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Adult intussusception is an uncommon clinical condition, representing a rare cause of intestinal obstruction. Unlike the pediatric form, most adult cases are secondary to an identifiable pathological lead point. Idiopathic intussusception, particularly involving the small bowel, is exceedingly rare and poses diagnostic and therapeutic challenges. We report the case of a 42-year-old woman with no prior abdominal surgery who presented with a three-day history of abdominal pain, vomiting, and cessation of stool and flatus. Physical examination revealed mild abdominal distension without peritoneal signs. Abdominal computed tomography demonstrated a jejuno-jejunal intussusception with the classic "target" configuration and no detectable underlying lesion. The patient underwent an exploratory laparotomy, which confirmed a jejuno-jejunal intussusception without any pathological lead point. Gentle manual reduction was performed, and no resection was required. The postoperative course was uneventful, and the patient was discharged on postoperative day three. Adult idiopathic intussusception is rare, accounting for a small minority of adult intussusception cases. CT imaging is the cornerstone of diagnosis, enabling visualization of characteristic features and assessment of complications. Surgical exploration remains the standard of care, with management tailored to intraoperative findings. Reduction without resection is justified when the bowel is viable, and no underlying pathology is evident. Idiopathic small bowel intussusception in adults is a diagnostic rarity that should be considered in cases of unexplained bowel obstruction. Early diagnosis and tailored surgical management can ensure favorable outcomes while avoiding unnecessary bowel resection.

Early detection of pancreatic cancer is crucial for survival, but detecting smalllesions remains challenging. Intraductal Ultrasound (IDUS) using intracardiac echocardiography (ICE) catheters for B-mode and Shear-Wave Elastography (SWE) potentially offers improved visualization and characterization of small tumors. This study assesses the feasibility of IDUS using ICE catheters to detect and visualize periampullary tumors in surgically resected specimens. In this two-phase ex-vivo feasibility study, 25 pancreatic specimens were included, of which the first 10 were used to establish and standardize the imaging protocol, followed by technical feasibility evaluation in the remaining 15 specimens. Catheters were introduced into the pancreatic duct, common bile duct, or positioned extraductally to enable tumor visualization with B-mode imaging and shear-wave elastography (SWE). Tumor visualization rates, catheter insertion success, SWE measurements in normal and tumor tissue, and image quality were assessed. ICE catheter insertion was successful in 12 of 15 specimens; unsuccessful access was primarily related to large tumor size (>4 cm) or unidentifiable ductal anatomy following surgical resection. However, extraluminal imaging successfully visualized tumors in one of these cases. Median shear-wave speed and elastic modulus for normal pancreatic parenchyma were 1.58 m/s and 7.6 kPa, respectively. SWE measurements in tumor tissue were suboptimal, likely due to ex-vivo tissue variability and catheter strain during repeated use. IDUS with ICE is feasible for qualitative B-mode visualization of periampullary tumors and enables SWE assessment of pancreatic parenchyma in an ex-vivo setting. Reliable elastography of tumor tissue remained challenging, indicating the need for further technical refinement and in-vivo validation.

Maternal iron deficiency anemia (iron deficiency anemia) is a persistent global health challenge with increased risk of adverse perinatal outcomes. A recent multicenter clinical trial found reduced rates of low birthweight infants in mothers treated initially (early second trimester) with IV ferric carboxymaltose compared to oral iron. Secondary findings included improved hematologic indices 4 weeks post-treatment, as well as reduced rate of stillbirth with single dose IV iron infusion. We aimed to determine if the initial response to iron therapy was associated with risk of stillbirth and other adverse perinatal outcomes in pregnant singletons with moderate iron deficiency anemia STUDY DESIGN: This is a secondary analysis of a multi-center randomized controlled trial in India that compared single dose intravenous iron to oral iron for the initial management of moderate iron deficiency anemia (Hb 7.0-9.9g/dL) at 14-17 weeks gestation. The primary outcome for this secondary analysis is stillbirth. Secondary outcomes were early preterm birth <34 weeks, small for gestational age infants (<10%ile). The predictors of interest were maternal hemoglobin, ferritin, and transferrin saturation (TSAT), measured at 20-24 weeks gestation. Longitudinal hematologic and iron indices through pregnancy and association with outcomes were also assessed. Relative risk of each outcome based on post-treatment hemoglobin, ferritin, and TSAT was assessed with Poisson regression, adjusting for maternal age, BMI, parity, treatment modality, baseline Hb, and study site. Two-sided alpha=0.05 used for all analyses. Given that most nutrients exhibit U-shaped or threshold risk curves, we also fit models allowing for a quadratic function for the relationship between hematologic parameters at all times and risk of each event RESULTS: 4252 participants were included in this analysis, 1421, 1424, 1407 received intravenous ferric derisolmaltose, ferric carboxymaltose, and oral iron respectively. In evaluating the linear relationship, each unit of increasing Hb response at 20-24 weeks was significantly associated with reduced risk of stillbirth (RR 0.74 (0.56, 0.98). In evaluating the quadratic relationship, we found that there was a significantly progressively increased risk of stillbirth (p<0.0001) and early preterm birth< 34 weeks (p=0.01). Although there was a significant quadratic relationship identified with small for gestational age infant and Hb (p=0.008), the relative risk of SGA and lower Hb was not statistically significant. Inadequate improvement in hemoglobin at 20-24 weeks following iron therapy in pregnancies complicated by moderate iron deficiency anemia is associated with increased risk of stillbirth and early preterm birth. Our findings highlight the potential importance of early screening and treatment of maternal anemia,. Given the association between persistent anemia at 20-24 weeks and adverse outcome, prospective trials should focus on whether early pregnancy, or even preconception, improvement in hemoglobin is an effective intervention to prevent adverse perinatal outcomes such as stillbirth and early preterm birth.

Marine sediments are one of the final sinks for microplastics. However, research on microplastic pollution in the inner Gulf of Thailand (GoT) remains limited despite intense anthropogenic pressures in this region. The spatiotemporal distribution, sources, and ecological risks of microplastics in the inner GoT sediments were investigated. The abundance of microplastics ranged in 40-3180 items/kg dry weight, with significantly higher abundances during the dry season than the rainy season (p&#x2009;<&#x2009;0.01). The majority of the microplastics were categorized as small-sized range of 0.03-0.3&#xa0;mm (71.54%), with fibers (49.69%) and fragments (49.01%) being the dominant shapes. Polyethylene terephthalate (50.47%), polypropylene (18.09%), and polyethylene (14.94%) were the primary polymers identified. These findings suggest that secondary microplastics could represent a major source, such as cloth materials, fishing gear, and degraded plastic packaging. The prevalence of small-sized microplastics (<&#x2009;0.3&#xa0;mm) suggests significant degradation of microplastics. We hypothesize that this is driven by accelerated degradation from high temperatures and intense UV radiation in tropical environments, such as the inner GoT. Although the pollution load index (PLi) of the microplastics indicated a low pollution load (category II), their potential ecological risk index (PERi) reached a serious potential risk (category V), particularly in the Chao Phraya estuary. This discrepancy underscores that PERi is governed by polymer-specific hazard levels rather than microplastic abundance. This research enhances the understanding of microplastic fate and ecological risk in marine environments, offering a scientific foundation for evidence-based policies in the inner GoT.

Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. An online, cross-sectional survey was conducted among adult patients with HS (September 2023-December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients' disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. The study included 583 patients (mean age, 34.8&#xa0;years; 95.5% female) representing a range of racial backgrounds: Black or African American (n&#x2009;=&#x2009;273; 46.8%), white (n&#x2009;=&#x2009;236; 40.5%), Two or More Races (n&#x2009;=&#x2009;47; 8.1%), American Indian or Alaska Native (n&#x2009;=&#x2009;18; 3.1%), Asian (n&#x2009;=&#x2009;7; 1.2%), and Native Hawaiian and Other Pacific Islander (n&#x2009;=&#x2009;2; 0.3%). Ethnic representation also varied (Hispanic/Latino&#x2009;=&#x2009;n&#x2009;=&#x2009;76; 13.0%). Patients of all races and ethnicities reported considerable QoL impact (Dermatology Life Quality Index, EQ-5D-5L), with results for smaller subgroups (n&#x2009;<&#x2009;10) included for descriptive completeness only and not intended for comparison with other groups. During flaring, most patients used over-the-counter products/medications (54.2%) or nonmedical intervention/home remedy (56.9%) Up to 36.5% of patients reported challenges in procuring food, utilities, medicine/healthcare, phone, clothing, or childcare when needed in the past year. Among those who paid out-of-pocket for their HS treatment, 55.6% reported that it stopped them from visiting a healthcare provider for treatment. The findings indicate a high burden and impact of HS across all races and ethnicities. Patients reported social drivers of health and challenges with healthcare utilization, indicating the need for integrating social workers and care management teams in dermatology practice, which could facilitate improved care of patients with HS. Hidradenitis suppurativa is a painful skin condition that causes lumps and abscesses. It affects people of all races and ethnicities but is more common in Black or African American individuals. This study surveyed 583 adults in the USA to understand how hidradenitis suppurativa affects people from different racial and ethnic backgrounds. Our focus was on how the disease impacts their daily lives, their ability to access healthcare, how often they visit doctors, their quality of life, and their mental and emotional well-being. Most people said that hidradenitis suppurativa lowers their quality of life and makes daily activities harder. During flaring, many used home remedies instead of seeing a doctor. People suffering from hidradenitis suppurativa also reported trouble getting basic needs such as food, medicine, and transportation. These challenges occurred among patients from different racial and ethnic groups; results for very small subgroups (Asian, Native Hawaiian/Other Pacific Islander) are reported descriptively only and should not be interpreted as representative of these groups or compared with other groups. The research underscores the importance of improving awareness and tailoring care for people with hidradenitis suppurativa, particularly those facing barriers to healthcare.

Low handgrip strength (HGS) and sarcopenia are common in patients with head and neck squamous cell carcinoma (HNSCC). This study aimed to explore associations between baseline HGS, fat-free mass index (FFMI), nutritional indices, and survival. This was a prospective observational sub-study of a randomized nutritional intervention trial, including 50 male patients with HNSCC undergoing curative-intent treatment (surgery and/or (chemo)radiotherapy). Sarcopenia was defined as low HGS (<27 kg) and FFMI (<17 kg/m2). Chi-square, Kaplan-Meier, and Cox analyses were used. Low HGS was observed in 16%, low FFMI in 46%, and sarcopenia in 12%. Patients with low HGS had lower body weight, BMI, and FFMI, alongside more malnutrition, elevated CRP, and heavy smoking. Low HGS and sarcopenia were associated with shorter overall survival (HR 3.7, [95% CI 1.5-9.1] and 5.5, [2.2-14.5], respectively); FFMI was not. Adjustment removed significance. Findings should be interpreted cautiously due to the small, all-male cohort size. In this small exploratory cohort HGS may serve as a simple screening surrogate for sarcopenia and survival. www. gov, identifier NCT02159508.

Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions. A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7%), flexible cystoscopy (19.9%), extraction strings (23.5%), and device-assisted methods (7.9%). Less invasive approaches, particularly flexible cystoscopy and extraction-string removal, were consistently associated with reduced pain scores and improved patient comfort, although extraction strings carried a small risk of premature dislodgement. While practice patterns vary, the evidence suggests that a 10-14&#xa0;day dwell time might be the optimal window to balance healing with the prevention of encrustation. Less invasive removal approaches, particularly flexible cystoscopy and extraction-string techniques, were generally associated with lower pain scores and high procedural success rates in selected patients. While these methods are safe and better tolerated, extraction strings carried a small, reproducible risk of premature dislodgement. High-quality prospective studies are needed to define determinant-based, individualized stent management strategies.

High-elevation plants face unique challenges from potential climate change impacts that will likely require upslope migration into increasingly smaller suitable habitat. This situation is particularly acute for endemic species that by definition occupy small geographic ranges. Here we assessed climate risk for eight endemic species occurring in the Cascade Range of Washington State and modeled their ability to persist through the end of the century. For current species distributions, we utilized online georeferenced herbarium specimen and observation data from Pacific Northwest herbaria and iNaturalist. We visualized future climate impacts on current habitat space for each species using principal component analysis under two future CO2 emission levels: SSP245 and SSP585. We then applied an ensemble modeling approach using spatial data for climate, canopy cover, topography, and geology to predict future suitable habitat for each species. Our models predicted substantial habitat area losses for seven of eight species examined, with four expected to lose 99-100% of suitable habitat if CO2 emissions continue at current levels (SSP585). Under reduced CO2 emissions levels (SSP245), an average of 26.8% of the habitat area loss for each species can be abated. While our models show habitat range shifts for these species, it remains uncertain whether any species will successfully migrate into future potential suitable habitat. Habitat loss predicted in this study informs potential conservation needs. We present a repeatable modeling framework for studying climate change impacts on habitat for targeted species using publicly available distribution and environmental data.

The evolving global disease landscape, in conjunction with the significant impact of an aging population, has led to mental&#x2012;physical multimorbidity, imposing unprecedented pressures on healthcare systems and economies. This study aimed to investigate the interrelationships among multimorbidity, depression, and catastrophic health expenditure (CHE) and to test whether the intensity of CHE mediates these links. The analysis employed data from the China Health and Retirement Longitudinal Study (CHARLS), which conducted a longitudinal survey from 2011 to 2018, tracking 5,274 participants aged 45 years and older over a seven-year timeframe. Multimorbidity was ascertained through self-reported data from participants, whereas depression was evaluated via the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The intensity of CHE was calculated as the ratio of out-of-pocket (OOP) payments to the capacity to pay (CTP), adjusted for a catastrophic threshold of 40%. The relationships among the three variables were analysed via an extension of the random intercept cross-lagged panel model (RI-CLPM), which includes covariates to predict the observed variables. Mediation via the intensity of CHE was tested using 5,000 bootstrap resamples. At the between-person level, multimorbidity and depression were positively correlated (Model 1 r&#x2009;=&#x2009;0.349; Model 2 r&#x2009;=&#x2009;0.246; both p&#x2009;<&#x2009;0.001), whereas the intensity of CHE showed negligible between-person associations with either variable. At the within-person level, all variables showed significant autoregressive stability, with multimorbidity demonstrating the strongest persistence (&#x3b2;&#x2009;=&#x2009;0.808 in Model 1 and 0.936 in Model 2). Cross-lagged associations were clearly asymmetric, with prior multimorbidity exerting the largest prospective effects on the intensity of CHE (&#x3b2;&#x2009;=&#x2009;3.028) and subsequent depression (&#x3b2;&#x2009;=&#x2009;0.646 in Model 1 and &#x3b2;&#x2009;=&#x2009;0.789 in Model 2), whereas prior depression and prior intensity of CHE had much smaller effects on later multimorbidity. Mediation analyses indicated that the intensity of CHE (T) partially mediated the association from multimorbidity (T&#x2011;1) to depression (T&#x2009;+&#x2009;1) (indirect effect&#x2009;=&#x2009;0.063, 95% CI [0.042, 0.084]), but showed negligible mediation for the reverse pathway from depression (T&#x2011;1) to multimorbidity (T&#x2009;+&#x2009;1) (indirect effect&#x2009;=&#x2009;0.001, 95% CI [0.000, 0.001]). The study identified asymmetric bidirectional relationships among multimorbidity, depression, and the intensity of CHE in Chinese middle-aged and older adults, with effects predominantly running from multimorbidity to increased intensity of CHE and later depression; the intensity of CHE explained only a small portion of the multimorbidity&#x2192;depression effect and virtually none of the depression&#x2192;multimorbidity pathway. Policies that integrate multimorbidity management with routine depression screening could help reduce the combined physical, psychological, and financial burdens among middle-aged and older adults.

MET amplification/overexpression is a key resistance mechanism to EGFR-tyrosine kinase inhibitors (TKIs) in patients with EGFR-mutated non-small cell lung cancer (NSCLC). However, real-world evidence remains limited regarding the efficacy of vebreltinib plus an EGFR-TKI. This single-center retrospective study enrolled patients with EGFR-mutant advanced NSCLC and MET amplification/overexpression after prior EGFR-TKI failure, who received vebreltinib plus an EGFR-TKI. MET alteration was confirmed by fluorescence in situ hybridization (MET gene copy number of&#xa0;&#x2265;&#xa0;5 or MET/CEP7 ratio of&#xa0;&#x2265;&#xa0;2.0), next-generation sequencing (MET gene copy number of&#xa0;&#x2265;&#xa0;5), or immunohistochemistry (c-MET 3&#xa0;+&#xa0;). The efficacy was assessed by RECIST 1.1 and safety by CTCAE 5.0. Among the 49 patients, the combination therapy reported an objective response rate (ORR) of 46.9%, disease control rate of 91.8%, median progression-free survival (PFS) of 8.5&#xa0;months [95% confidence interval (CI): 4.5-10.2], and median overall survival (OS) of 16.0&#xa0;months (95% CI: 14.7-not reached). Patients with brain metastases (n&#xa0;=&#xa0;23) reported an intracranial ORR of 69.6% and intracranial PFS of 9.7&#xa0;months (95% CI: 5.12-not reached). Strong c-MET expression (immunohistochemistry 3&#xa0;+&#xa0;) was associated with significantly longer OS (not reached vs. 14.7&#xa0;months,p&#xa0;=&#xa0;0.033). Treatment-related adverse events occurred in 67.3% of patients (mostly grade 1-2), with peripheral edema as the most common type (30.6%). No permanent therapy discontinuation occurred. Vebreltinib plus an EGFR-TKI demonstrates favorable efficacy and manageable safety in real-world NSCLC patients with MET-driven resistance, with notable intracranial activity. Immunohistochemistry 3&#xa0;+&#xa0;may serve as a practical predictive biomarker.

Virtual reality (VR) has generated growing enthusiasm as a tool to deliver evidence-based mental health treatments. By immersing individuals in interactive, simulated environments, VR allows for repeated exposure to feared stimuli, real-time practice, and clinician involvement. While the strongest evidence supports using VR exposure therapy for anxiety-related disorders, promising applications are emerging across a range of conditions. Despite promising findings, most studies have small samples with limited follow-up. Broader integration in clinical practice will require continued innovation, testing, and adaptation to meet patient needs, enhance therapist training, and address health care system constraints.

Mechanotransduction, i.e., the conversion of mechanical cues into biochemical signals, is essential for bone development, remodeling, and adaptation. Although mechanical loading is known to regulate osteoblast function and bone homeostasis, dissecting the early and sustained mechanotransductive responses at the microscale remains challenging due to limitations of existing in vitro models. Here, we report the development and application of a mechanostimulation system comprising a polypyrrole (PPy)-based wire actuator that expands and contracts (4&#x202f;&#x3bc;m in radius) upon electrical actuation and enables precise, localized micromechanical stimulation of a small number of cells within standard culture formats. Using this system, we applied short-term (30&#x202f;min) cyclic (Cyc30) or static (Stat30), as well as prolonged (120&#x202f;min) cyclic (Cyc120) stimulations to two osteoblast-like cells (MC3T3-E1 or KUSA-A1). Subsequent transcriptomic profiling and computational network analyses revealed that Cyc30 was not capable of inducing significant changes in mRNA expression, suggesting cellular adaptation to short-term cyclic loading. In contrast, Stat30 induced the upregulation of Fos, Btg2, Egr1, and Fosl1, all known genes associated with mechanotransduction, supporting the validity and reproducibility of our experimental mechanostimulation system. Notably, two long non-coding RNAs (B930036N10Rik and 5430431A17Rik) were identified for the first time as being upregulated in response to Stat30 stimuli. Among the differentially expressed genes (DEGs) upregulated by Cyc120 stimuli, Hmox1, a stress-inducible enzyme known for its roles in maintaining cellular homeostasis and promoting survival, was the only DEG repeatedly observed across the Cyc30/Cyc120 and Stat30/Cyc120 comparisons in both cell types, potentially emerging as a key stress-response gene under prolonged mechanical loading. Collectively, these results establish the PPy-based microactuator as a powerful tool for microscale mechanobiology, and provide molecular insight into immediate-early responsive transcriptional programs underlying osteoblastic mechanoadaptation conserved across different cell types.