Background: Burn wound healing is a complex biological process requiring coordinated interactions among inflammatory cells, keratinocytes, fibroblasts, endothelial cells, extracellular matrix components, and neural structures. Increasing evidence suggests that sensory nerves actively regulate tissue repair through modulation of inflammation, angiogenesis, epithelial regeneration, and tissue remodeling. However, the role of sensory innervation in burn wound healing remains incompletely understood. The aim of this study was to investigate the effects of sensory denervation on healing of experimental second- and third-degree burns in rats. Methods: Thirty-two adult male Wistar albino rats were randomly allocated into four groups: denervated second-degree burns (Group 1), denervated third-degree burns (Group 2), innervated second-degree burns (Group 3), and innervated third-degree burns (Group 4). Bilateral T5-T7 sensory denervation was performed microsurgically in denervated groups. Standardized contact burns were subsequently created. Histopathological assessment of inflammation, neovascularization, epithelialization, fibroblast proliferation, and collagen deposition was performed on postoperative days 3, 7, 14, and 21. Results: Sensory denervation adversely affected multiple parameters of burn wound healing. Delayed epithelialization, impaired fibroblast proliferation, and reduced collagen deposition were most pronounced in denervated third-degree burns. Significant differences were identified between denervated and innervated wounds, particularly during proliferative and remodeling phases of healing. Conclusions: Sensory denervation significantly delays burn wound healing, particularly following third-degree thermal injury. Intact sensory innervation appears essential for successful epithelial regeneration, fibroblast activation, and extracellular matrix remodeling.
This report describes the surgical management and long-term follow-up of a dentigerous cyst associated with an ectopic mandibular third molar located in the condylar process. A 55-year-old female presented with pain, limited mouth opening, and a "cyst near the ear." Imaging revealed a radiolucent lesion in the left mandibular ramus associated with an impacted tooth in the condyle. Histopathologic analysis following incisional biopsy confirmed a dentigerous cyst. Given the lesion size and the inaccessible position of the tooth, surgical excision was performed through a preauricular approach under general anesthesia, including removal of the tooth and associated cyst. A 2.0-mm osteosynthesis plate was placed to reduce the risk of iatrogenic fracture. Although rare, ectopic third molars in the condyle are frequently associated with odontogenic lesions. In such cases, an extraoral approach may be required to achieve adequate exposure. A 10-year follow-up demonstrated complete bone healing and no recurrence.
Humans often struggle to accurately determine whether two different unfamiliar voice samples or face images belong to the same person. One method shown to boost face-matching performance is to have participants perform the task in pairs, which results in subsequent improvements for the poorer performers. This is a phenomenon known as 'the pairs training effect'. Previous studies have explored the pairs training effect using simultaneous face matching tasks whereby the two face images are presented side by side at the same time. Here we tested the efficacy of the pairs paradigm in unfamiliar voice matching (Experiment 1) which requires sequential presentation of the voices. We also tested sequential face matching (Experiment 2) to align the face task with the temporal demands of the voice task. In both experiments, participants completed one third of trials individually, one third in a pair, and a final third individually again. Across both tasks, we found that participants who initially performed poorly in the first individual task improved when completing the task in a pair and, importantly, retained this improvement in the final individual phase. Our findings show that the pairs training effect extends to identity matching of unfamiliar voices and remains even when stimuli are presented sequentially.
Shigella spp. is recognized by the World Health Organization as a high-priority pathogen due to its global prevalence, unique pathogenic mechanisms, and growing antimicrobial resistance (AMR). Nearly half of all Shigella strains worldwide are now multidrug-resistant (MDR), and the emergence of extensively drug-resistant (XDR) variants-resistant to ciprofloxacin, ceftriaxone, and azithromycin-has severely limited effective treatment options. The present study is based on prospective laboratory surveillance involving 323 Shigella isolates collected during 2021-2023, with pre-COVID-19 pandemic data included from a previously published study solely for historical comparison. The presence of antibiotic resistance genes (ARGs) was investigated, and whole-genome sequencing (WGS) was performed on representative isolates to assess phylogenetic relatedness with global isolates. Approximately 10% of isolates exhibited resistance to third-generation cephalosporins. While only 3% of Shigella isolates carried the blaCTX-M-15 gene from 2013 to 2019, its prevalence increased to 26% by 2022-2023. Among 38 ceftriaxone-resistant S. sonnei isolates, 33 were also resistant to azithromycin, categorizing them as XDR. These isolates showed 48% clonal similarity and high phylogenetic resemblance to the isolates reported from England. Hybrid genome assembly revealed a plasmid harboring both the blaCTX-M-15 and mphA ARGs. Conjugation experiments and plasmid profiling confirmed the plasmid's transferability. We report a rising trend in third-generation cephalosporin resistance among Shigella spp., primarily driven by the spread of extended-spectrum β-lactamase-producing S. flexneri and the emergence of XDR S. sonnei. These findings underscore the urgent need for strengthened national AMR containment strategies and enhanced international surveillance of cephalosporin-resistant Shigella to mitigate this growing public health threat.IMPORTANCEShigella is a leading cause of diarrheal disease globally and has been prioritized by the World Health Organization due to its rapid acquisition of antimicrobial resistance. Our prospective surveillance in Kolkata, India, reveals a worrisome escalation of third-generation cephalosporin resistance over the past decade, primarily associated with the spread of blaCTX-M-15 and the emergence of extensively drug-resistant (XDR) S. sonnei. The detection of plasmids carrying both blaCTX-M-15 and mphA, coupled with evidence of their transferability, highlights the potential for accelerated dissemination of multidrug resistance. When compared with a global data set of international genomes, the Kolkata XDR isolates were found to cluster closely with isolates reported from England. By linking local surveillance with global genomic context, our findings provide critical insights for treatment guidelines, antimicrobial stewardship, and the design of international containment strategies aimed at curbing the rise of cephalosporin- and azithromycin-resistant Shigella.
to report three cases of Silicone Oil-related Vision Loss (SOVRL) with an unreported Optical Coherence Tomography sign before and after removal. Three patients with SOVRL underwent multimodal retinal imaging, including spectral-domain OCT. Three male patients underwent pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). SO was used as intraocular tamponade in two cases with giant retinal tear (GRT) retinal detachment, and one case of macula-on retinal detachment and epiretinal membrane (ERM). In all cases, a foveal columnar hyperreflectivity (FOCOH) was identified before silicone oil removal (ROSO). Following ROSO, all the patients experienced reduction in visual acuity after an initial recovery. Two patients demonstrated regression of the FOCOH sign-one with concurrent visual recovery, while the other experienced persistent visual impairment despite disappearance of the sign (final VA 20/20 and 20/200). In the third case the hyperreflectivity persisted, accompanied by inner retinal cystoid spaces and poor final visual acuity (final VA 20/200). In the first case FOCOH disappeared after three months, in the second case the sign disappeared after one month from ROSO, and in the third case the FOCOH persisted for more than 2 months. The early presence of FOCOH under SO suggests its potential role as a predictive biomarker of visual decline. Recognizing FOCOH may provide additional clues for the early diagnosis of SOVLR and guide therapeutic interventions.
Tooth avulsion accounts for 0.5% to 16% of dentoalveolar traumas, and prognosis depends on immediate management. The International Association of Dental Traumatology developed an educational poster to guide laypeople in responding to such injuries. This study evaluated children's perceptions of the "Save a Tooth" poster and the knowledge acquired from it. Children aged 8 to 10 years were recruited. The poster's illustrations, children's comprehension, and readability were assessed using instrument 1, while knowledge acquired about emergency management of avulsion was assessed using instrument 2. Both instruments were administered after the poster presentation. Responses to instrument 1 were analyzed by categories, and responses to instrument 2 were classified as correct or incorrect. A total of 58 children from third to fifth grade participated. Most children reported that the poster was easy to understand, used accessible language, presented a new topic, required only one reading, had an adequate length, and would be understandable to peers of the same age. However, participants did not identify with the characters depicted, and fourth-grade students suggested that the poster could include more illustrations. The reported frequency of dental trauma among acquaintances ranged from 36.8% to 65%. All participants expressed interest in reading similar materials. Regarding knowledge acquisition, 65% of third graders, 63.16% of fourth graders, and 66.67% of fifth graders answered the sequence of emergency procedures incorrectly. Although the "Save a Tooth" poster was perceived as engaging and accessible, children demonstrated limited identification with the characters and a low level of knowledge retention regarding the correct sequence of emergency management for tooth avulsion.
Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice.
Anthracosilicosis is a legally recognized occupational disease that imposes a significant public health and economic burden on developing countries. Environmental exposure to mixed metals may influence the onset and progression of the disease, but relevant evidence among Chinese coal miners remains inconclusive. To evaluate the association between exposure to individual metal elements and their mixtures and the risk of anthracosilicosis using a case-control design. This case-control study included 154 coal miners (84 anthracosilicosis cases and 70 controls) who applied for occupational disease diagnosis at the Third People's Hospital of Xinjiang Uygur Autonomous Region between 2020 and 2024. Controls were frequency-matched to cases by age and work tenure. Plasma levels of seven metal elements (Al, Cd, Co, Cu, Ga, Mn, Sr) were measured by inductively coupled plasma mass spectrometry (ICP-MS). Single-metal exposure was analyzed using binary logistic regression and restricted cubic splines (RCS). Mixture effects were evaluated using quantile g-computation (QGC), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). The case group had higher concentrations of Cd, Co, Cu, and Mn than the control group (P < 0.05). Serum levels of Cd, Cu, Mn, and Sr were positively correlated with the risk of anthracosilicosis (P < 0.05), whereas an inverse association was observed for Ga (P < 0.05). Both QGC and WQS analyzes indicated that the mixture of seven metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with anthracosilicosis risk (P < 0.05). The BKMR model indicated that when the overall mixture exposure level exceeded the 50th percentile, the joint exposure to metals was positively associated with an increased risk of anthracosilicosis (P < 0.05). Mn may be the largest contributor to the cumulative effect of mixed metal exposure on risk, and Ga was negatively associated with the risk of anthracosilicosis. The combined exposure to 7 metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with the risk of anthracosilicosis.
Fetal lung interstitial tumor (FLIT) is a rare benign mesenchymal lung tumor that is often mistaken for more common congenital lung lesions such as congenital pulmonary airway malformation (CPAM). Prenatal detection is exceedingly uncommon. Here, we report a case of prenatally detected FLIT presenting in the third trimester with rapid interval growth, mediastinal shift, and fetal hydrops, raising concern for a malignancy, including pleuropulmonary blastoma. Prenatal ultrasonography and fetal magnetic resonance imaging (MRI) demonstrated a rapidly enlarging right lung mass first identified late in gestation with associated findings of pleural effusion, ascites, and diffuse skin edema consistent with hydrops. Progressive mass effect prompted expedited delivery. Postnatal imaging confirmed a large pulmonary lesion, and the neonate developed significant respiratory distress requiring lobectomy. Histopathologic evaluation revealed an immature mesenchymal proliferation diagnostic of FLIT. This case highlights the imaging overlap between FLIT, CPAM, and pleuropulmonary blastoma and underscores the importance of considering FLIT in the differential diagnosis of late-presenting fetal lung masses. Although imaging is essential for detection and prenatal planning, definitive diagnosis requires histopathologic confirmation, and complete surgical resection yields an excellent prognosis.
In clinical research, alternatives to venipuncture can reduce participant burden and increase accessibility and sampling opportunities for biomarkers. Residual pancreatic beta-cell function is assessed in clinical research and in diabetes care using fasting and stimulated C-peptide measurements, and changes are assessed over time. Operational, technical, and acceptability considerations of utilizing Tasso+ SST devices for C-peptide collection compared to venipuncture-derived serum samples were investigated. Samples were collected from prospectively enrolled healthy participants via Third Generation Tasso+ SST micro-sampling devices and phlebotomy. Eleven fasted Tasso+ samples collected on-site or remote underwent alternative handling conditions and were evaluated for consistency, quality, and stability. Participants responded to device acceptability questionnaires. The Tasso+ SST micro-sampling device showed excellent concordance with simultaneous venipuncture-derived fasted C-Peptide, with concentration being largely conserved in healthy volunteers despite alternative sample handling. Delayed centrifugation over 72 hours caused no consequential degradation of C-peptide when kept at 4°C. Questionnaire responses indicate acceptable device usability and associated comfort levels. Fasting C-peptide levels can be accurately collected using micro-sampling collection techniques. Tasso+ C-peptide stability is seen when kept at 4°C. Micro-sampling devices can be used with shipping mechanisms (without centrifugation) to decrease participant burden, expand trial populations, and aid biomarker measurements. This study focused on finding an easier way to collect blood samples for measuring C-peptide, a marker used in diabetes research, without needing a traditional needle stick in a vein (venipuncture). Instead, researchers tested a small, easily applied device that collects a small amount of blood from the upper arm. Healthy volunteer participants gave blood samples from both this device (called the Tasso+) and from the standard way (venipuncture). Some of these samples were collected away from a doctor’s office. The researchers checked to see if the small device gave accurate and reliable results for C-peptide, even if the samples were handled in different ways. These different ways included delays before processing and being stored in a fridge or freezer. They also asked participants about their experience with using the device.The study showed that transdermal micro-sampling devices, such as the Tasso+, provided C-peptide measurements similar to those from standard blood draws. The C-peptide in the samples stayed stable for up to 3 days in the refrigerator, even if not processed right away. Participants found the device easy and comfortable to use.In summary, using this device to collect small amounts of blood is a reliable way for samples related to diabetes to be collected and can help with research with less stress. This can make taking part in studies easier, allow for sample collection at home, and help researchers to include more people in studies while still getting trustworthy results.
To investigate content validity, test-retest reliability, and inter-rater reliability, and agreement between in-person and video-call assessments of the Modified Bradykinesia Rating Scale (MBRS), a new instrument to assess different components of bradykinesia (speed, amplitude, and rhythm). This methodological study followed the COSMIN guidelines. Content validity was evaluated by experienced health professionals using the Content Validity Index (CVI). For reliability analysis, two trained raters assessed individuals with PD using the MBRS and, 7 to 14 days later, rater 1 performed the second assessment in-person and a third assessment via video call. Intraclass Correlation Coefficient (ICC) was used (α = 5%). Nine professionals confirmed adequate content validity (CVI ≥ 0.80) for all items. Fifty-two individuals with PD (66.9 ± 6.2 years; 61.5% men) were included. The MBRS showed adequate measurement properties: test-retest reliability (ICC: 0.464 ≤ ICC≤ 0.745; p ≤ 0.001), inter-rater reliability (ICC: 0.266 ≤ ICC ≤ 0.537; p ≤ 0.003), and agreement between in-person and video-call assessments (ICC: 0.488≤ ICC≤ 0.741; p ≤ 0.001). The MBRS demonstrated adequate content validity, test-retest, and inter-rater reliabilities and can be used in both in-person and video-call assessments. Bradykinesia is one of the most common and disabling symptoms in individuals with Parkinson’s disease (PD); however, the assessment of this outcome in this population is still limited and needs to be improved.The Modified Bradykinesia Rating Scale (MBRS) is a measurement instrument developed for the specific assessment of each component of bradykinesia (speed, amplitude, and rhythm).In addition to presenting good clinical applicability, the MBRS demonstrated adequate test-retest reliability, inter-rater reliability, and agreement for use via video calls, and it can be used with Brazilian individuals with PD.These findings may contribute to the increased use of the MBRS as a useful and adaptable instrument in various clinical contexts, including via video calls, which are an increasingly common method in rehabilitation.
South Asia faces a difficult nutrition transition, where chronic undernutrition persists alongside increasing overweight and obesity. We develop a mother-child dyad-level classification framework to capture malnutrition burdens and their correlates. Using nationally representative DHS data from Bangladesh, India, Maldives, Nepal, and Pakistan, mother-child pairs are classified into single-member malnutrition (HSBM), single burden of malnutrition (SBM), and double burden of malnutrition (DBM). Country-specific multinomial logit models show mother--daughter pairs face significantly lower odds of SBM and DBM than mother-son pairs in India (SBM: RRR = 0.882***; DBM: RRR = 0.884***), with more strongly in Maldives (SBM: RRR = 0.469***; DBM: RRR = 0.724**). Pakistan shows the reverse, with mother-son pairs at lower SBM risk (RRR = 1.636***). Third-or-later-born children face higher DBM risk across countries. Well-nourished dyads decline steadily with age while DBM rises. Wealth's effect is mixed: the richest quintile protects against SBM everywhere but raises DBM risk in India and Pakistan.
The divalent anion sodium symporter (DASS) family mediates the uptake of Krebs cycle intermediates and sulfate and influences adiposity, insulin resistance, and metabolism in mammals. While Na+:substrate stoichiometry is known for several DASS transporters, the location of key Na+-binding sites remains elusive; important information for understanding the mechanism. In VcINDY, a bacterial DASS protein, we visualized a nonprotein cryo-electron microscopy (cryo-EM) density in the middle of the transport domain. Its size and coordination suggest that it may represent either a third Na+ ion or a structural water molecule. Using a combination of in vitro binding and transport assays, cryo-EM structural determination, and molecular dynamic simulations, we show that the density is not a Na+ ion. Instead, the data indicate that the density likely represents a structural water molecule critical for transport domain integrity. Sequence and structural similarities suggest this feature may be conserved across human DASS transporters such as NaCT and NaDC3.
Numerous cutaneous adnexal tumors have recently been characterized by specific molecular hallmarks, notably oncogenic gene fusions. Herein, we report three cases of a sweat gland tumor exhibiting a secretory morphology and harboring SFPQ::NFATC3 or NPM1::NFATC3 fusions. The cases presented in a 36-year-old woman (left thigh), a 55-year-old man (paraumbilical region), and a 65-year-old woman (scalp), and were dermal-based neoplasms. Histopathological examination revealed ill-defined tumors with an infiltrative growth pattern, predominantly centered in the dermis, with one case extending into the subcutis. Two cases were characterized by cords, small nodules, and nests of epithelioid cells with large hyperchromatic nuclei, while prominent glandular and cribriform structures were observed in the third case. Numerous round ductal structures filled with a dense eosinophilic secretory material were identified in all cases. Mitotic activity was very low (< 1/mm²). No lymphovascular or perineural invasion was observed. Immunohistochemistry demonstrated diffuse SOX10 positivity in one case and p63 expression in the remaining two. PanTRK and NUT were negative, and YAP1 expression was preserved. Molecular analysis revealed in-frame SFPQ::NFATC3 (n = 2) or NPM1::NFATC3 (n = 1) fusions with identical breakpoints within the NFATC3 gene. These three cases of sweat gland tumor harboring NFATC3 gene fusions may represent the first identified examples of a previously undescribed adnexal tumor.
Pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide, ranking third among cardiovascular-related deaths after myocardial infarction and stroke. Despite extensive research, data on PE incidence and characteristics within the Israeli population remain limited. This study aimed to investigate the demographic, clinical, and prognostic factors associated with provoked (PPE) and unprovoked PE (UPE) cases in Israel. We conducted a retrospective observational study analyzing medical records of patients diagnosed with PE at Ziv Medical Center, Safed, Israel, from 2017 to 2022. Patients were classified into PPE or UPE groups based on identifiable risk factors. Demographic data, clinical characteristics, and mortality outcomes were compared using descriptive and inferential statistical methods, including the Mann-Whitney U test, chi-square test, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards modeling. A total of 348 patients (mean age: 68.6 ± 17.6 years; 54.3% female) were included, with 189 (54.3%) classified as PPE and 159 (45.7%) as UPE. Female patients were significantly older than males (p < 0.001), and Jewish patients were slightly older than Arab patients (p = 0.060). The average hospital stay was 10.7 ± 16.2 days. Although no group differences emerged in unadjusted analyses, male sex was associated with longer hospitalization and UPE with shorter hospitalization than PPE in the adjusted model. Ethnicity emerged as a significant predictor of PE type, with Jewish patients less likely to have UPE (OR = 0.457, 95% CI 0.256-0.817, p = 0.008). Among PPE cases, 67.2% were of Jewish origin and 32.8% were Arab, compared to 56.0% and 44.0%, respectively, in the UPE group. In-hospital mortality was 16.1% (n = 56). Age was a significant predictor of mortality (HR = 1.03, 95% CI 1.00-1.06, p = 0.020), while ethnicity, gender, and PE type showed no significant associations in multivariable models. Our findings highlight key demographic and clinical factors influencing PE outcomes in Israel. The significant association between ethnicity and PE type warrants further investigation to refine diagnostic and therapeutic strategies for high-risk populations.
To quantify and characterize aggression and violence against nurses, identify associated clinical characteristics, evaluate measures in response, and explore predictors of recurrent incidents in the ICU. Retrospective single-center study. Incidence and characteristics of aggression and violence against ICU nurses were the primary outcomes. Aggression was defined as hostile behavior or resistance to care without intent to harm. Violence comprised verbal, physical, or sexual acts to threaten or inflict harm. Secondary outcomes included risk factors for recurrent incidents, defined as multiple episodes of aggression/violence separated by greater than or equal to 24 hours. Multivariable analyses were performed to identify potential independent associations. Data were collected from 2023 to 2024 at the tertiary medical-surgical ICU with up to 35 beds at the University Hospital Basel. Nursing operations followed a three-shift system: day (07:00-15:00), late (15:00-23:00), and night (23:30-07:00). Clinical reports from ICU nurses were screened. None. During 2190 shifts, 308 aggressive or violence incidents (14% of shifts) were reported. Most occurred during late (37%) or night (34%) shifts; 75% involved violence. Violent incidents were combined in nature (79% physical, 43% verbal, and 3% sexual). Patients were mainly involved (97%) and predominantly male (71%; median age 67; 90% emergency admissions). Psychiatric comorbidities, drug, and alcohol abuse were found in 20-33%. Recurrent aggression/violence occurred in 27%, predicted by longer ICU stay (adjusted odds ratio [OR] = 1.05/every additional hour), aggression as the first incident (adjusted OR = 6.9), and verbal violence as the first incident (adjusted OR = 4.3). Nurses (89%, two-thirds female, median 7 yr' experience) rarely documented harm (1.3%), but patients were reported to suffer complications in 60% of incidents, mainly from oversedation and physical harm from restraints. Violence in the ICU is frequent and almost always caused by patients. Recurring violence was independently associated with longer ICU stay, initial aggression, and verbal violence. Staff harm was rare, but incidents were frequently associated with complications in patients.
Background: Urolithiasis is a common condition characterized by a high risk of recurrence, although this risk varies substantially between patients. The present study aimed to quantify incidence, identify determinants, and model recurrence risk between stone composition and recurrence, and to assess the role of selected clinical and behavioral factors in a cohort of patients with confirmed stone clearance. Methods: This retrospective cohort study included adult patients with urolithiasis managed between 2017 and 2021 in a specialized referral center. Only patients with confirmed stone-free status and available follow-up were included. Stone composition was determined using morpho-spectroscopic analysis. Clinical and behavioral variables were collected from medical records. Recurrence was defined as a new stone event during follow-up. Time-to-event analysis was performed using Kaplan-Meier estimates and Cox proportional hazards models. Results: A total of 962 patients were included, with a median follow-up of over three years. During this period, recurrence occurred in approximately one-third of patients. Uric acid stones were associated with a higher risk of recurrence compared with calcium oxalate monohydrate stones, while the effect size was moderate. Previous stone history and low fluid intake were also independently associated with recurrence. Other dietary variables did not retain statistical significance after adjustment. Conclusions: Recurrence in urolithiasis appears to reflect the combined effect of compositional, clinical, and behavioral factors. While certain variables are associated with increased risk, no single determinant fully explains recurrence patterns. These findings support a more individualized approach to risk assessment and follow-up.
Characterize parents' views and preferences for managing their child's weight. Semistructured interviews with Hispanic primary caregivers whose health care provider told them their 8-12-year-old child's weight was above the recommended weight for their age. Virtual interviews. The community sample of participants (n = 16) were primarily mothers (81%), immigrants (94%), and aged 37 ± 6 years. Participants were from Mexico (56%), Ecuador (19%), Colombia (13%), El Salvador (6%), and the US (6%). Parent perceptions of and preferences for weight management and weight-inclusive paradigms. Inductive thematic analysis. We identified 3 themes. First, parents consider context to decide how to address their child's weight. Second, parents view weight management as a personal responsibility that is made challenging by environmental barriers. Third, parents follow guidance from sources they feel are reliable and relatable. Parent perspectives aligned with aspects of both weight management and weight-inclusive paradigms. In practice, these themes indicate parents are likely to want clear, specific guidance on weight that is sensitive to personal factors (e.g., child developmental stage, culture), structural barriers (e.g., time, access, affordability), and that clarifies expectations about potential outcomes from pursuing either approach.
Background: Spinal epidural abscesses (SEA) are rare, occurring 2.5-3 times per 10,000 hospital admissions. While streptococcus species comprise 7% of reported SEAs, Group A Streptococcus (GAS) has been described only once in the medical literature to our knowledge. Case presentation: We present a case of GAS pharyngitis with subsequent paraplegia from a GAS SEA. A 33-year-old female presented to the emergency department (ED) and was initially diagnosed with GAS pharyngitis and a suspected strained lower back. Following treatment with amoxicillin, she returned with worsened back pain, radiculopathy, and leukocytosis, for which she was treated with cyclobenzaprine. On her third presentation, she had new bilateral lower extremity weakness with decreased sensation, bilateral ankle clonus, and hyperreflexia. MRI of the thoracic and lumbar spine revealed a multiloculated SEA at T5-T10 requiring laminectomy and abscess evacuation. Intraoperative cultures grew Streptococcus pyogenes. Despite surgery, medical management, and physical therapy, she remained paraplegic. Conclusions: To our knowledge, this is the first report of SEA preceded by GAS pharyngitis. This case exposes the critical association between a recent infection, progression of back pain, eventual neurologic symptoms, and inflammatory markers that should trigger concern for SEA and early evaluation with MRI.
This study explores systemic factors that can influence unethical practices in academic publishing, particularly institutional pressures, editorial practices, and the impact of artificial intelligence (AI) tools. The study shifts responsibility away from individual actors. It takes a qualitative approach to examine how the interactions between researchers, editors, and institutional structures contribute to conditions in which unethical practices may occur. A qualitative research design was used to gather data through semi-structured interviews and observations with 30 participants, comprising university lecturers, postgraduate students, journal editors, and research support professionals from various regions.The results suggest that competition for publication and career advancement, as well as a lack of mentorship, create environments that participants see as encouraging unethical practices - such as author manipulation, use of third-party writers, and inappropriate use of AI - to occur. AI tools were specifically characterized as facilitating interventions that may support these practices in the context of systemic pressures. Furthermore, some participants expressed concerns about the editorial and financial arrangements, which could negatively affect the peer-review process.This study indicates that unethical publishing practices should be understood as resulting from complex systemic and cultural factors, rather than individual actions. The study identifies the need for institutional changes, guidance on AI use, and policies to promote research integrity. The qualitative nature and limited sample size of the study mean the results are explorative and suggestive of perceived patterns, rather than generalizable. We suggest that future research use mixed methods to investigate the extent and effects of these dynamics.