Given the importance of timely comprehensive genomic profiling (CGP) for the treatment of cancer, this study aimed to provide generalizable estimates of turnaround time (TAT) for tissue-based CGP. Secondary aims were to identify TAT trends over time and explain variation based on clinical, demographic, and administrative factors. Data for solid tumor samples profiled from 2018 through 2024 from a commercial laboratory were analyzed. Descriptive statistics were used to summarize and compare TAT between sites. Linear regression was used to assess for yearly trends and to measure associations between clinical, demographic, and administrative variables and TAT. A total of 271,574 solid tumor malignancies originating from 5,497 clinical sites were included in the analysis. The overall TAT (specimen collection to CGP results reporting) decreased from a median of 43 days (IQR, 31-72) to 32 days (IQR, 22-51) from 2018 to 2024. When comparing overall TAT for 2024 by clinical site, the shortest and longest overall TAT quintiles were 23.1 days (IQR, 20.6-24.6) and 46.5 days (IQR, 42.7-50.8), respectively (P < .001). There was variability in timeliness of ordering between sites with a median time from biopsy to CGP ordering of 10.0 days (IQR, 8.0-12.0) versus 30.8 days (IQR, 26.6-35.0) for the shortest and longest quintiles, respectively. Factors associated with shorter ordering and overall TAT included, but were not limited to, higher clinical site ordering volumes, cancer type, and ordering method. Delay in the time from biopsy to CGP ordering was the largest contributor to protracted TAT and varied between clinical sites. Increasingly, the appropriate treatment of cancer is dependent on biomarker testing and delays in testing likely contribute to suboptimal patient care.
Poor dietary habits are major modifiable risk factors for stroke. With population aging and shifts in dietary patterns, the stroke burden attributable to dietary risks has changed in both China and Japan; however, long-term cross-country comparisons remain limited. This study assessed and compared trends in dietary risk-attributable stroke burden in China and Japan from 1990 to 2023. Data were obtained from the Global Burden of Disease 2023 study. Stroke deaths, age-standardized mortality rates (ASMRs), age-standardized disability-adjusted life-year rates (ASDRs), and corresponding 95% uncertainty intervals attributable to dietary risks were analyzed. Estimates were stratified by age, sex, stroke subtype-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and nine dietary risk factors. Temporal trends were evaluated using estimated annual percentage change (EAPC) and Joinpoint regression to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). From 1990 to 2023, dietary risk-attributable stroke burden declined in both countries but remained consistently higher in China across all demographic groups and stroke subtypes. ICH predominated in China, whereas IS accounted for the largest share in Japan. Burden increased with age and was higher in men. High sodium intake and low fruit intake were the leading contributors, followed by low whole grain and low fiber intake, while high red meat intake showed a protective association in both countries. ASMR attributable to dietary risks showed sustained declines (AAPC: -4.03% in China; -4.23% in Japan). All dietary risk-related burdens decreased except for sugar-sweetened beverage intake in China, which demonstrated an upward trend. Although declining, dietary risk-attributable stroke burden remains substantially higher in China than in Japan. Persistent high sodium intake and insufficient fruit and whole-grain consumption continue to drive the burden. Strengthening salt-reduction policies, improving dietary quality, and enhancing nutrition education are essential to further reduce diet-related stroke burden in both countries.
To evaluate clinicopathologic factors associated with progression-free survival in patients with epithelioid trophoblastic tumor and to construct validated prognostic models. This study combined a retrospective institutional case series (57 patients) with systematically identified literature cases (150 patients), totaling 207 individuals with epithelioid trophoblastic tumor diagnosed between 1998 and 2024. The primary end point was progression-free survival. Prognostic variables were identified with Cox and least absolute shrinkage and selection operator regression. Two nomograms were developed: a clinical model and a clinicopathologic model. Internal validation was performed with 1,000 bootstrap resamples. Model performance was assessed with concordance index, time-dependent receiver operating characteristic curves, calibration plots, and decision-curve analysis. Patients with stage IV disease had the shortest median progression-free survival (9.0 months); those with stage II-III disease and solitary extrauterine lesions had outcomes similar to those of patients with stage I disease (P=.219). Independent prognostic factors included high mitotic count (5 or more per 10 high-power fields; hazard ratio [HR] 17.91, 95% CI, 4.13-77.70, P<.001), interval from last pregnancy of 20 months or more (HR 2.59, 95% CI, 1.32-5.08, P=.006), tumor size 4 cm or larger (HR 1.81, 95% CI, 1.05-3.15, P=.034), and International Federation of Gynecology and Obstetrics stage IV (HR 4.46, 95% CI, 1.67-11.93, P=.003). Model discrimination (C index) was 0.72 (95% CI, 0.69-0.75) for the clinical model and 0.82 (95% CI, 0.78-0.86) for the clinicopathologic model. Clinicopathologic characteristics are significantly associated with prognosis in epithelioid trophoblastic tumor. The validated nomogram-based model may support individualized clinical risk assessment.
ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual. ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines.Clinical Practice Guidelines and other guidance ("Guidance") provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases, or stages of diseases. Guidance is based on review and analysis of relevant literature and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and 2 (online only) for more. To provide guidance on the use of circulating tumor DNA (ctDNA) testing in patients with solid tumors or lymphoma. A systematic review by a multidisciplinary panel with patient representation was conducted. The PubMed database was searched from January 2017 to February 2025. Guideline recommendations were based on consideration of the identified evidence. Fifty-four meta-analyses and 22 study reports were identified, including reports of seven randomized trials. ctDNA testing for tumor genetic alterations may be used in situations where: tumor tissue testing is challenging, not feasible, or tumor biopsy represents unacceptable risks to the patient; tumor tissue testing results may not be available within a clinically actionable time frame to determine appropriate management options; or a drug's regulatory approved indication allows for or requires ctDNA testing. If ctDNA testing results are negative, inconclusive, or inconsistent with the clinical scenario, tissue-based confirmation should be sought. Other than testing for genetic alterations, ctDNA testing may be offered if a specific, evidence-based action can be taken with the results or there is conflict or ambiguity with standard-of-care assessment that may be resolved by ctDNA testing. Fractional, percentage, or concentration-based measures of ctDNA or total cell-free DNA concentration are not recommended as a surrogate measure of disease. The panel recognizes this is a rapidly evolving field and guidelines are anticipated to change, bringing in tumor-type specific recommendations and incorporating more data on molecular residual disease settings.Additional information is available at www.asco.org/molecular-testing-and-biomarkers-guidelines.
The study of high-performance sensing platforms is essential to achieve a high sensitivity for hormonal analytes, short response times, and cost-effectiveness. Nevertheless, standard analytical procedures, such as high-performance liquid chromatography, inductively coupled plasma mass spectrometry, and gas chromatography mass spectrometry (HPLC, ICP-MS, and GC-MS), are rather limited because their sensitivity is low at pM/nM concentrations, and the costs of these processes are too high. Moreover, modern sensor technology can be ill-equipped to selectively respond to intricate biological sample types, and there is no single standard used to quantify sensor signals. This review addresses these knowledge gaps by providing a comprehensive discussion on the role of biomass-derived materials as useful interfaces in electrochemical hormone sensing systems. To achieve improved results, we critically investigated the recent advances in the electrode modification process through biomass-based nanomaterials to promote electron transfer kinetics and interfacial engineering. The present article also discusses contemporary issues such as problems with stability, reproducibility, and selectivity in complex matrices. Furthermore, we highlighted some of the new approaches, such as the development of artificial intelligence, Internet of Things, and wearable point-of-care devices, to create the next generation hormone sensors. Overall, this current review is a comprehensive overview of biomass-derived materials, which have the prospect of enhancing surface modification at the advanced phase, AI integration, and the development of point-of-care diagnostics.
Non-transfusion-dependent thalassemia (NTDT) is characterized by variable degrees of anemia, ineffective erythropoiesis, and iron overload, with a heightened risk of age-related complications. However, the clinical profiles of patients who first present to thalassemia care in adulthood, as well as the gaps in management, are poorly described. In a multi-institutional study, we identified 82 patients with NTDT aged ≥18 years who were referred to three U.S. thalassemia centers between 2013 and 2023. Data were collected by manual chart review and included clinical history, laboratory tests, and imaging. The median age at initial visit was 36.8 years (range 18-74), and 37 (45%) of the patients had α-thalassemia, while 45 (55%) had β-thalassemia. Complications assessed included symptomatic anemia, prior splenectomy, extramedullary hematopoiesis, iron overload, pulmonary hypertension, cardiac arrhythmia, endocrine complications, and thrombosis. Iron overload was common, with 71% of available liver MRIs showing hepatic iron >5 mg Fe/g dry weight. Among patients with LIC >5 mg Fe/g, only 24.4% were on chelation at referral. Strikingly, 49% of patients were recommended to start regular transfusions following the consultation, predominantly for symptomatic anemia or complications of ineffective erythropoiesis. Patients with NTDT referred for initial comprehensive thalassemia care in adulthood had high rates of morbidities and undertreated iron overload. The criteria for initiating regular transfusions must be widely implemented to mitigate long-term complications and improve the quality of life of adults with NTDT.
Individual differences in musical reward have increasingly been studied in neuroscience and music research. However, there are limited validated tools for evaluating musical reward with multidimensional measures in Turkish-speaking populations. The extended Barcelona Music Reward Questionnaire offers a comprehensive assessment of how individuals experience pleasure from music. This study aims to investigate the validity and reliability of the Turkish version of the extended Barcelona Music Reward Questionnaire (eBMRQ-TR). A total of 266 Turkish-speaking adults aged 18-65 completed the eBMRQ-TR using an online platform. This study included 189 non-musicians, 57 amateur musicians, and 20 professional musicians. Construct validity was investigated using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach's alpha and McDonald's omega. Test-retest reliability over a three-week period was evaluated in a subsample of 65 participants through intraclass correlation coefficients (ICCs). Exploratory analyses were performed to define group differences in musicianship, gender, and age. The eBMRQ-TR comprised 24 items across six factors, accounting for 52.41% of the total variance. Confirmatory factor analysis indicated acceptable model fit [χ² (237) = 628, CFI = .946, TLI = .938, RMSEA = .079, SRMR = .057], supporting a six-factor structure for the eBMRQ-TR. The total eBMRQ-TR showed excellent internal consistency (α = .92; ω = .93). The test-retest reliability of the total eBMRQ-TR showed satisfactory temporal consistency, with an ICC of  .80. Musicians demonstrated higher total eBMRQ-TR scores than non-musicians (p < .001, η² = .11). The eBMRQ-TR is a valid and reliable instrument for measuring musical reward in Turkish-speaking adults. As a multidimensional measure, it could inform future studies of individual differences in musical engagement, particularly for research on musical reward and music perception.
Personalised medicine represents a key direction of modern healthcare, enabling the adaptation of prevention, diagnosis and treatment based on individual patient characteristics. The European Partnership for Personalised Medicine (EP PerMed) was established as a strategic European Union initiative to coordinate research, innovation and implementation of personalised medicine across Member States. This article provides a comprehensive overview of the origin, objectives, programmes and major challenges of EP PerMed, with a particular focus on its relevance for clinicians and researchers and on the participation of the Czech Republic. Special attention is dedicated to the role of the Czech Health Research Council (AZV ČR) as a key national coordinating and funding body facilitating the involvement of Czech teams in EP PerMed joint transnational calls. The article discusses benefits and future perspectives of personalised medicine in both the European and Czech contexts.
Government of India launched Anemia Mukt Bharat (AMB) program in 2018. Despite its implementation, the prevalence of anemia remains high. To address the gaps in coverage, adherence and effective implementation, the Indian Council of Medical Research (ICMR) initiated the Precision driven Response for Anemia Control and Sustainable Health (PRAKASH) study. It is an implementation research study aimed at co-developing and optimizing a district-level model of evidence-based anemia control interventions. The intended goal is to reduce anemia prevalence to 20% or lower through scalable, context-specific, and sustainable strategies. This multi-site study targets six key population groups: children (aged 6-59 months and 5-9 years), adolescents boys and girls (10-19 years), women of reproductive age (20-49 years) and pregnant women. Interventions are anchored in six pillar i. Test-Treat-Track until resolution, ii. prophylactic iron and folic acid supplementation, ensuring high complianceiii. anemia-relevant health interventions, iv. fortified rice distribution, v. dietary diversification and promotion of iron-rich foods, and vi. behavior change communication through Jan Andolan. Anemia prevalence will be estimated through a series of community-based cross-sectional surveys. Mixed methods approach will be employed to assess barriers and enablers at the individual, household, facility, and community levels. The study will utilize implementation science frameworks, including Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC), to guide iterative implementation, real-time model refinement, and monitoring of performance. Information on outcome indicators will be collected to evaluate anemia prevalence, fidelity, feasibility, and service delivery improvements. The study will try to readdress the implementation challenges across diverse regions and aims to develop a comprehensive and replicable model for the AMB 2.0 program. The study is likely to contribute to the global evidence base on implementation science for anemia reduction in low- and middle-income countries.
Anion exchange membranes (AEMs) are promising for hydrogen production via water electrolysis. Imidazolium cations provide high thermal stability and performance, but their alkaline degradation mechanisms remain difficult to resolve due to the complexity of the pathways involved. We performed comprehensive ab initio molecular dynamics (AIMD) simulations using density functional theory (DFT) to elucidate the competing degradation pathways of imidazolium-based AEMs. The AIMD simulations identified five unique degradation pathways of the AEMs, including ring-opening, demethylation, dissociation and other side reactions. The transition state (TS) calculations found that all degradation pathways start with the OH- attack on the imidazolium cations, while the subsequent C-N and C-C bond cleavage are the rate-determining steps. The noncovalent interaction analysis shows that the alkyl protection of imidazolium introduces steric hindrance to elevate the energy barriers of OH- attack, which suppresses the formation of the enol-like intermediates for further degradations. The electrostatic potential (ESP) analysis reveals a direct correlation between the charge distributions of imidazolium cations and the nearby motions of OH- anions, where a symmetric backbone framework of imidazolium cations introduces accumulated positive charges, facilitating the OH- attack for degradation. Our findings suggest that modulating the probability of OH- attack on imidazolium cations is key to ensuring high alkaline stability, and that using a branched imidazolium cation with an alkyl protecting group is an effective strategy to prevent OH- attack-induced degradation.
Objectives. To assess US patterns of distribution for all naloxone products. Methods. We conducted a retrospective, cross-sectional study using manufacturer reports (total US naloxone distribution) and IQVIA National Sales Perspectives (estimated sales to US health care settings) to assess naloxone distribution quantity and patterns from 2018 to 2023. Results. Aggregated manufacturer-reported data showed that total US distribution of naloxone increased from 7.65 million units (vials, syringes, devices) to 29.7 million units from 2018 to 2023; the largest increase was in distribution of nasal spray devices (2.9 million to 23.4 million devices). Although sales to health care settings doubled (6.3 million units in 2018 and 13.6 million units in 2023), we infer that naloxone distributed to non-health care settings increased from 1.39 million units in 2018 to 16.1 million in 2023, accounting for 54% of total naloxone distributed in the United States by 2023. Conclusions. Distribution of naloxone markedly increased between 2018 and 2023, with the largest increases in distribution to non-health care settings and for nasal spray devices. Public Health Implications. This comprehensive overview of the naloxone supply, with insights into changes in distribution for community use, may help inform assessments, including those involving factors contributing to recent declines in opioid overdose deaths. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308541).
Calcium (Ca2+) signaling has emerged as a central regulator of activity-dependent myelination in oligodendrocytes. These Ca2+ signals encompass both the stimulus-independent spontaneous Ca2+ local transients (SCaLTs) generated intrinsically in a voltage-independent manner or facilitated by the membrane voltage, as well as evoked responses triggered by ATP and glutamate release. To investigate the regulatory mechanisms underlying this combined spiking activity, we developed a stochastic spatiotemporal flux-balance model of Ca2+ transients in oligodendrocyte precursor cells (OPCs). The model incorporates all the relevant fluxes in these cells and integrates membrane voltage dynamics with a Ca2+-induced Ca2+-release (CICR) mechanism using parameters fitted to Ca2+ fluorescence recordings. The model reproduced the intrinsic and voltage-facilitated SCaLTs in OPCs in the absence of purinergic and glutamatergic receptors, and captured the three distinct patterns of evoked Ca2+ responses induced by prolonged ATP and glutamate stimulations identified using machine classifier. The model highlighted the role of ATP and glutamate in generating these clusters, and showed that the fast dynamics of CICR is key to producing these evoked responses. Further analysis of the model also revealed that voltage-gated L- and T-type Ca2+ channels slightly increase the frequency of SCaLTs, while stimulation with ATP and glutamate, using randomly distributed pulses mimicking in vivo conditions, leads to an increase in both the amplitudes of Ca2+ spikes (i.e., the combination of SCaLTs and evoked responses) and the prevalence of wide spikes, especially upon glutamate stimulation. Bifurcation analysis of the deterministic version of the model, in the absence of diffusion, demonstrated that ATP and glutamate stimulation can shift the system into an oscillatory regime, thereby increasing the deterministic component of SCaLT dynamics. This study thus offers a comprehensive representation of OPC Ca2+ transients linking recorded in vitro behaviors to in vivo dynamics.
Clinical decision support systems (CDSS) have emerged as valuable tools for enhancing healthcare for rare diseases. Nonetheless, most tools focus on diagnosis, while few support patient monitoring. We aim to report the methods to develop an evidence-based CDSS for monitoring rare diseases, using Bardet-Biedl Syndrome (BBS) as a case study. We assembled a multidisciplinary team of over 40 healthcare providers from 11 specialities to develop rare disease monitoring plans. We conducted a scoping review to map the existing literature on BBS monitoring, followed by the systematic development of a plan framework with four sections: a tailored medical record with clinical manifestations, a multidisciplinary appointment schedule, a questionnaire tracker, and a complementary exam tracker. We extracted data from articles, books, guidelines, and point-of-care resources. We included 128 references in the analysis. Common study designs included case reports (37.5%), case series (19.5%), and cohort studies (16.4%). We documented 108 clinical manifestations of BBS across ten body systems. The multidisciplinary appointment schedule identified 24 healthcare professionals essential for BBS follow-up, and primary consultations were recommended with 13 specialities. We identified 28 scales and questionnaires, 8 sets of laboratory analyses, 7 electrophysiological studies, and 6 imaging studies for patient follow-up. Our CDSS provides a structured, evidence-based approach to monitoring BBS and improving patient outcomes. This model can be adapted for other rare diseases, promoting comprehensive and multidisciplinary patient care.
The article presents a method of comprehensive surgical and orthopedic rehabilitation of a patient with a combined defect of the alveolar process of the upper jaw. A patient consulted the Central Research Institute of Stomatology and Oral Surgery of the Ministry of Health of the Russian Federation regarding the missing tooth 2.6 and the presence of a combined bone defect of the alveolar process. During the patient's treatment, a combined approach was used, involving the sequential restoration of the bone contour and volume, implantation, and the sequential provision of temporary and permanent prostheses to create a natural gingival contour. Preoperative diagnostics (CT), surgical technique, individualized temporary and permanent prosthetics, and monitoring of results are described. After 8.5 months, stable bone volume, reliable implant osteointegration, and restoration of the function and aesthetics of the dentition were achieved. Представлена методика комплексной хирургической и ортопедической реабилитации пациента с комбинированным дефектом альвеолярного отростка верхней челюсти. В ФГБУ НМИЦ «ЦНИИСиЧЛХ» Минздрава России обратился пациент на консультацию по поводу отсутствующего зуба 2.6 и наличия комбинированного костного дефекта альвеолярного отростка. При лечении пациента применены комбинированный подход с последовательным восстановлением контура и объема костной ткани, имплантацией, а также последовательное временное и постоянное протезирование с формированием естественного десневого контура. Описаны предоперационная диагностика (КЛКТ), хирургическая техника, индивидуализированное временное и постоянное протезирование и контроль за результатами. Через 8,5 мес достигнут устойчивый объем кости, надежная остеоинтеграция имплантата, восстановление функции и эстетики зубного ряда.
This systematic review synthesized cross-linguistic evidence on speech error patterns in children with speech sound disorders (SSDs), focusing on percent consonants correct (PCC), SODA (substitution, omission, distortion, and addition) error profiles, and phonological processes, as well as factors contributing to variations in error patterns. Comprehensive searches were conducted in PubMed, CINAHL Ultimate, Scopus, Web of Science, and Linguistics and Language Behavior Abstracts in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included empirical research on children with phonological, articulation, or functional SSDs that reported quantitative error analyses. Twenty-eight studies met the inclusion criteria. Methodological quality, evaluated using a 16-item framework, ranged from 50.0% to 100.0% (M = 82.7%). The 28 studies spanned nine languages (English, German, Spanish, Portuguese, Italian, French, Turkish, Korean, and Chinese), including three dialects each of Spanish and Chinese and two dialects of Portuguese. Reported PCC values (typically 65.0%-85.0%) indicated predominantly mild-moderate to moderate impairment. Substitution errors were the most prevalent across languages, followed by omissions and distortions. Both language-common and language-specific phonological processes were documented. The findings indicate that PCC is generally comparable across languages, whereas SODA error profiles and phonological processes reflect both cross-linguistic similarities and language-specific characteristics. Phonological processes, in particular, exhibit greater cross-linguistic variation. Collectively, these results emphasize the need for culturally responsive diagnostic practices and highlight the importance of developing cross-linguistic frameworks to guide the assessment of SSDs. https://doi.org/10.23641/asha.32649549.
Kangaroo mother care (KMC) is an effective intervention to reduce preterm infant mortality and complications. Updated review of current evidence supports revision of current neonatal guidelines. To systematically retrieve, appraise, and synthesize the best current evidence on safe and effective KMC practices for preterm infants. Comprehensive search (inception to December 2024) using the "6S" model across UpToDate, JBI, BMJ Best Practice, Cochrane Library, NICE, NGC, GIN, PubMed, CINAHL, Embase, CBM, Wanfang, CNKI, and Baidu Scholar. Included guidelines, systematic reviews, meta-analyses, evidence summaries, expert consensuses, and clinical decision support articles focused on KMC for preterm infants/families/nurses (PIPOST model). Excluded non-Chinese/English, duplicates, and incomplete texts. Nine (9) documents were finally included from 56 full-texts screened (3 guidelines, 3 systematic reviews, 2 clinical decision supports, 1 evidence summary). The 6-member research team comprised 4 researchers who independently conducted quality assessments of guideline documents, while 2 researchers independently evaluated systematic reviews and evidence summaries. Quality appraisal revealed high-quality evidence overall. Twenty-four (24) best practice recommendations were synthesized into 6 domains: (1) Support System, (2) Staff Training, (3) Recipient Assessment, (4) Timing of Intervention, (5) Implementation Key Points, and (6) Outcome Evaluation. Provides an updated, evidence-based reference for clinical KMC implementation. Clinicians should adapt recommendations to local contexts. Future research should focus on high-quality primary studies and addressing evidence-practice gaps.
The clinical swallow examination, including palpation of hyo-laryngeal motion, is an important screening technique for dysphagia. However, this method lacks objectivity and precision, and it cannot reliably quantify hyoid movement velocity, which may be more closely associated with the risk of penetration and aspiration. This prospective observational study aimed to evaluate the predictive value of ultrasonographic hyoid motion parameters for identifying penetration, aspiration, and pharyngeal residue across International Dysphagia Diet Standardisation Initiative (IDDSI) food textures. Forty-seven adults with suspected oropharyngeal dysphagia underwent submental ultrasonography alongside either videofluoroscopic swallowing study or flexible endoscopic evaluation of swallowing. Six kinematic parameters, including hyoid displacement and velocity metrics, were measured and compared to instrumental swallowing outcomes. Penetration and aspiration were most prevalent with thin liquids (IDDSI Level 0, 57.4%). At this consistency, reduced maximal hyoid displacement was significantly associated with higher Penetration-Aspiration Scale scores (odds ratio [OR] = 0.75, p = .036). In contrast, in the present study, vallecular residue showed stronger associations with the velocity-based parameters examined. At IDDSI Level 2, lower average velocity of anterior hyoid bone excursion (HBE; OR = 0.18, p = .036) and lower average velocity of maximal HBE (OR = 0.24, p = .036) were associated with increased vallecular stasis severity. Similar associations were observed at Level 5, with area under the curve values up to .69. Pyriform sinus residue showed limited association with hyoid motion parameters. Receiver operating characteristic analysis and ordinal logistic regression demonstrated consistency-dependent associations between specific sonographic parameters and swallowing outcomes. Submental ultrasonography allows noninvasive quantification of hyoid motion during swallowing. Certain kinematic parameters demonstrated associations with airway invasion and vallecular residue at specific food consistencies. However, integration with complementary assessments remains essential for comprehensive evaluation. https://doi.org/10.23641/asha.32616798.
Recent research has increasingly focused on childhood apraxia of speech (CAS) in non-English-speaking populations, with Cantonese emerging as a significant language of study. This tutorial seeks to consolidate current knowledge regarding CAS in Cantonese speakers and proposes an assessment battery accompanied by observational criteria to support both clinical practice and research applications. The proposed assessment battery includes five tasks: the Hong Kong Cantonese Articulation Test, a connected speech sample derived from a story retelling task, the Cantonese Oral and Speech Motor Assessment, the Imitation of Polysyllables task, and the Tone Sequencing Task (Version 3.2). Diagnostic criteria incorporate five key features observed across these tasks, supported by quantitative thresholds, reference values, and cutoff scores drawn from prior research. A modified version of the Profile of Childhood Apraxia of Speech and Childhood Dysarthria, tailored for Cantonese speakers, is also included to differentiate CAS from childhood dysarthria. This tutorial offers a comprehensive overview of CAS in Cantonese speakers and provides an evidence-based assessment battery alongside diagnostic criteria to support both clinical and research applications.
Neurobrucellosis is a rare but serious complication of systemic Brucella infection, occurring in approximately 3-15% of cases and accounting for about 0.5% of all community-acquired central nervous system (CNS) infections. Although uncommon, it poses significant diagnostic challenges and carries the risk of long-term neurological sequelae. This review provides a comprehensive overview of the epidemiology, pathogenesis, clinical manifestations, diagnostic strategies, and management of neurobrucellosis, with an emphasis on current evidence and diagnostic difficulties. A thorough literature review was conducted, incorporating clinical studies, case series, and reviews addressing various aspects of neurobrucellosis. Neurobrucellosis can affect both the central and peripheral nervous systems. Central involvement includes meningitis, meningoencephalitis, cranial neuropathies-most commonly affecting the eighth cranial nerve-white matter lesions, vascular complications, and spinal cord syndromes such as arachnoiditis or transverse myelitis. Peripheral nervous system involvement, though less frequent, may present as polyradiculoneuropathies or mimic Guillain-Barré syndrome. Diagnosis is based on clinical suspicion supported by cerebrospinal fluid analysis, serologic testing, neuroimaging, and molecular methods such as PCR. MRI is the imaging modality of choice, although up to 60% of cases may show no abnormalities. Treatment typically consists of a prolonged combination antibiotic regimen tailored to disease severity and localization. Neurobrucellosis requires early recognition and prompt, appropriate antibiotic therapy to reduce the risk of permanent neurological damage. A high index of suspicion is essential, particularly in endemic regions or in patients with unexplained neurological symptoms and epidemiologic risk factors.
Parents and caregivers substantially contribute to youth emotional development. Emotion dysregulation is a significant, pervasive concern for youth with attention-deficit/hyperactivity disorder, with adolescence being a salient but understudied developmental period. Several parent-related factors have shown to independently predict youth Emotion dysregulation. However, it is unclear whether there are underlying patterns of co-occurring parent-related factors that relate to emotion dysregulation in adolescents. This study examined potential latent profiles of parent factors and whether parent profiles (1) differed among parents of adolescents are diagnosed with or without attention-deficit/hyperactivity disorder and (2) were associated with adolescent emotion dysregulation outcomes. The study sample included 266 adolescents (54.1% male; 81.6% White; 51.1% comprehensively diagnosed with attention-deficit/hyperactivity disorder). Three distinct parent profiles emerged: Low Internalizing/Emotion dysregulation and High Authoritative Parenting (62.5% of sample), Moderate Internalizing/Emotion dysregulation and Permissive Parenting (10.9% of sample), and High Internalizing/Emotion dysregulation and Moderate Authoritative Parenting (26.6% of sample). Results indicated that parents of adolescents with attention-deficit/hyperactivity disorder are more likely to be in the High Internalizing/Emotion dysregulation and Moderate Authoritative Parenting profile. Profiles characterized by authoritative parenting practices were generally associated with less emotion dysregulation, though no significant differences in self-reported adolescent emotion dysregulation were observed across profiles. These findings underscore the potential for parent psychopathology, emotion dysregulation, and parenting practices to serve as targets for interventions aimed at reducing emotion dysregulation, particularly in neurodiverse populations.