Musicians convey timing "feels" in groove-based performance by manipulating onset asynchrony between instruments and the durational ratio of metrical subdivisions (non-isochrony, or "swing"). The present study tested whether listeners perceive such fine-grained timing deviations by measuring the just-noticeable difference (JND) thresholds of asynchrony and swing in a naturalistic funk pattern featuring Guitar, Bass, and Drums (Kick, Snare, Hi-hat). Sixty-four participants (32 musicians, 32 non-musicians) completed a 1IFC staircase task with uniform onset displacements (asynchrony: ±1-100 ms; swing: +1-71.5 ms). Pupillary responses, an index of attentional allocation and sensory conflict, were recorded throughout. Results show that: (1) JND thresholds of asynchrony and swing are higher in realistic, multi-instrumental groove-based contexts than in previously reported non-/quasi-musical contexts; (2) instrument type strongly modulates sensitivity with percussive instruments yielding the lowest thresholds and stringed instruments the highest; (3) listeners exhibit a bias whereby late displacements require larger magnitudes for detection, suggesting asymmetric temporal prediction in auditory timing; (4) musical training enhances sensitivity globally but especially benefits the perception of less salient instruments; and (5) pupil responses track the absolute magnitude of microrhythmic expression related to swing as well as asynchrony, providing a physiological index of salience scaling with microrhythmic displacement.
Genetic information is essential for understanding evolutionary processes across different temporal scales, particularly those occurring over contemporary or recent generations influenced by management, and for guiding conservation actions. These components are now explicitly incorporated into the Kunming-Montreal Global Biodiversity Framework (GBF), which emphasizes metrics such as effective population size (Ne) as key indicators for monitoring and management. However, the genetic context of partially clonal and economically important systems remains insufficiently explored. Agave karwinskii, a mezcal-producing species with a restricted distribution in southern Mexico that occurs along a gradient of management intensity dominated by clonal propagation, provides an excellent model for informing conservation strategies in these understudied systems. We generated genomic data using RADseq and conducted population-level analyses following the framework proposed by Funk et al., (2012), integrating the species' biological and management context to understand its genetics patterns and delineate conservation units. We additionally evaluated GBF-relevant indicators to assess genetic diversity and support management planning. Agave karwinskii exhibited high genetic diversity (Hs = 0.25) and moderate population differentiation (FST = 0.19), shaped by geographical, ecological, and particularly by management factors. We identified 173 SNPs as candidate loci potentially associated with local adaptation to environmental variation, including 15 robust SNPs consistently detected by four complementary approaches and associated with defence responses, adaptation to environmental stressors, growth, and metabolic regulation. Two Evolutionarily Significant Units and seven Management Units were delineated. Ne declined sharply in clonal and semi-cultivated systems, with most units falling below the GBF threshold (Ne > 500), despite large census sizes. Traditional mixed management helps maintain diversity by promoting gene flow and reducing inbreeding, acting as a form of in situ conservation. This study provides a population genetic framework for understanding evolutionary processes influenced by management and guiding conservation strategies in A. karwinskii, offering insights applicable to other perennial, partially clonal, and semi-domesticated plant species.
The accurate identification of gametes, embryos, and patients is a fundamental requirement for the intended treatment in the context of assisted reproductive technology (ART). Embryo mix-ups are among the most serious errors in ART and are considered highly sensitive, which can impede error management and the identification of error sources. Here, we present five cases of embryo mix-ups that occurred at five different ART facilities. These reports highlight misidentification of patients and specimens as underlying factors in all five mix-up cases and emphasize the importance of facility-wide root cause analysis to improve process safety for patients and staff. Although human error was an important factor, the underlying conditions that make these critical errors possible must be identified to allow for effective risk mitigation. In all cases, a sequence of errors led to embryo mix-ups that could have been prevented by adherence to clear institutional guidelines and workflows regarding patient identification and verification of patient and sample identities prior to embryo transfer. It is important that operating guidelines are integrated into daily work routines and ART facilities have control systems in place to monitor critical steps and allow for the detection of error sources or faulty processes to prevent subsequent damage.
Multidisciplinary tumor boards integrate longitudinal treatment histories, molecular profiling and rapidly evolving evidence to guide decisions in hematological malignancies, yet access to this level of subspecialty deliberation is increasingly uneven. Here we develop HemaGuide, a locally deployable, modular large language model agent that converts unstructured clinical documents into structured case representations, autonomously routes cases to specialized decision modes ('guideline', 'advanced' and 'molecular') and grounds recommendations in disease-specific guideline flowcharts and a clinical decision memory of >2,000 real-world tumor board cases. In expert-blinded benchmarking on 45 high-complexity cases across six foundation models, HemaGuide substantially improved concordance with tumor board decisions. A systematic ablation study across 11 layers confirmed that performance gains were routing-type-dependent, with no single component sufficient across case types. Automated classification of 70 clinically relevant missense variants showed high concordance with expert standards; no oncogenic variant was downgraded to benign and the whole workflow was completed under real-time conditions on commodity hardware with a median latency of 39 s rather than the hours typically required for manual molecular board workflows. In a simulated practice study, agent-assisted resident physicians achieved near-senior concordance and partially outperformed senior physicians in their subspecialty. External validation on 555 independent cases from a second academic center yielded 81.8% concordance across 47 entities, and a prospective 1-month silent trial on 64 consecutive, unselected cases achieved 82.8% concordance. Hallucinations occurred in 2 of 664 evaluated cases (0.3%). Together these data provide evidence that locally deployable, case-grounded large language model agents can deliver auditable clinical decision support across hematological malignancies, with concordance maintained across institutions and under real-time conditions on commodity hardware.
This study examines the symptoms experienced by patients investigated for Acute Coronary Syndrome (ACS). It aims to determine whether symptom clusters exist, whether these predict acute myocardial infarction (AMI), and whether symptom patterns differ between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. This analysis of the LEGEND trial included 2185 patients (22.7% of whom identified as Aboriginal and Torres Strait Islander). Data on presenting symptoms and outcomes were collected from patient medical records. Regression analyses examined whether individual symptoms predicted AMI for Aboriginal and Torres Strait Islander and non-Indigenous patients. Factor analysis identified symptom clusters. Regression analyses estimated the associations between each symptom cluster and AMI. Six symptom clusters were identified: pleuritic, numbness, anginal, palpitations, epigastric, and infectious. Anginal was most strongly associated with AMI (Risk ratio [RR] = 1.46; 95% CI: 1.31-1.62), while pleuritic was linked to a reduced risk (RR = 0.47; 95% CI: 0.35-0.62). Numbness (RR = 1.29; 95% CI: 1.11-1.49) and infectious (RR = 1.21; 95% CI: 1.05-1.41) were associated with an increased AMI risk. There were individual symptoms that differed for Aboriginal and Torres Strait Islander patients. However, cluster-level predictive performance was similar across groups. No symptom cluster provided sufficient discriminatory power to rule in or rule out AMI. Symptom presentation in AMI is heterogeneous, and reliance on "classic" symptoms alone may miss at-risk patients. While some differences in individual symptom associations were observed for Aboriginal and Torres Strait Islander patients, overall cluster patterns were comparable.
The NLRP3 inflammasome contributes to a wide range of conditions from infections to Alzheimer's disease. NLRP3 forms an inactive decameric cage, that upon interaction with the trans-Golgi network (TGN) and microtubule organization center (MTOC), leads to inflammasome activation, yet whether non-decamer NLRP3 species form functional inflammasomes remains unclear. Here, we design a NLRP3 exon 3 deletion variant that forms low molecular weight NLRP3 assemblies. Spatially and dynamically highly resolved microscopy in THP-1 and human macrophages shows that nigericin, a K+-dependent NLRP3 stimulus, can trigger two distinct activation pathways: (i) the rapidly engaged decameric cage-dependent pathway; and (ii) a decameric cage-independent, TGN/MTOC-distal, and slow-reacting pathway employed by low molecular weight NLRP3 species, that dominates in human neutrophils. Collectively, our results delineate two parallel yet biologically distinct NLRP3 activation pathways, thereby providing a framework to understand NLRP3-driven inflammation across a wide range of pathological context and cell types.
The autoimmune hair loss disorder alopecia areata (AA), is characterized by immune privilege (IP) collapse of the hair follicle (HF) bulb resulting from a Th1-dependent inflammatory response. Although CD8+ T cells are recognized key drivers of the disease, it remains to be clarified whether the activation of HF resident T cells suffice to initiate IP loss and thus elicit the cascade of events leading to AA. Here, we utilized the human microdissected HF organ culture model to answer this question by activating intra- and peri-follicular HF resident T cells with αCD3/αCD28 antibodies. TCR stimulation indeed resulted in enhanced resident T cell proliferation, as indicated by significantly increased CD3+Ki-67+ cells, and higher intrafollicular CD3+ T cell numbers. Furthermore, αCD3/αCD28 stimulation promoted key signs of HF IP collapse, by increasing bulbar MHC class I and II expression and elevating MHC class II+ cells numbers. We next sought to investigate whether T cell proliferation plays a central role in the TCR activation-dependent collapse of the bulb IP. To test this, we co-administered the DHODH inhibitor farudodstat 1 day prior and during the stimulation with αCD3/αCD28 in HF organ culture. Short-term treatment with farudodstat reduced the increase in T cell proliferation and significantly decreased the upregulated MHC class I and II expression induced by TCR stimulation with αCD3/αCD28. Our results show that stimulation of HF resident T cells via TCR engagement induces an AA-like phenotype in healthy human HFs ex vivo, characterized by T cell proliferation and subsequent IP collapse. DHODH inhibition with farudodstat only partially reduces T cell numbers but prevented HF IP collapse induction.
This article reviews cardiotoxic syndromes in ruminants caused by various toxins, including ionophores, vitamin E/selenium deficiencies, gossypol, Taxus plants, cardiac glycosides, grayanotoxins, and others. It emphasizes that early recognition, thorough history, and diagnostic sampling are crucial for accurate diagnosis. Since no specific antidotes exist, prompt removal of the toxic source and environmental management are key to improving outcomes. Understanding clinical patterns and implementing herd-wide prevention strategies are vital for reducing morbidity, mortality, and long-term health impacts in affected animals.
A novel machine-learning-based flavor-tagging algorithm combining same-side and opposite-side tagging is used to obtain the equivalent of 27 500 tagged B_{s}^{0}→J/ψϕ(1020) decays from pp collisions at sqrt[s]=13  TeV, collected by the CMS experiment and corresponding to an integrated luminosity of 96.5  fb^{-1}. A time- and flavor-dependent angular analysis of the μ^{+}μ^{-}K^{+}K^{-} final state, consistent with a ϕ(1020)→K^{+}K^{-} decay, is used to measure parameters of the B_{s}^{0}-B[over ¯]_{s}^{0} system. The weak phase is measured to be ϕ_{s}=-73±22(stat)±10(syst)  mrad, which, combined with the sqrt[s]=8  TeV CMS result, gives ϕ_{s}=-75±23  mrad. This value differs from zero by 3.2 standard deviations, providing the first evidence for mixing-induced CP violation in B_{s}^{0}→J/ψϕ(1020) decays. All measured physics parameters are found to agree with standard model predictions where available.
Histophilosis is an important cause of morbidity and mortality as well as antimicrobial use in feedlot cattle across North America. Detection of Histophilus somni by culture is challenging, and there is no standardized tool for distinguishing isolates that carry virulence factors most likely to contribute to disease. The DR2 repeat of H. somni-associated virulence factor 'immunoglobulin-binding protein A' (ibpA DR2) harbors a Fic domain that mediates host cell cytotoxicity and is essential for histophilosis. For rapid detection of ibpA DR2 in extracted DNA, we developed a real-time recombinase polymerase amplification (RPA) assay with a runtime of 24 min at 39 °C. DNA from H. somni-RPA-positive respiratory swabs (n = 73) was screened for ibpA DR2 using the novel RPA assay and long-read metagenomic sequencing, as well as nanopore whole-genome sequencing (WGS) of H. somni isolated from the same samples. IbpA DR2 was identified in 71% and 70% of tested samples using RPA and WGS, respectively, and in ≤41% of samples using metagenomic sequencing. The likelihood of detection by RPA did not differ (OR 1.1, 95% CI (0.42, 2.9), P > 0.99) from WGS; however, agreement between these assays was only fair (κ = 0.31). Conversely, RPA (OR 3.4, 95% CI (1.6, 8.2)) and WGS (OR 8.0, 95% CI (2.4, 42)) were more likely (P < 0.001) to detect ibpA DR2 than metagenomic sequencing, likely reflecting limited coverage of H. somni by metagenomics. This study demonstrated that RPA and long-read WGS detected ibpA DR2 with similar frequencies in extracted DNA and H. somni isolates, respectively. Further testing of non-target isolates confirmed the analytical specificity of ibpA DR2 to H. somni. Further investigation of the diagnostic validity for RPA-based ibpA DR2 detection is required in a larger cohort of field samples, as a rapid screening tool for H. somni most likely to contribute to disease.
Respiratory rate data are of interest in marine mammals due to their reliance on living in a marine environment. Polar bears (Ursus maritimus), the most terrestrial of the marine mammals, are considered old bears, or geriatric, when they reach their twenties. Current accepted and utilized respiratory rate information on polar bears were studied on subadult and adult polar bears, with little to no information on geriatric bears. As marine mammals in managed care facilities are outliving their wild counterparts, there is now a population of geriatric animals that there is very little data on in regard to expectations for vitals. This study compared the resting respiratory rate of the geriatric polar bear at the Pittsburgh Zoo & Aquarium to a scale of respiratory rates between terrestrial and marine mammals in subadult and adult age classes. This study also classified any significant differences in respiratory rate between different activity levels the polar bear exhibits on a regular basis. Respiration rates were collected observationally, which was the most easily accessible, non-invasive, and easily repeatable method of collection. The average resting respiratory rate (24.7 ± 11.8 breaths per minute) of the polar bear was not significantly different than the expected values from the scale created with data from subadults and adults. The active respiratory rate was two times higher than the resting respiratory rate, which was statistically significant. There was also a significant difference in the respiratory rate between each behavior exhibited during the observation period. The behavior with the highest respiratory rate was standing (51.9 ± 9.9 breaths per min), which was over four times higher than the behavior with the lowest respiratory rate, sleeping. Sitting (38.3 ± 13.0 breaths per min) was 1.5 times higher than the respiratory rate of laying and 3 times higher than sleeping. The keeper and veterinary teams at the Pittsburgh Zoo & Aquarium will be able to use the analyses for comparing future respiratory rates, which will help to provide continued insight into the polar bear's heart health.
Polycythemia vera (PV) is a myeloproliferative neoplasm associated with an increased risk of thromboembolic and cardiovascular events. This retrospective real-world cohort study used Optum's Market Clarity electronic health records from over 105 million US patients between 2007 and 2019 to assess the rates of thromboembolic events (TEs) in patients with low-risk, event-based high-risk (ie, prior TEs at any age), or age-based (ie, age ≥ 60 years without prior TEs) high-risk PV. Requirements included ≥ 2 PV diagnoses in a ≥ 60-day span, with indexing at the first PV diagnosis after ≥ 1 year of data. Among 20,089 patients with new or established PV, 25.1% experienced ≥ 1 post-index TE. TE incidence was 50.2% (1634/3256) in the event-based high-risk group, 25.0% (2481/9924) in the age-based high-risk group, and 13.3% (991/6909) in the low-risk group. Overall, the most common arterial events were stroke (7.1%) and myocardial infarction/acute coronary syndrome (6.4%). Common venous events were deep vein thrombosis/deep thrombophlebitis (8.1%) and pulmonary embolism (4.5%). The strongest pre-index risk factors for TEs were a history of TEs, elevated white blood cells > 25,000/µL, and cytoreductive medication. Each 1% increase in a patient's median post-index hematocrit was associated with a 3% increase in the risk of a subsequent TE. Although patients with a prior history of TEs had the highest thrombotic risk, all groups were at risk of developing additional TEs, highlighting the need for improved therapies that reduce the risk of TEs and other cardiovascular events in patients with PV.
This study aimed to estimate the association between the risk of violence and dimensions related to social interactions, social support, and quality of life among participants in the EpiFloripa Aging longitudinal study. Interviews from the first (2009/2010; n = 1,702), second (2013/2014; n = 1,197), and third waves (2017/2019; n = 1,335) of the cohort of older adults (≥ 60 years) living in the urban area of Florianópolis, Santa Catarina State, Brazil, were analyzed. The risk of domestic violence, also characterized by the condition of vulnerability to violence, the outcome of this study, was assessed by the scale Hwalek-Sengstock Elder Abuse Screening Test, associated with the use of the internet, paid work, participation in social groups, social support (Social Support Scale of the Medical Outcomes Study) and quality of life (CASP-19 - Control, Autonomy, Self-realization and Pleasure). Associations were estimated using a longitudinal analysis model, Generalized Estimation Equations, adjusted for sex, age, education, and income. The prevalence of the outcome was 31.4% (95%CI: 27.8; 35.2) in the second wave and 22.3% (95%CI: 19.1; 25.9) in the third wave. There was a lower occurrence of violence among participants with paid work (OR = 0.67; 95%CI: 0.49; 0.91), participation in social groups (OR = 0.76; 95%CI: 0.63; 0.92) and high social support (OR = 0.44; 95%CI: 0.33; 0.59). Individuals with better quality of life showed lower vulnerability to violence, both in control/autonomy (OR = 0.30; 95%CI: 0.23; 0.38) and self-realization/pleasure (OR = 0.44; 95%CI: 0.34; 0.55). Greater social interactions, social support and better quality of life were associated with a lower occurrence of violence, contributing to the identification of relevant protective factors in aging. O objetivo deste estudo foi estimar a associação entre o risco de violência e dimensões relacionadas às interações sociais, ao apoio social e à qualidade de vida entre os participantes do estudo longitudinal EpiFloripa Idoso. Foram analisadas entrevistas das ondas 1 (2009/2010; n = 1.702), 2 (2013/2014; n = 1.197) e 3 (2017/2019; n = 1.335) da coorte de pessoas idosas (≥ 60 anos) residentes na área urbana de Florianópolis, Santa Catarina, Brasil. O risco de violência doméstica também caracterizado pela condição de vulnerabilidade à violência, desfecho deste estudo, foi avaliado pela escala Hwalek-Sengstock Elder Abuse Screening Test, associado ao uso de internet, trabalho remunerado, participação em grupos sociais, apoio social (Escala de Apoio Social do Medical Outcomes Study) e qualidade de vida (CASP-19 - Control, Autonomy, Self-realization and Pleasure). As associações foram estimadas por um modelo de análise longitudinal, equações de estimação generalizadas, ajustadas por sexo, idade, escolaridade e renda. A prevalência do desfecho foi de 31,4% (IC95%: 27,8; 35,2) na onda 2 e 22,3% (IC95%: 19,1; 25,9) na onda 3. Observou-se menor ocorrência do desfecho entre participantes com trabalho remunerado (OR = 0,67; IC95%: 0,49; 0,91), participação em grupos sociais (OR = 0,76; IC95%: 0,63; 0,92) e apoio social elevado (OR = 0,44; IC95%: 0,33; 0,59). Níveis superiores de qualidade de vida apresentaram menor vulnerabilidade à violência, tanto em controle/autonomia (OR = 0,30; IC95%: 0,23; 0,38) quanto em autorrealização/prazer (OR = 0,44; IC95%: 0,34; 0,55). Maiores interações sociais, apoio social e elevados níveis de qualidade de vida associaram-se a menor ocorrência de violência, contribuindo para a identificação de fatores protetores relevantes no envelhecimento. El objetivo de este estudio fue estimar la asociación entre el riesgo de violencia y las dimensiones relacionadas con las interacciones sociales, el apoyo social y la calidad de vida entre los participantes del estudio longitudinal EpiFloripa Idoso. Se analizaron entrevistas de las olas 1 (2009/2010; n = 1.702), 2 (2013/2014; n = 1.197) y 3 (2017/2019; n = 1.335) de la cohorte de adultos mayores (≥ 60 años) residentes en el área urbana de Florianópolis, Santa Catarina, Brasil. El riesgo de violencia doméstica caracterizado también por la condición de vulnerabilidad a la violencia, desenlace de este estudio, se evaluó según la escala Hwalek-Sengstock Elder Abuse Screening Test, asociado al uso de internet, trabajo remunerado, participación en grupos sociales, apoyo social (Escala de Apoyo Social, Medical Outcomes Study) y calidad de vida (CASP-19 − Control, Autonomy, Self-realization and Pleasure). Las asociaciones se estimaron utilizando un modelo de análisis longitudinal, ecuaciones de estimación generalizadas, ajustadas por sexo, edad, educación e ingresos. La prevalencia del desenlace fue del 31,4% (IC95%: 27,8; 35,2) y en la ola 2 fue del 22,3% (IC95%: 19,1; 25,9) en la ola 3. Se observó una menor incidencia del desenlace entre los participantes con trabajo remunerado (OR = 0,67; IC95%: 0,49; 0,91), participación en grupos sociales (OR = 0,76; IC95%: 0,63; 0,92) y alto apoyo social (OR = 0,44; IC95%: 0,33; 0,59). Los niveles más altos de calidad de vida se asociaron con una menor vulnerabilidad a la violencia, tanto en términos de control/autonomía (OR = 0,30; IC95%: 0,23; 0,38) así como en la autorrealización/placer (OR = 0,44; IC95%: 0,34; 0,55). Una mayor interacción social, apoyo social y niveles más altos de calidad de vida se asociaron con una menor incidencia de violencia, lo que contribuyó a la identificación de factores protectores relevantes en el envejecimiento.
Tau is an intrinsically disordered protein that functions to support cytoskeletal stability by binding microtubules in neuronal axons. While tau is involved in healthy neuronal function, it can become pathogenic by forming protein aggregates leading to neurologic diseases collectively known as tauopathies, which include Alzheimer's disease, frontotemporal dementia, and chronic traumatic encephalopathy. Post-translational modifications, including phosphorylation, glycosylation, acetylation, methylation, ubiquitination, and protein truncation are molecular drivers that promote tau aggregation and subsequent disease development. There is a growing, but incomplete, understanding of the complex crosstalk that occurs among distinct modifications and how they orchestrate tau pathogenesis in concert. The drivers of tau post-translational modifications are not fully understood, but environmental factors, such as traumatic brain injuries, microbial infections, alcohol abuse, chronic stress, and heavy metal pollutants, increase risk of tau pathology formation. In this article we review the current literature describing the molecular changes that increase tau aggregation propensity, the environmental factors that promote those changes, and the multifactorial crosstalk that modulates tau pathogenesis. Our goal is to outline the biological pathways and molecular factors that drive tau pathogenesis in order to identify potential points of behavioral and/or therapeutic intervention for tauopathies.
The purpose of this project was to evaluate a recently implemented postoperative dexmedetomidine infusion protocol for required prolonged bedrest in a pediatric cardiac catheterization laboratory post-anesthesia care unit (PACU). This project utilized program evaluation methodology, including a baseline needs assessment, clinician interviews, and retrospective cohort analysis. Following the formal protocol implementation in March 2024, we allowed a 6-month integration period before conducting a retrospective chart review of a 3-month convenience sample (October 1-December 31, 2024). Data collected included patient demographics, rebleeding incidence, agitation and pain scores, rescue medication use, and PACU length of stay (LOS). Eligible records included patients under 21 years of age who underwent cardiac catheterization with femoral access and recovered in the PACU. Exclusion criteria were non-cardiac catheterization procedures, non-femoral access, or direct admission to the intensive care unit (ICU). Additionally, a supplemental analysis of all rebleeding events from March 1, 2024 to March 30, 2025 was performed to better characterize these occurrences. SPSS v29.0 was used for descriptive statistics and significance testing, with α = 0.05. Sixty-five pediatric patients met inclusion criteria for the 3-month convenience sample, with a mean age of 6.1 years and mean weight of 25.4 kg. Most patients (89.2%) received general anesthesia, and 30 (46.1%) received the dexmedetomidine infusion protocol in the PACU. Within this 3-month cohort, the incidence of rebleeding was low (n = 2). Across the extended analysis period (March 1, 2024, to March 30, 2025), 13 patients experienced a rebleeding event; these patients had a higher mean age (9.7 years), and most (69.2%) did not receive a dexmedetomidine infusion. In the primary post-protocol sample, patients who did not receive dexmedetomidine infusions exhibited significantly higher agitation scores at multiple time points (p <.05). Pain scores were similar across groups at all measured intervals (p =.427 to.897). Rescue medication use was significantly higher among patients who did not receive the dexmedetomidine infusion (χ²(6, N = 65) = 34.94, p <.001). PACU LOS did not significantly differ between groups (p =.254). Implementation of a standardized dexmedetomidine infusion protocol in the pediatric catheterization laboratory PACU was associated with reduced postoperative agitation and decreased need for rescue medications, without prolonging PACU length of stay. A supplemental review of rebleeding events for the first full year of the protocol use suggested that older patients, often not receiving protocol-directed infusions, may remain at risk for agitation-related rebleeding events. These findings support dexmedetomidine infusions in PACU as an effective adjunct for promoting bedrest compliance and suggest that expanding protocol eligibility beyond children under 5 years of age may enhance its clinical benefit. Further research is warranted to optimize patient selection and confirm these findings in larger, more diverse populations.
Resident physicians should be integrated early into a broad spectrum of surgical procedures during postgraduate training. At the same time, medical standards must be maintained and patient safety ensured. This study investigates whether resident involvement in stereotactic brain biopsy affects perioperative performance and complications. This retrospective, two-center study compared 217 consecutive patients undergoing navigated frameless and frame-based stereotactic brain biopsies performed either by a supervised neurosurgery resident (teaching cases) or by a BCFN (non-teaching cases). The primary endpoint was the occurrence of a complication. Operation and anesthesia time as well as hospitalization length served as secondary endpoints. Categorical data were analyzed using Pearson's chi-square and Fisher test, and continuous data using the Mann-Whitney U Test. A total of 217 biopsies were stratified into n = 60 (27.6%) teaching cases and n = 157 (72.4%) non-teaching cases. Complication rates (asymptomatic hemorrhages) were comparable with 1/60 (1.7%) for resident-performed cases and 3/157 (1.9%) for BCFN cases. Mean operation time for navigated stereotactic biopsies was 38.1 ± 14.8 min for residents and 44.7 ± 22.6 min for BCFNs (p = 0.133). For frame-based biopsies, mean operation time performed by residents was 47.5 ± 32 min and 32.9 ± 9.9 min for BCFNs (p = 0.047). Anesthesia time for navigated biopsies was 119.2 ± 39.6 min for residents and 124.7 ± 27.9 min for BCFNs (p = 0.049). For frame-based biopsies, anesthesia time was 164.5 ± 98 min for residents and 111.8 ± 28.4 min for BCFNs (p < 0.01). Residents completed frameless biopsies faster than frame-based ones in terms of anesthesia time (p < 0.01) whereas BCFN were faster with frame-based procedures (operative time (p < 0.01) and anesthesia time (p < 0.01)). Mean hospitalization time was significantly longer in the BCFN group with 12.5 ± 15 vs. 7.52 ± 8.8 days (p = 0.015). There was no significant correlation between neurosurgical residents' year of training and the above parameters. The study supports the safety of supervised early surgical education for stereotactic brain biopsies. Residents require significantly more time for frame-based cases than BCFN, but complication rates remain comparable.
The vasculature of the pancreas and colon is highly variable and clinically relevant in pancreatic and colon surgeries. Although variant arterial branching between colonic and pancreatic arteries has been described, the variant in this study has not previously been reported. This study highlights variant arterial anatomy between the colon and pancreas to enhance anatomic knowledge for surgical planning. During a routine cadaveric dissection in our medical school anatomy laboratory, we identified an unusual branching pattern of the superior mesenteric artery (SMA) on a 72 y/o male donor. An unnamed artery originated from the posterior middle colic artery (MCA). This artery descended from its origin and bifurcated into an inferior branch and a transverse branch that crossed the SMA anteriorly. The transverse branch bifurcated into a small intestinal branch and a long ascending branch that supplied the head, uncinate process, body, and tail of the pancreas. This case represents a previously undescribed arterial branching pattern of the colon and pancreas. Knowledge of unique arterial variants benefits fields of anatomy and surgery and supports efforts to reduce operative complications in colorectal and pancreatic surgeries.
A hot and dense state of nuclear matter, known as the quark-gluon plasma, is created in collisions of ultrarelativistic heavy nuclei. Highly energetic quarks and gluons, collectively referred to as partons, lose energy as they travel through this matter, leading to suppressed production of particles with large transverse momenta (p_{T}). Conversely, high-p_{T} particle suppression has not been seen in proton-lead collisions, raising questions regarding the minimum system size required to observe parton energy loss. Oxygen-oxygen (OO) collisions examine a region of effective system size that lies between these two extreme cases. The CMS detector at the CERN LHC has been used to quantify charged-particle production in inclusive OO collisions for the first time via measurements of the nuclear modification factor (R_{AA}). The R_{AA} is derived by comparing particle production to expectations based on proton-proton (pp) data and has a value of unity in the absence of nuclear effects. The data for OO and pp collisions at a nucleon-nucleon center-of-mass energy sqrt[s_{NN}]=5.36  TeV correspond to integrated luminosities of 6.1  nb^{-1} and 1.02  pb^{-1}, respectively. The R_{AA} is below unity with a minimum of 0.69±0.04 around p_{T}=6  GeV. The data exhibit better agreement with theoretical models incorporating parton energy loss as compared to baseline models without energy loss.
In the field of toxicologic pathology, there are a number of working conventions that are generally understood and practiced by experienced pathologists, despite having received little formal discussion in the published literature. One of these involves the use of an absolute versus relative approach to the semi-quantitative severity scoring of non-neoplastic histopathological findings. Although severity scoring can be performed legitimately using either approach, they have different use-case scenarios, and inherent attributes that may affect the consistency of histopathology data within and among toxicological studies. As a rule, relative scoring is generally more expedient, as it tends to generate fewer diagnoses in both the treated animals and controls, while advantages of the absolute approach include superior objectivity, precision, transparency, and replicability. The purpose of this mini-review is to describe the absolute and relative scoring approaches and discuss potential ramifications that stem from the selection of one approach versus another.