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In December 2024, a clinical laboratory notified the New York City Health Department of three patients with fungal keratitis caused by an unidentified mold following laser eye surgery at an ophthalmology clinic. All three patients experienced vision loss, and one patient required corneal transplantation. Corneal cultures from two of the patients grew Purpureocillium lilacinum, an environmental mold that can cause a range of infections in humans; eye infections have been reported. The clinic paused surgeries. The health department assessed the clinic's infection prevention and control (IPC) practices and identified multiple deficiencies, including incomplete instrument sterilization logs, absence of disinfectants approved for use on work surfaces, use of expired topical ocular medications, and opportunities for exposure to nonsterile water from cool-mist humidifiers in the procedure room. CDC environmental infection control guidelines recommend avoidance of cool-mist humidifiers in health care facilities. All environmental cultures were negative for P. lilacinum, but fungal amplicon sequencing detected P. lilacinum DNA in the tubing of a surgical device. No further cases were identified after implementation of recommended IPC measures and resumption of surgeries during January 2025. Adherence to published IPC guidance during all procedures in ambulatory settings can reduce the risk for health care-associated infections.

Stress urinary incontinence (SUI) is a prevalent pelvic floor disorder with significant effects on women's quality of life. While surgical and non-surgical interventions exist, limitations underscore the need for alternative therapies. Injectable platelet-rich plasma (PRP) has emerged as a regenerative approach targeting tissue restoration. This study aimed to systematically evaluate the efficacy and safety of PRP injections for female SUI. This systematic review and meta-analysis adhered to the PRISMA guidelines. Comprehensive searches of PubMed, Scopus, and Cochrane Library up to April 2025 identified randomized controlled trials (RCTs) and quasi-experimental studies assessing PRP for SUI. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251118485). Eligible studies reported outcomes on symptom severity, urodynamic parameters, quality of life, or adverse events. Risk of bias was assessed using Cochrane RoB 2.0 for RCTs and the NHLBI tool for before-and-after studies. Pooled effect sizes were calculated using random- or fixed-effects models as appropriate. Eight studies (three RCTs and five quasi-experimental; n&#x202f;=&#x202f;257) were included. PRP significantly improved symptom severity, with pooled reductions in UDI-6 and ICIQ-SF scores at 1-3&#x202f;months. Urodynamic analysis revealed significant increases in abdominal leak point pressure (MD&#x202f;=&#x202f;51.07; 95% CI: 36.21-65.93; p&#x202f;<&#x202f;0.0001), while functional profile length remained unchanged. Quality-of-life scores (IIQ-7, ICIQ-SF) showed consistent improvement. Reported adverse events were mild and self-limiting, with no serious complications observed. Injectable PRP demonstrates promising short-term efficacy in reducing symptoms, improving urodynamic function, and enhancing quality of life in women with SUI, with a favorable safety profile. Larger, standardized RCTs with longer follow-up are needed to validate durability and define its role relative to established therapies. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251118485, CRD420251118485.

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We analyze decay phase observations of the GOES class C6.7 flare SOL2022-08-19T20:31 by the Visible Spectropolarimeter (ViSP) on the National Science Foundation's Daniel K. Inouye Solar Telescope (DKIST). The data include the first flare-time DKIST observations of the chromospheric Ca&#x2009;II&#xa0;H 396.8&#xa0;nm and H &#x3f5; 397.0&#xa0;nm spectral lines. These diagnostics have rarely been studied together during the modern era of high-resolution solar flare observations, and never at the spectral and spatial resolution of the DKIST. We directly compare DKIST spectra to state-of-the-art RADYN+RH simulations, including one heated by a nonthermal electron beam and one by in-situ thermal conduction. While certain salient properties of the spectra such as the width of H &#x3f5; are reproduced, the models severely underestimate the width of Ca II H in the red wing and fail to reproduce the exact relative intensity of Ca II H to H &#x3f5; . The models exhibit a range of chromospheric electron densities spanning over an order of magnitude. Unlike the modeled lower-order Balmer-series lines, we find that the width of H &#x3f5; is not solely related to the high-density upper chromosphere; the widths and intensities are also sensitive to the deeper flare layers. We outline possible avenues towards improvement of flare models, such as a comprehensive evaluation of flare heating mechanisms in the context of both impulsive and decay phase high-resolution data.

Understanding the mechanisms underlying the emergence and spread of high pathogenicity avian influenza virus (HPAIV) is critical for tracking its global dissemination, particularly via migratory seabirds, given their role in transmission over long distances. Scavenging seabirds, such as skuas, may act as both reservoirs and vectors, and have been linked to multiple outbreaks since 2021. Here, we report the detection of HPAIV H5N1 clade 2.3.4.4b in three Tristan skua (Stercorarius antarcticus hamiltoni) carcasses on Gough Island in the central South Atlantic Ocean. To investigate potential incursion routes, we combined genomic analyses with year-round tracking data from global location sensors. Although migratory movement patterns suggested southern Africa as the most obvious pathway, the strain detected on Gough Island was more closely related to that identified in South Georgia, indicating that infection may have occurred during the pre-laying exodus, when skuas disperse into frontal waters south of the island. No further cases have been confirmed for Gough, but more systematic monitoring is needed to understand the dynamics of virus infection. The detection of HPAIV H5N1 in skuas on Gough Island highlights the importance of continued vigilance, proactive and geographically inclusive surveillance strategies, and biosecurity measures globally, alongside efforts to reduce other pressures on globally important seabird populations to help strengthen their resilience.

Psychotic disorders are marked by heterogeneity in symptoms and treatment response, yet efforts to develop clinically useful predictive models through neuroimaging have been limited. Although MRI is gold standard for neuroimaging in psychosis, CT is frequently used in psychiatric care due to accessibility and cost. Advances in artificial intelligence, particularly deep learning, offer the potential for extracting meaningful information from CT brain scans. We conducted a systematic review of peer-reviewed studies applying machine learning, including deep learning to CT brain imaging in dementia or psychotic disorders. Six databases were searched from inception to Nov. 22, 2024. Studies were included if they involved deep or machine learning models using CT scans for diagnostic or prognostic modelling. Risk of bias was assessed using PROBAST&#x2009;+&#x2009;AI; reporting quality was evaluated with TRIPOD-AI or CLAIM. Seven studies met inclusion criteria: one related to psychosis and six to dementia. All studies included used deep learning models for classification or segmentation. Sample sizes ranged from 65 to 917. All predictive studies were rated as high risk of bias. TRIPOD-AI adherence was limited with most items poorly reported (16-21/27). Segmentation studies had low-to-moderate CLAIM adherence with limitations in external validation, code availability and reproducibility. Only one study to date has applied deep learning to CT imaging in psychosis. Research in dementia offers transferable insights. From a translational viewpoint, future work should prioritise the construction of large and well characterised psychosis cohorts including medical imaging, clinical and functional outcome prediction, external validation and transparent methodology to support clinical translation.

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Practice conditions that replicate performance environments can enhance motor learning. Dyad practice, where learners alternate between physical practice and observing a partner, offers a promising approach to music training by combining motor learning principles with collaborative strategies. This study examined whether dyad practice enhanced motor learning in novice marimba players compared to individual practice. Seventy-three university-trained musicians, who were na&#xef;ve to marimba playing, were assigned to one of three groups: individual practice, dyad-full (physical plus observation), or dyad-half (reduced physical plus observation). Participants completed acquisition, retention, and transfer tests using mallet endpoint error as the primary measure. Acquisition analysis revealed that only the dyad groups improved right-mallet accuracy, while the individual group showed no such gains. At retention, performance advantages were observed only in the dyad-full group, likely due to greater overall task exposure. Critically, both dyad groups outperformed the individual group on transfer, indicating superior generalization of motor skills. These findings extend dyad training principles to musical motor learning and highlight its potential to improve training efficiency and promote equity in music education by enabling shared resources and collaborative learning environments.

The human cerebellum is implicated in various neurological and psychiatric diseases, but its complex development and cellular diversity have posed challenges for in vitro modeling. Here, we report the generation of human induced pluripotent stem cell (iPSC)-derived cerebellar organoids (hCBOs) that are characterized by induction of rhombomere 1 (R1) cellular identity and followed by derivation of typical neuronal and glial cell types of the cerebellum. In contrast to forebrain organoids with multiple neural rosettes and inside-out neuronal migration, hCBOs develop a germinal zone on the outermost surface of the organoids with outside-in neuronal migration. These hCBOs produce various neuronal cell types resembling granule neurons, Purkinje cells, Golgi neurons, and deep cerebellar nuclei. By using a glial induction strategy, we generate Bergmann glial cells (BGCs) that serve as scaffolds for migratory granule cells and enhance electrophysiological activity of the hCBOs. Furthermore, by generating hCBOs from patients with Friedreich's ataxia (FRDA), we reveal disease-specific phenotypes that can be reversed by histone deacetylase (HDAC) inhibitors and gene editing by CRISPR-Cas9. Taken together, our advanced hCBO model provides new opportunities to investigate the mechanisms of cerebellar ontogenesis and utilize patient-derived iPSCs for translational research.

CD388 is an investigational antiviral drug-fragment crystallizable (Fc) conjugate comprising multiple copies of neuraminidase inhibitor stably conjugated to an Fc fragment of recombinant human IgG1 through a polyethylene glycol based linker. The neuraminidase inhibitor, a novel, dimeric presentation of zanamivir and linker (di-ZAN), is attached to multiple Fc lysine residues with an average drug-antibody ratio of 4.5. This study aimed to compare CD388 metabolism and excretion in humans, rats, and monkeys, the primary species used for nonclinical safety assessments. Incubation of CD388 with plasma or liver microsomes showed no change in CD388 concentrations, whereas in liver lysosomes, catabolism of the Fc fragment and subsequent release of metabolite 2 (di-ZAN), primarily still attached to lysine (metabolite 1: lysine + di-ZAN), was observed. No metabolites were detected in a microsomal metabolic stability experiment of di-ZAN. In people, after subcutaneous administration of up to 900 mg CD388, no circulating metabolites were detected except for trace levels of di-ZAN, 2 hours after dosing because of its presence in the dosing solution. The drug-antibody ratio of CD388 in human, rat, and monkey plasma remained unchanged, and no circulating metabolites were detected after a single CD388 dose was administered. Based on metabolite profiling in human urine and rat excreta, CD388 was primarily renally excreted as 2 metabolites, metabolite 1 and metabolite 2 with negligible excretion as unchanged drug. These results indicate that CD388 is stable in vivo making it suitable for long-acting influenza prevention with low metabolic drug-drug interaction potential. SIGNIFICANCE STATEMENT: CD388 showed excellent stability in vitro and in vivo. No decrease in plasma drug-antibody ratio over time indicates no loss of individual di-ZAN. After slow catabolism of the Fc portion of the molecule, the di-ZAN portions do not circulate and are renally excreted without further metabolism. Intact CD388 is not cleared renally, improving half-life and the potential for single CD388 administration to provide seasonal influenza protection. Additionally, the minimal metabolism of CD388 make the potential for metabolic drug interactions low.

Leadless pacemakers have been developed to reduce complications associated with transvenous systems; however, their impact on pacing-induced cardiomyopathy (PICM) remains uncertain. This study aimed to evaluate the prevalence of PICM following leadless pacing, compared PICM risk with transvenous pacing, and assessed cardiac resynchronization therapy (CRT) upgrade. This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, and ScienceDirect were searched up to January 2026. Studies reporting PICM following leadless pacing or comparing leadless and transvenous systems were included. Random-effects models estimated pooled prevalence and risk ratios (RRs), and meta-regression explored potential modifiers. Eight studies comprising 3224 patients with leadless pacing were included. The pooled prevalence of PICM following leadless pacing was 13% (95%CI: 4%-23%; I2 = 92%). In comparative analysis (5 studies; n = 6025), the risk of PICM was similar between leadless and transvenous pacing (RR 1.00; 95%CI: 0.77-1.29; I2 = 52%). Leadless pacing was associated with a lower observed rate of CRT upgrade (RR 0.56; 95%CI: 0.48-0.66; I2 = 42%), although this finding should be interpreted cautiously because it may reflect patient selection, procedural factors, and differing thresholds for CRT upgrade. Meta-regression identified baseline heart failure (HF) as a significant predictor of PICM (p < 0.0001). Leadless pacemakers demonstrate a non-inferior risk of PICM and similar safety profiles to transvenous systems, while a lower observed rate of CRT upgrade. Future studies should standardize PICM definitions and improve reporting of pacing burden, ventricular function, and patient-level outcomes.

Members of the Chlamydiaceae family infect a wide range of vertebrate hosts, yet their diversity and ecology in remote insular ecosystems remain poorly understood. Two previous studies screened 2274 samples from seabirds and mammals collected across five sub-Antarctic islands in the Southern Indian and Atlantic Oceans between 2017 and 2022. Here, we further characterise 424 Chlamydiaceae positive samples, including members of the Chlamydia and Chlamydiifrater genera. Chlamydiifrater spp. were detected in almost all seabird species, particularly king penguins (Aptenodytes patagonicus) and lesser sheathbills (Chionis minor), with local prevalence reaching up to 57% and 78%, respectively. In this study, phylogenetic analyses of 16S and 23S rRNA genes revealed a distinct sub-Antarctic lineage structured into three host-associated clusters, likely structured by ecological interactions and spatial segregation. Chlamydia psittaci was detected in a limited number of penguin and sheathbill samples, with ompA- and MLST-based typing revealed at least two novel genotypes. In mammals from Amsterdam Island, C. muridarum-related strains were identified in brown rats (Rattus norvegicus), while C. felis-related strains were detected in sub-Antarctic fur seals (Arctocephalus tropicalis). This is the first evidence of C. felis in a wild non-feline host, raising the issue of spillover from introduced species (here, cats (Felis catus)), to native species. These findings demonstrate that Chlamydiaceae are diverse and widespread in sub-Antarctic wildlife, encompassing both endemic and potentially introduced lineages. This emphasizes the need for ongoing surveillance, including whole-genome sequencing, to enhance our understanding of the interactions between hosts, infectious agents and the environment, and to assess potential zoonotic risks to fieldworkers in these sensitive ecosystems.

Oritavancin is a long-acting lipoglycopeptide with excellent bone penetration and activity against biofilm-embedded bacteria, making it a promising candidate for the treatment of bone and joint infections (BJIs). To explore its potential in this clinical context, we assessed the in vitro activity of oritavancin in comparison with other glyco-, lipo- and glycolipo-peptides against a panel of 148 multidrug-resistant staphylococcal clinical isolates, mainly collected from BJI cases. Although oritavancin showed lower overall activity than dalbavancin, resistance to oritavancin could not be reliably inferred from the activity of related antibiotics. This lack of cross-resistance highlights the need for dedicated phenotypic susceptibility testing prior to clinical use.

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Worldwide radiologists are facing a high administrative workload. ICD-10 coding is mandatory for reimbursement in many health systems and a frequent source of billing errors. Large language models have shown promise in supporting coding related tasks, but previous studies with earlier ChatGPT versions reported mixed results and evidence specific to radiology reports remains scarce. We therefore aimed to investigate whether ChatGPT-5 can be consulted when assigning ICD-10 codes to radiology reports and whether this leads to a measurable time advantage. 2,738 fictious radiology reports across multiple modalities were derived from the PARROT database. Additionally, 100 fictitious PET/CT reports were created. Each report was assigned a single, most relevant ICD-10 code using ChatGPT-5. For PARROT, ChatGPT-derived codes were compared with predefined database reference labels. For PET/CT, ChatGPT-derived codes were compared with codes assigned by an independent manual coder. Exact and character-level concordance were assessed. In cases of discordance, a blinded adjudicator selected the most accurate ICD-10 code. Coding efficiency was evaluated for PET/CT reports by measuring coding time per report. For PARROT, exact-code concordance was 1,590/2,738 (58.1&#xa0;%). In a random subset of 200 mismatches, blinded adjudication preferred the ChatGPT derived code in 123 and the reference label in 77 cases (p&#xa0;=&#xa0;0.0015). Coding non-English reports resulted in significantly lower concordance (first character: p&#xa0;=&#xa0;0.002; second/third characters: p&#xa0;<&#xa0;0.001; last characters: p&#xa0;=&#xa0;0.012) and longer coding times than English reports (p&#xa0;=&#xa0;0.002). Regarding PET/CT reports, median coding time was 8&#xa0;s with ChatGPT and 135&#xa0;s without. The median time saved was 127&#xa0;s per report. Applied to daily clinical care, higher code correctness might reduce billing errors, while saved time could be reallocated to patient care. Radiologists should collaborate with developers to create versions of LLMs that operate within data-secure environments.

The preoperative planning of adolescent idiopathic scoliosis (AIS) remains largely debated. We hypothesized that adopting a biomechanical energetic framework could provide valuable insights for exploring the impact of spinal arthrodesis. Using this approach, we conducted a comparative analysis to quantify discrepancies between in silico simulations derived from preoperative radiographs and the actual three-dimensional spinal alignment obtained from post-operative imaging. Fifty-two consecutive patients with Lenke Type 1 AIS (mean age: 16 years; mean thoracic Cobb angle: 52&#xb0;) who underwent posterior spinal fusion were included in the analysis. All patients had complete biplanar radiographs at three time points: preoperatively, post-operatively and at two-year follow-up. Discrepancies between in silico simulated surgery, calculated using preoperative radiographs and a biomechanical model, and actual clinical outcomes were quantified using two metrics: maximum coronal/sagittal deviations (MaxC/MaxS) from T1 to L5, and a comprehensive predictability factor ( a c and a s ) measuring cumulative 3D position discrepancies across 17 vertebral levels, normalized by total spinal length. Mean MaxC was 4.7 mm (SD=4.9) and MaxS was 5.7 mm (SD=3.8). Mean values of a c were 3.4% (SD=3.8) and a s were 4.1% (SD=2.6). Of the cohort, 44 patients (90%) showed very good or good agreement in the coronal in silico simulation and 43 patients (88%) in the sagittal in silico simulation. When the coronal and sagittal results were combined, 38 patients (78%) showed very good or good agreement. The distribution of biomechanical energy obtained from preoperative radiographs is reliable to simulate spine alignment after arthrodesis in a Lenke 1 AIS cohort.

Ferritins are ubiquitous among life forms, as they are essential for iron homeostasis. Here, we unveiled a novel member of the ferritin family, baptised mini-bacterioferritin. The characterised mini-bacterioferritin was isolated from a microbial enrichment dominated by the methanotrophic archaeon 'Candidatus Methanoperedens carboxydivorans'. Its atomic resolution crystal structure reveals a 12-mer assembly with a diiron ferroxidase centre located within a four-helix bundle. Redox-cycling experiments on protein crystals reveal a shift in iron position at the active site, which follows the established ferritin catalytic cycle. The 12-mer sphere-like structure harboured six Fe-coproporphyrin III ligands, positioned at the interdimeric interface, a characteristic previously only found in 24-mer bacterioferritins. Phylogenetics, together with structure predictions of closely related proteins, revealed that mini-bacterioferritins form a distinct clade within the ferritin family that might conserve ancestral traits. Future research will need to investigate the physiological roles of these enzymes, which were unsuspectingly widely distributed among prokaryotes.

Pseudocapacitive materials store electrochemical energy through fast and reversible surface charge transfer reactions. Titanium carbide MXenes are two-dimensional materials which have shown redox or intercalation pseudocapacitive properties depending on the electrolyte. Nevertheless, the intrinsic pseudocapacitive charging mechanism in individual MXene flakes remains unresolved. Here, we employ in situ scanning transmission X-ray microscopy (STXM) to map the local chemical changes in individual Ti3C2Tx MXene flakes during spontaneous and electrochemical intercalation of protons and lithium ions in aqueous electrolytes. Our investigations reveal that proton and lithium-ion intercalation induces a reduction and an oxidation, respectively, of the titanium atoms in the MXene. This difference reveals a profoundly different chemical origin between redox and intercalation pseudocapacitive processes. By elucidating the interplay between ion hydration, MXene surface chemistry and flake morphology, our study highlights the relevance of chemical imaging in single entities for the fundamental understanding of electrochemical charge storage mechanisms.

Pulmonary hypertension (PH) is one of the unfavorable clinical turning points in the natural history of heart failure with preserved ejection fraction (HFpEF). However, as it is identified as an independent predictor of worse prognosis, its true prevalence is uncertain. This review aims to investigate the pooled prevalence, associated risk factors, and characteristics of patients with PH-HFpEF. Systematic searches of 3 databases (PubMed, ScienceDirect, and Scopus) with citation searching were conducted. Studies conducting direct surveillance using echocardiography or catheterization for estimating the prevalence of PH-HFpEF patients (left ventricular ejection fraction &#x2265;50%) were included. The Newcastle-Ottawa scale was used for quality assessment. RStudio was used for statistical analysis. This review comprises 11 studies (n = 1838 patients) that met the eligibility criteria. The pooled prevalence of PH-HFpEF was 0.63 (95% CI, 0.52-0.74). This value was robust based on leave-one-out and cumulative sample sensitivity analysis. Meta-regression revealed a significant relationship between PH prevalence and several associated factors, including history of coronary artery disease (&#x3b2; = 0.50; P < 0.0001), baseline female sex (&#x3b2; = 0.49; P < 0.0001), hypertension (&#x3b2; = 0.49; P < 0.0001), and diabetes (&#x3b2; = 0.46; P < 0.0001). Meta-analyses of echocardiography characteristics revealed that patients with PH-HFpEF have significantly worse diastolic function and more advanced left atrial remodeling compared to those without PH. In conclusion, PH was present in over half of HFpEF patients at baseline, with a history of coronary artery disease, female sex, hypertension, and diabetes significantly associated with greater susceptibility, emphasizing risk-based screening across these HFpEF phenotypes.