups. In the multivariable random-effects model of the 506 matched patients, POUR was associated with the use of prophylactic α1-antagonists after surgery (RR 1.94, 95% CI 1.07-3.52), female sex (RR 1.83, 95% CI 1.41-2.39), intraoperative Foley catheter use (RR 0.25, 95% CI 0.12-0.52), the normalized duration of surgery (RR 0.42, 95% CI 0.20-0.88), patient-controlled anesthesia use (RR 2.63, 95% CI 1.47-4.70), and postoperative UTI (RR 3.52, 95% CI 1.34-9.21). Prophylactic α1-antagonist use immediately after surgery did not reduce POUR, and patients who received prophylaxis were at greater risk of POUR in this large PS-matched analysis. Female sex was associated with a greater incidence of POUR while intraoperative Foley catheter use and a longer operative duration were associated with reduced risk of POUR. Potentially modifiable risk factors, such as patient-controlled anesthesia use and UTI, significantly increased the risk of POUR and thus should be addressed in the early postoperative setting.
Colorectal cancer (CRC) frequently exhibits an immune-excluded tumor microenvironment that limits the efficacy of PD-1 blockade. Through systematic profiling of 106 protein tyrosine phosphatases (PTPs), we identify three PTP-based molecular subtypes, among which the immune-excluded Cluster 2 is highly resistant to immunotherapy. Integrative analyses across patient cohorts highlight PTPRN2 as a prominent PTP enriched in immune-excluded tumors and strongly associated with anti-PD-1 non-response. Functional studies demonstrate that PTPRN2 promotes CRC cell proliferation and invasion, and more importantly, suppresses tumor-intrinsic MHC-II expression. Mechanistically, PTPRN2 may promote STAT1 Y701 dephosphorylation and inhibit STAT1 activation, thereby downregulating CIITA expression and impairing antigen presentation. PTPRN2 knockdown restores MHC-II, enhances CD4⁺ and CD8⁺ T-cell activation in organoid co-culture, and increases T-cell infiltration in vivo. Therapeutically, PTPRN2 knockdown combined with PD-1 blockade achieves more effective tumor suppression than either treatment alone. Furthermore, IL-15 rescues STAT1 phosphorylation and MHC-II expression in PTPRN2-overexpressing cells, revealing a cytokine-sensitive regulatory axis. Collectively, our study identifies PTPRN2 as a potential regulator of immune exclusion and a candidate therapeutic target to improve immunotherapy efficacy in CRC.
After the fall of communism, Polish psychiatry and special education underwent profound transformations, adopting different paradigmatic assumptions in their approach to intellectual disability. The aim of this study is to compare the theoretical foundations of both disciplines and analyze the effects of these discrepancies. Contemporary psychiatry and clinical psychology are based on the biopsychosocial paradigm, integrating biological factors with the environmental model and quantitative research, which ensures their presence in international scientific discourse. Polish special education, on the other hand, has adopted a humanistic paradigm, favoring qualitative methodologies and rejecting the biomedical perspective, which results in its methodological isolation and the neglect of the medical aspects of disability. Despite the converging practical goals of community psychiatry and pedagogy, there is a fundamental divergence between the disciplines that hinders cooperation. In conclusion, there is a need to establish a dialogue and develop a common conceptual framework that combines the medical basis of neurodevelopmental disorders with the humanistic dimension of support.
In occupational therapy, progress notes and other client-related administrative tasks are essential for providing treatment but are time-consuming. Therapists spend at least as much time on these tasks as providing care, which contributes to growing waitlists. This study aimed to create a custom large language model to make the process of writing progress notes more efficient by converting point-form scratch notes from pediatric occupational therapy treatment sessions into draft documentation in subjective-objective-assessment-plan format. Using a dataset of redacted historical progress notes, various training methods, including domain-adaptive pretraining and low-rank adaptation fine-tuning, were applied to train Llama 2 and 3 models. Since the historical notes lacked corresponding scratch notes, few-shot prompting with human-in-the-loop evaluations was used to generate synthetic scratch notes. This pairing of historical notes and generated scratch notes enabled effective fine-tuning of the Llama models on the desired task. The final model, a fine-tuned Llama 3 8B Instruct model, was piloted in a pediatric rehabilitation center and compared with Microsoft Copilot. Ten therapists used both models for 3 weeks each. The custom model notes scored higher than manually written notes on clarity, completeness, relevance, and organization (P<.001) , and similarly on conciseness. They scored higher than those from Copilot on conciseness (P<.001). However, in this small pilot, a significant reduction in time spent on documentation when using the custom model versus manual notes was not detected. Follow-up investigation revealed that time savings were observed only when therapists were coached to write sparse scratch notes; however, they tended to revert to detailed notes after coaching for which the model was not shown to improve efficiency. The model had the capacity to save time when therapists provided brief input to the model. However, in practice, therapists preferred to provide detailed input. Used in this way, the model improved note quality rather than saving time.
Large language models (LLMs) are poised to transform mental health care, offering advanced capabilities in diagnosis, prognosis, and decision support. Since their inception, numerous mental health-focused LLMs have emerged in the scientific literature, reflecting the growing interest in leveraging these models across various clinical applications. With a broad range of models available, diverse optimization strategies, and multiple use cases, reviewing the current landscape is critical to understanding where future impact lies. This study aimed to conduct a scoping review investigating the use of LLMs in mental health across diagnostic, prognostic, and decision support tasks. We screened 3121 papers from PubMed, Scopus, and Web of Science for studies published between January 2023 and October 2025, using terms related to LLM and mental health. After removing duplicates, 2 reviewers (MCL and WWBG) independently screened the studies, with a third (JJK) to resolve conflicting opinions. We extracted and synthesized information on the models, use cases, datasets, and adaptation methods from selected papers. In total, 41 papers were selected. Many studies included evaluations on OpenAI's GPT series applications: GPT-4 (24 studies, 58.5%) and GPT-3.5 (16 studies, 39%). Others included Bidirectional Encoder Representations from Transformers-derived models (9 studies, 22%), LLaMA (8 studies, 19.5%), and RoBERTa-derived models (6 studies, 14.6%). While all studies initially applied out-of-the-box LLMs, several adapted them through few-shot learning or fine-tuning to better align with specific research goals. The most common use case was in diagnostics (31 studies, 75.6%), while the most common target condition was depression (11 studies, 26.8%). While many studies reported superior performance of LLMs, only a minority of studies (13 studies, 31.7%) validated LLM performance against clinician assessments using real patient data, with the majority relying on proxy outcomes such as clinical vignettes, examination questions, or social media posts. Despite rapid growth and diversity of LLM applications in mental health, the field remains nascent and exploratory. Future developments must emphasize consistent model adaptation procedures to ensure safety and clinical workflow alignment. Models must also be evaluated on robust evaluation criteria by using standardized protocols and real clinical outcome measures.
Patients with breast cancer in Ethiopia are generally diagnosed with late-stage disease, and there is a high proportion of young female and male patients. The role of genetic predisposition is yet unknown in this setting. To increase the knowledge about hereditary breast cancer in Ethiopia, this study investigated germline pathogenic variants (PVs) in breast cancer-predisposing genes in a high-risk cohort of young women and men with breast cancer. One hundred women (age 18-39) and men (all ages) diagnosed with breast cancer at the Tikur Anbessa Specialized Hospital, Addis Ababa, were included. Basic patient and tumor characteristics, and family history were collected, and blood samples drawn. DNA was extracted locally before transport to Lund University, Sweden, for DNA analysis using next-generation sequencing. Type and frequency of PVs in breast cancer-related genes (ATM, BARD1, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, RAD51C, RAD51D, STK11, and TP53) were analyzed. A high proportion of the 89 study participants with successful genetic analysis carried PVs in breast cancer susceptibility genes (23.6%; 95% CI 15.2 to 33.8). In total, 22 PVs were detected in BRCA1 (n = 7), BRCA2 (n = 8), PALB2 (n = 4), BARD1 (n = 1), PTEN (n = 1), and ATM (n = 1). Potential founder variants and two novel PVs were found (BRCA1 c.5278-864_5332+621del and PALB2 c.1169_1170del). Genetic predisposition plays an important role among young women and men in the study setting, with nearly one in four patients carrying a PV. The results call for further research and interventions targeting individuals at high risk, with the long-term potential of reduced morbidity and mortality.
This study aimed to evaluate the influence of patient clinical and demographic characteristics, platelet-rich plasma composition, and genetic factors on the response to PRP therapy in patients with KOA. Patients of both sexes over 18 years old diagnosed with mild/moderate KOA (Ahlbäck grade I-II) received three intra-articular injections of 8 mL of leucocyte- and erythrocyte-free PRP with a moderate platelet concentration. In cases of degenerative meniscal lesions, additional intrameniscal injections were performed. Patients did not receive any other medical treatment or physiotherapy. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and at 6 months. Patient-related variables, PRP composition, and genetic polymorphisms were analyzed. Associations with treatment response were evaluated using chi-squared tests, and a prognostic model was developed using binary logistic regression. A total of 300 patients were included. The mean age was 55.5 ± 13.6 years with a median body mass index (BMI) of 26.7 ± 4.0 and 110 women (36.7%). At 6 months, 207 patients (69.0%) were responders showing minimal clinically important improvement. The application of intrameniscal PRP in patients with associated degenerative meniscus injury showed a significant association with the response to PRP (p = 0.011). While platelet concentration was not associated with a greater response (p = 0.938), insulin-growth factor 1 (IGF-1) concentration was (p = 0.033). Twelve genetic polymorphisms showed a significant association, including both effector molecules and cell receptors, with particular relevance to the IGF family. Intrameniscal PRP application in meniscal injuries associated with KOA, the presence of IGF-1 in PRP composition, and polymorphisms within the IGF family and genes related to growth factors, cell receptors, and inflammatory pathways were associated with treatment outcomes. These variables enabled the development of a preliminary multivariable model to estimate the probability of response to PRP. Level IV.
Aim: This review aims to present diagnostic modalities suitable for monitoring patients after endovascular aortic repair. Materials and Methods: A literature search was conducted across electronic databases from January 2024 to May 2025 using a combination of keywords and Boolean operators. Conclusions: While computed tomography angiography remains the reference standard for monitoring after endovascular aortic repair, with 92% sensitivity for endoleak detection, magnetic resonance imaging and ultrasonography offer viable alternatives that eliminate radiation exposure and may reduce contrast agent requirements. Magnetic resonance imaging detects twice as many endoleaks as computed tomography angiography, whereas contrast-enhanced duplex ultrasonography achieves 98% sensitivity and 88% specificity. Treatment of abdominal aorta aneurysm with endovascular aortic repair offers a significant opportunity for a carefully selected patient population. The selection of surveillance modalities should be tailored to individual patient characteristics.
Syringomyelia is a progressive neurological disorder characterized by intramedullary fluid-filled cavities. Shunt placement remains a key treatment option when decompression fails, yet comparative outcomes across shunt types remain poorly defined. The aim of this study was to compare revision rates, time to failure, and neurological outcomes among patients treated with syringopleural, syringosubarachnoid, and syringoperitoneal shunts. A retrospective review was conducted using a prospectively maintained database of the senior surgeon from 1997 to 2025 to identify patients who underwent syrinx shunt placement. Demographic data, shunt type, revision rates, time to revision, and neurological outcomes at early and late follow-up time points were analyzed. Revision was defined as a return to the operating room for shunt-related complications. Thirty-one patients (19 male, mean age 47.2 years) underwent 48 surgeries for placement of syringopleural (n = 20, 41.7%), syringosubarachnoid (n = 21, 43.8%), and syringoperitoneal (n = 7, 14.6%) shunts. Common etiologies included traumatic injury and Chiari malformation. Ten patients (32.2%) required at least one revision surgery, while 21 patients (67.7%) did not require revision. The mean hospital length of stay was significantly longer for syringosubarachnoid (10.1 days) and syringoperitoneal (10.0 days) compared with syringopleural (5.4 days) surgeries (p = 0.036). Revision rates were highest for syringopleural shunts (55.0%), followed by syringoperitoneal (28.6%) and syringosubarachnoid (19.0%) (p = 0.003). Early motor and/or sensory function improvement was observed in 55.0% of syringopleural cases, 33.3% of syringosubarachnoid cases, and 14.3% of syringoperitoneal cases (p = 0.117). Sustained long-term improvement was rare across all groups (p = 0.551). The mean time to revision surgery was 1093 days for syringopleural, 515 days for syringosubarachnoid, and 89 days for syringoperitoneal shunts (p = 0.144). Syrinx shunting provided modest early neurological benefit, but long-term durability remained limited. Syringopleural shunts demonstrated greater early clinical improvement but carried greater revision risk. Syringosubarachnoid shunts had lower mechanical failure rates but limited clinical efficacy. Optimizing patient selection and vigilant postoperative monitoring are crucial. Further research is needed to refine surgical strategies and improve durable outcomes.
There is a need for scalable and simple interventions for trauma-exposed people. In this case series, we built on our previous case study and case series findings and further explored the use and potential effectiveness of a brief novel intervention to reduce the number of past intrusive memories of trauma. The imagery competing task intervention consists of a memory reminder and the visuospatial task Tetris played with mental rotation, targeting 1 intrusive memory at a time. Here, we test remote delivery of the intervention, including guidance from researchers without specialist mental health training, in a sample of women in Iceland with current intrusive memories from trauma. In a case series of trauma-exposed women, we aimed to explore whether this brief novel intervention reduces the number of established intrusive memories (primary outcome) and improves general functioning and symptom reduction in posttraumatic stress, depression, and anxiety (secondary outcomes). The acceptability of the intervention along with adaptations, that is, delivery by psychology students without specialist mental health training and digital delivery, was explored. Participants (N=8) monitored the number of intrusive memories from an index trauma (occurring 3-16 years previously) in a daily diary at baseline, during the intervention, and postintervention at 1-month and 3-month follow-ups. The intervention was delivered digitally with guidance from clinical psychologists or psychology students. A repeated AB design was used ("A": preintervention baseline, "B": intervention phase). Intrusions were targeted one by one, creating repetitions of an AB design (ie, length of baseline "A" and intervention "B" varied for each memory). The number of intrusive memories reduced for all participants from the baseline phase compared with the intervention phase, although the reduction was minimal for 2 participants (6.3%-93%). The number of intrusive memories continued to reduce for 6 out of 8 participants (58%-100% reduction at 1-month follow-up; 72%-100% reduction at 3-month follow-up). Symptoms of posttraumatic stress, depression, and anxiety were reduced for most participants postintervention and continued to decrease during the follow-up periods. Functioning was improved for 7 of the 8 participants from baseline to postintervention and continued to improve at the follow-up assessments for 3 participants. The intervention delivered digitally and partly by students was perceived to be an acceptable way to reduce the frequency of intrusive memories by all participants (mean rating 9.5 out of 10). Data from this case series of traumatized women provide preliminary evidence for the effectiveness of this novel brief intervention in reducing intrusive memories of trauma occurring several years ago and in improving functioning and reducing core symptom burden. This study will inform a randomized controlled trial of this novel intervention, which may have considerable implications for large-scale clinical management of traumatized populations.
To assess the pre- and post-operative distribution of patients undergoing total knee arthroplasty among the nine categories of the Coronal Plane Alignment of the Knee-CPAK classification (Aim 1). Another goal was to assess whether the clinical outcome (patient-reported outcome and implant survival) differed between those whose CPAK type changed vs. those who maintained their CPAK type (Aim 2). Most previous studies investigated only small cohorts and provided only pre-operative data. Moreover, no studies related the change in CPAK type to robust clinical information such as implant survival. A retrospective, comparative design was applied and included patients who had undergone primary total knee arthroplasty. A digital analysis of whole-leg radiographs was performed to allocate the cases to the CPAK classes pre- and post-operatively. Likewise, the patient-reported outcomes were assessed pre- and 1 year post-operatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 2056 patients (742 men, 1314 women; age 69.55 ± 8.61 years) were analysed. Pre-operatively, the most frequent CPAK types were V, II and I, constituting 18.6%, 18.3% and 17.6% of cases, respectively. The mean follow-up period for the whole study population regarding implant survival was 8.36 years. Following TKA, CPAK type V was dominant with 46.1% followed by types IV and VI with 15% and 14.2%, respectively. Of the study patients, 80.0% (n = 1645) underwent a change in CPAK type. One year post-operatively, WOMAC total was 12.29 (4.77-26.97) for CPAK changers and 11.76 (4.31-25.53) for CPAK maintainers (p = 0.399). Moreover, no differences were seen in the WOMAC subscores pain, stiffness or function (0.128 < p < 0.678). The 10-year implant survival was 91.2% among the CPAK changers and 92.9% among the maintainers (p = 0.506). The pre-operative CPAK knee alignment was preserved in 20% of patients. However, this did not seem to have a negative impact on clinical outcome, as CPAK type changers and CPAK type maintainers did not show significant differences in WOMAC scores or implant survival. Level III.