The present study was designed to disentangle the contributions of Spanish-language similarity and Hispanic background in the selection of school friends. Participants were drawn from two cohorts that included 491 students (291 girls, 200 boys; 45.8% European American, 28.7% Hispanic American, 22.0% African American; 166 students reported speaking Spanish at home) attending public primary (third-fifth grade; range = 8-10 years old) and middle (sixth-seventh grade; range = 11-13 years old) schools in Florida. Students nominated friends from a roster of same-sex classmates. Self-reports of ethnicity and whether Spanish was spoken at home were collected from students. Logistic regression and multilevel analyses indicated that classmates were more likely to be nominated as friends when both the target and the nominator spoke Spanish at home, even after accounting for the contribution of shared Hispanic background. In contrast, after accounting for the contribution of shared Spanish language, targets were not more likely to be nominated as friends when both the target and nominator reported a Hispanic background. We conclude that although there is considerable overlap between those who speak Spanish at home and those who identify as having a Hispanic background, similarity on the former is the more important determinant of friend selection. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Although Erik H. Erikson himself and some scholars have acknowledged the significant contributions of his wife, Joan M. Erikson, to psychological theory, her specific role in shaping this framework has remained insufficiently examined. Drawing on an analysis of Joan's educational background, her shared life with Erik, and the affective and intellectual interdependence between them, this study suggests that Joan was not merely a supporter but a collaborator who was deeply involved in conceptual construction, structural refinement, textual revision, and the publication process of the theory. In particular, her involvement in discussions surrounding the concept of basic trust, the establishment of the "generativity" stage, and her systematic articulation of the ninth stage in later life represent important moments in the historical development of life cycle theory. This study further suggests that Joan's scholarly labor was not entirely invisible but rather was rendered partially visible and simultaneously marginalized within dominant academic narratives. Revisiting Joan's role in the construction and development of the theory helps restore the actual collaborative conditions of theoretical production rather than diminish Erik's scholarly achievements. This case highlights the value of attending to collaboration, intimacy, and the division of intellectual labor in accounts of knowledge production within psychoanalysis, developmental psychology, and the history of science. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Pleomorphic adenomas (PAs), the most common salivary gland tumors, are comprised of ductal epithelial and myoepithelial cells within a stromal background. A rare subset of PAs exhibits bizarre cells and 12q amplification involving HMGA2 and MDM2; in reported cases, bizarre cells have been confined to the myoepithelial component. We report the first case of a PA with bizarre-cytological features in both the ductal and myoepithelial components. A 75-year-old woman presented with a palatal mass. Histology revealed a well-circumscribed biphasic tumor with marked nuclear pleomorphism in both luminal ductal and non-luminal myoepithelial cells. Despite the alarming atypia, mitotic activity was low, and neither necrosis nor invasive growth was observed. Immunohistochemically, luminal bizarre cells exhibited ductal characteristics, whereas non-luminal bizarre cells exhibited myoepithelial characteristics. Tumor cells were negative for androgen receptor and HER2 and showed a p53 wild-type expression pattern. The Ki-67 labeling index was < 5%, and the bizarre cells rarely tested positive. Molecular analysis demonstrated amplification of HMGA2 and MDM2, whereas no other pathogenic variants related to salivary gland tumors were detected. Complete excision was performed; no evidence of recurrence or metastasis was observed after 10 months. Marked cytological atypia of bizarre cells in PA, even when involving ductal cells, may not necessarily indicate malignancy. This case highlights the value of integrating clinicopathological and genetic findings to better define PAs with bizarre cells and prevent overdiagnosis of carcinoma based on atypia alone.
Cues presented before (pre-cue) or after (retro-cue) a task-relevant stimulus (target) can improve visual working memory for the cued target. Griffin and Nobre (2003) found a differential cueing advantage depending on whether participants were required to detect a change in a target's color (identity recognition) or its location (spatial recognition). We investigated how interleaving identity- and spatial-recognition trials influenced the effectiveness of cueing. Participants completed a successive same-different procedure in which colored background pre- or retro-cues signaled whether to match a target based on its identity or location. When identity- and spatial-recognition trials were encountered in separate blocks and instructions were provided at the start of each block, cueing effects were not observed (Experiment 1). In Experiment 2, interleaving the same trials within blocks produced main effects of cueing and trial type, as well as an interaction. In Experiment 3, the trial-by-trial task requirement was consistent throughout each session (similar to Experiment 1), but the more discriminable difference (identity or spatial) was cued on each trial (similar to Experiment 2). Congruency effects, but no cueing effects, were observed. These experiments revealed several key factors that influence cueing effects. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Background in forensic toxicology, the detection of pharmacologically active exogenous substances is routinely performed. Interpretation of analyte concentrations must consider multiple variables, markedly affected by diffusion and degradation. These factors complicate toxicological assessment and have stimulated interest in alternative substrates. To assess the toxicological informativeness of cerebrospinal fluid (CSF) through comparison with standard post-mortem matrices, and to investigate whether quantitative relationships exist between CSF and femoral blood concentrations of cocaine and benzoylecgonine. CSF and standard toxicological matrices were collected from 10 forensic cases and three controls. All specimens underwent solid-phase extraction followed by HPLC-Orbitrap mass spectrometry for detection and quantification of cocaine, benzoylecgonine, and other relevant substances. Cocaine and benzoylecgonine were consistently detected in cerebrospinal fluid whenever present in standard matrices, indicating their passage across the blood-brain barrier and supporting CSF as a reliable alternative post-mortem matrix. However, the limited sample size and absence of temporal or clinical information precluded robust quantitative interpretation, highlighting the need for larger studies to clarify pharmacokinetic relationships. Cocaine and benzoylecgonine are detectable in cerebrospinal fluid when present in peripheral blood, but no stable proportional relationship allowing quantitative extrapolation from CSF to femoral blood could be established.
Hip and knee arthroplasty rank among the most frequently performed elective procedures in Germany. Against a background of rising quality requirements and ongoing health policy reform, structured quality assurance in arthroplasty is gaining increasing importance. To describe the concept, development and current challenges of the EndoCert certification system in the context of scientific and health policy developments. Narrative review based on published peer-reviewed literature, the EndoCert system manual, annual reports, health policy documents (KHVVG, KHAG), and internal data analyses provided by EndoCert GmbH. EndoCert is the world's first certification system for arthroplasty centers, available nationwide since October 2012. It integrates structural, process, and outcome quality within a standardized annual audit procedure and has established itself as the leading quality assurance instrument in German-speaking arthroplasty care, with more than 500 certified institutions. Over 5800 audits identifying more than 4300 deviations demonstrate the practical effectiveness of the certification process. Since 2026, joint-specific certification levels allow institutions to align their certification precisely with their respective scope of care. The current hospital reform (KHVVG/KHAG) conceptually confirms the core principles of EndoCert. Key challenges include the further development of risk adjustment models and the broader use of patient-reported outcomes. EndoCert has established itself as an adaptive quality assurance system that integrates structural requirements, standardized processes and data-driven outcome monitoring within a single certification framework. The ongoing hospital reform offers the opportunity to establish the standards implemented by EndoCert since 2012 as mandatory nationwide requirements. HINTERGRUND: Die Implantation von Hüft- und Knieendoprothesen gehört zu den häufigsten elektiven Eingriffen in Deutschland. Angesichts steigender Qualitätsanforderungen und gesundheitspolitischer Veränderungen gewinnt strukturierte Qualitätssicherung in der Endoprothetik zunehmend an Bedeutung. ZIEL: Darstellung von Konzept, Entwicklung und aktuellen Herausforderungen des EndoCert-Zertifizierungssystems vor dem Hintergrund wissenschaftlicher und gesundheitspolitischer Entwicklungen. Narrative Übersicht auf Basis publizierter Peer-reviewed-Literatur, des EndoCert-Systemhandbuchs, der Jahresberichte, gesundheitspolitischer Dokumente (KHVVG, KHAG) sowie interner Auswertungen der EndoCert GmbH. EndoCert ist das weltweit erste Zertifizierungssystem für Endoprothetikzentren und seit Oktober 2012 bundesweit verfügbar. Es verbindet Struktur‑, Prozess- und Ergebnisqualität in einem standardisierten, jährlichen Auditverfahren und hat sich mit über 500 zertifizierten Einrichtungen als führendes Qualitätssicherungsinstrument in der deutschsprachigen Endoprothetik etabliert. Mehr als 5800 Audits mit über 4300 identifizierten Abweichungen belegen die praktische Wirksamkeit des Verfahrens. Seit 2026 ermöglichen gelenkspezifische Zertifizierungsstufen eine weitere Differenzierung in Bezug auf den jeweiligen Versorgungsbereich. Die aktuelle Krankenhausreform (KHVVG/KHAG) bestätigt konzeptionell die Grundprinzipien von EndoCert. Zentrale Herausforderungen umfassen die Weiterentwicklung der Risikoadjustierung sowie die stärkere Nutzung patientenberichteter Endpunkte. EndoCert hat sich als lernendes Qualitätssicherungssystem etabliert, das strukturelle Mindestanforderungen, standardisierte Prozesse und datenbasierte Ergebnissteuerung in einem Auditverfahren vereint. Die laufende Krankenhausreform bietet die Chance, die von EndoCert seit 2012 umgesetzten Standards bundesweit regulatorisch zu verankern.
Military conflicts constitute an increasingly important yet still insufficiently quantified source of environmental contamination in agricultural ecosystems. This study investigated soils affected by missile strikes during the Russian aggression in Ukraine, with particular emphasis on heavy metal accumulation, radionuclide occurrence, and associated phytotoxic effects on wheat (Triticum aestivum L.). Geochemical analyses using X-ray fluorescence spectroscopy revealed pronounced enrichment of Pb, Zn, Cu, Cr, Ni, and Mn in crater soils, frequently exceeding local geochemical background levels and environmental guideline thresholds. Elevated activity concentrations of ^137Cs were additionally detected, indicating contamination associated with explosive materials and projectile components. Despite locally increased radionuclide levels, the calculated radiological indices demonstrated that the investigated soils do not currently pose a significant radiological hazard to human health. The contamination was accompanied by soil acidification, compaction, and degradation of physical structure, suggesting long-term disturbance of soil functioning in affected agricultural areas. Among the detected contaminants, Pb was consistently enriched in crater soils and was therefore selected as a representative model toxicant to investigate the biological mechanisms linking field-observed contamination to crop responses under controlled conditions. Hydroponic experiments demonstrated that Pb exposure induced a clear, dose-dependent inhibition of plant growth, biomass accumulation, and stress tolerance indices, whereas low Pb concentrations produced a slight hormetic response. Anatomical analyses of wheat roots revealed substantial structural reorganisation, including reduced stele and xylem development, enhanced cortical porosity, increased endodermal suberisation and lignification, and reduced vessel diameter, potentially limiting water and nutrient transport. Strong correlations between Pb concentration, anatomical modifications, and morphophysiological responses indicate that root structural disruption represents a major mechanism of toxicity. The results demonstrate that missile-derived contamination may significantly affect soil quality and crop performance even outside active combat zones. Furthermore, the study highlights the usefulness of root anatomical traits as sensitive biomarkers for early detection of military-induced soil stress and provides new insight into the combined, radiological and mechanistic biological approaches for assessing post-conflict agricultural environments.
Given the substantial disease burden of stomach adenocarcinoma (STAD)-the dominant and lethal subtype of gastric cancer-and the pivotal role of folate metabolism reprogramming in malignancy and treatment response, this study aimed to construct a prognostic model utilizing folate metabolism-related genes (FMRGs). Such a model is urgently required to supplement traditional TNM staging and to guide personalized precision medicine. Interrogation of TCGA and GEO transcriptomic profiles enabled the identification of differentially expressed FMRGs. These genes subsequently facilitated the construction of a prognostic signature via LASSO-Cox regression, which was then subjected to external validation. We further evaluated the clinical relevance of this risk signature by exploring its correlations with the tumor immune microenvironment, immunotherapy efficacy, and drug sensitivity, employing CIBERSORT and ssGSEA analytical frameworks. A five-gene prognostic model established from 220 FMRGs demonstrated moderate prognostic performance in identifying high-risk stomach adenocarcinoma patients with poorer survival. The high-risk group exhibited immunosuppressive microenvironments with stromal activation, while the low-risk group demonstrated "hot" tumor phenotypes characterized by higher immunogenicity and superior responses to immunotherapy and chemotherapy. Consequently, this model serves as a robust independent prognostic indicator. This five-gene folate metabolism signature shows moderate prognostic value in STAD and may help inform future investigations of the tumor immune microenvironment and therapeutic stratification.
Persistent olfactory dysfunction (OD) poses a significant clinical challenge with limited therapeutic options. Intranasal platelet-rich plasma (PRP), an autologous source of regenerative growth factors, presents a biologically plausible intervention, yet its efficacy across various OD etiologies remains synthetically underexplored. This systematic review and meta-analysis adhered to PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Web of Science, and Cochrane Library (2010-2025) identified studies assessing intranasal PRP for persistent OD (> 6 months). Random-effects models pooled standardized mean differences (SMD) for objective (e.g., Sniffin' Sticks TDI) and subjective outcomes. Seven studies (n = 473) were included. Meta-analysis of controlled studies (n = 314) demonstrated a moderate, significant improvement in objective olfactory scores favoring PRP over control (SMD 0.61, 95% CI 0.38-0.84). The pooled mean TDI change from baseline was 7.73 points (95% CI 6.59-8.87), exceeding the minimal clinically important difference of 5.5 points. Benefits were observed across post-COVID-19, post-viral, and post-traumatic etiologies. Adverse events were predominantly mild and transient (e.g., epistaxis). Intranasal PRP appears to be a generally well-tolerated and promising therapeutic strategy, yielding clinically meaningful improvements in persistent OD of diverse origins. However, the evidence remains preliminary and should be interpreted cautiously, as it is based on only two small RCTs plus non-randomized or single-arm studies. Future studies must optimize its protocol and evaluate its potential synergy with standard therapies like olfactory training.
The dislocation rate of primary hip arthroplasty has been reduced since the 1970s to rates of 0.7-8.8%. Dislocations after primary arthroplasty are only recorded in arthroplasty registries when implant components are exchanged. In the EndoCert® certification process, dislocations in the early postoperative phase up to 3 months are additionally assessed without mandatory follow-up. Is early dislocation a significant quality indicator in primary hip arthroplasty? In a joint database (EndoDok®), all dislocations after primary hip endoprostheses at two certified EndoProsthetics Centers of maximum care from various clinic providers were prospectively recorded over at least 3 months postoperatively using the available documents, including discharge, rehabilitation, outpatient, and physicians' reports. All patients who suffered a dislocation were analyzed in comparison to the control group without dislocation. Factors considered included gender, side, age, BMI, ASA, operation time, primary procedure, and prosthesis fixation. During the observation period of 9 years, elective primary total hip arthroplasty implantations were performed on a total of 3265 patients according to the same standards. The dislocation rate was low at 0.18% following elective hip arthroplasty. Risk factors such as increased BMI, prosthesis fixation, inclination angle, and operation duration were presented. The dislocation rate was not significantly influenced by training interventions. In the certification process, complications are consistently evaluated to improve processes. Under the quality-oriented conditions of the EndoCert® system, very low dislocation rates can be achieved in primary endoprosthetics. Even without follow-up examinations, consistent recording of dislocations allows for a comparable evaluation of provider quality and, in particular, provides the prerequisite for the mandatory complication analysis of all reported dislocations. HINTERGRUND: Die Luxationsrate der primären Hüftendoprothetik konnte seit den 1970er-Jahren reduziert werden auf Raten von 0,7–8,8 %. Luxationen nach Primärendoprothetik werden in Endoprothesenregistern nur bei Austausch von Implantatteilen erfasst. Im Zertifizierungsverfahren EndoCert® werden Luxationen in der frühen postoperativen Phase bis 3 Monate zusätzlich bewertet, ohne verpflichtende Nachuntersuchung. Ist die frühe Luxation ein wesentlicher Qualitätsindikator in der primären Hüftendoprothetik? In einer gemeinsamen Datenbank (EndoDok®) wurden retrospektiv alle Luxationen nach primärer Hüftendoprothese an zwei zertifizierten Endoprothetikzentren der Maximalversorgung verschiedener Klinikträger über mindestens 3 Monate postoperativ erfasst über die verfügbaren Dokumente, also Entlassungs‑, Reha‑, Ambulanz- und Arztberichte. Analysiert wurden alle Patienten, die eine Luxation erlitten im Vergleich zu der Kontrollgruppe ohne Luxation. Betrachtet wurden Faktoren wie Geschlecht, Seite, Alter, BMI (Body-Mass-Index), ASA (American Society of Anesthesiologists), Operationszeit, Ausbildungseingriff und Prothesenverankerung. In dem Beobachtungszeitraum von 9 Jahren wurden bei insgesamt 3265 Patientinnen und Patienten elektive primäre Hüfttotalendoprothesenimplantationen nach denselben Standards durchgeführt. Die Luxationsrate war mit 0,18 % nach elektiver Hüftendoprothese gering. Risikofaktoren, wie erhöhter BMI, Prothesenverankerung, Inklinationswinkel und Operationsdauer wurden dargestellt. Die Luxationsrate war nicht signifikant durch Ausbildungseingriffe beeinflusst. Im Zertifizierungsverfahren werden Komplikationen zur Verbesserung der Prozesse konsequent ausgewertet. Unter den qualitätsorientierten Bedingungen des EndoCert®-Systems können sehr niedrige Luxationsraten in der Primärendoprothetik erzielt werden. Auch ohne Nachuntersuchung ist bei konsequenter Erfassung der Luxationen eine vergleichbare Auswertung der Versorgerqualität und insbesondere die Voraussetzung zur verpflichtenden Komplikationsauswertung aller gemeldeten Luxationen gegeben.
Oropharyngeal dysphagia is common in Parkinson's disease, but it may remain clinically silent until complications occur. Bedside screening is widely used in routine care, although its diagnostic accuracy remains uncertain. Submental ultrasonography has emerged as a non-invasive adjunct for bedside assessment of swallowing-related structures and movement. In this retrospective cross-sectional study, institutional records of adults with Parkinson's disease assessed between October 2021 and June 2023 were analyzed. Bedside swallowing screening was performed with the Gugging Swallowing Screen. Submental ultrasonography was used to measure tongue thickness and hyoid-thyroid approximation during swallowing. Videofluoroscopic swallowing study served as the reference standard. Swallowing safety was classified as safe or unsafe according to the Penetration-Aspiration Scale, with unsafe swallowing defined as a score of 3-8. The primary outcome was the diagnostic performance of the Gugging Swallowing Screen for identifying unsafe swallowing on videofluoroscopic swallowing study. Thirty-nine participants were enrolled, and 36 completed videofluoroscopic swallowing study. A positive Gugging Swallowing Screen result was observed in 7 of 36 participants, corresponding to 19.4%, whereas unsafe swallowing on videofluoroscopic swallowing study was observed in 12 of 36 participants, corresponding to 33.3%. The Gugging Swallowing Screen showed moderate discriminative ability, with an area under the curve of 0.792. Sensitivity was 58.3%, specificity was 100%, overall accuracy was 86.1%, positive predictive value was 100%, and negative predictive value was 82.8%. Participants with unsafe swallowing had lower tongue thickness and shorter resting and minimum hyoid-thyroid distances. In Parkinson's disease, the Gugging Swallowing Screen may help prioritize referral for instrumental assessment, particularly when abnormal, but it cannot reliably exclude unsafe swallowing when used in isolation. Submental ultrasonographic measures differed between videofluoroscopy-defined swallowing-safety groups; however, their diagnostic utility, optimal cut-offs, and incremental value over the Gugging Swallowing Screen require prospective validation.
Metabolic acidosis is common after kidney transplantation and has been linked to adverse graft outcomes, but its potential contribution to functional decline has not been prospectively evaluated. We investigated whether persistent metabolic acidosis is associated with longitudinal frailty trajectories in kidney transplant recipients. In this prospective single-center cohort study, 239 adult kidney transplant recipients were followed for 24 months. Serum bicarbonate was measured at baseline, 6, 12, and 24 months, and acidosis persistence was defined by the number of visits with bicarbonate < 22 mmol/L (none, transient, recurrent, or persistent). Frailty was assessed using the Fried phenotype at baseline, 12 months, and 24 months. Longitudinal frailty trajectories were analyzed using mixed-effects ordinal logistic regression. Frailty prevalence at 24 months increased progressively with greater acidosis persistence, from 7.4% in patients without acidosis to 27.4% among those with persistent acidosis (p for trend = 0.004). In mixed-effects models, increasing acidosis persistence was associated with higher odds of worse frailty category (unadjusted proportional OR [pOR] per category 1.91, 95% CI 1.42-2.56). This association remained significant after adjustment for demographic, transplant-related, and clinical variables (pOR 1.52, 95% CI 1.12-2.06) and after additional adjustment for time-varying kidney function (pOR 1.42, 95% CI 1.04-1.95). Persistent acidosis was also associated with higher frailty scores in linear mixed models (β 0.31 per category increase, p < 0.001). Persistent metabolic acidosis was associated with worsening frailty trajectories after kidney transplantation, suggesting that persistent low bicarbonate may represent a clinically relevant marker of functional decline, although causality cannot be established.
Simulation-based training has demonstrated effectiveness in enhancing proficiency in interventional procedures. The endovascular treatment of peripheral arterial lesions has become a prominent minimally invasive therapeutic option. However, operators from various specialties, including Interventional Cardiology, Interventional Radiology, and Vascular Surgery, often follow diverging guideline recommendations and training pathways. Despite growing use of simulation in this field, the influence of an operator's specialty on learning outcomes remains poorly understood. This study aimed to evaluate the impact of simulation training on peripheral angioplasty performance scores across different interventional specialties and assess how specialty-specific factors influence skill acquisition. This quasi-experimental observational study will be conducted at the Simulation Center of the Faculty of Medicine of Sfax, Tunisia (trial registration: PACTR Trial ID 30697). Participants consist of 60 novice fellows from three specialties: Cardiology (n=20), Interventional Radiology (n=20), and Vascular Surgery (n=20). All participants will undergo identical simulation training using a high-fidelity Mentice simulator, comprising five standardized clinical scenarios addressing peripheral angioplasty of complex iliac and femoral lesions (TASC B-D). Each participant will receive a 4-hour hands-on training session with pre- and posttest assessments using a 25-item Global Score (10 knowledge items, 15 competence items). Primary outcomes consist of percentage change in performance scores from baseline to posttraining (threshold for clinical significance:≥25% improvement) and comparison across specialty groups using nonparametric statistics. Secondary outcomes consist of radiation protection parameters, including fluoroscopy duration, cumulative radiation dose, air kerma, and dose area product (KAP), measured by a simulator with real-time ALARA (As Low As Reasonably Achievable) feedback. Study enrollment started on September 15, 2024. As of December 2025, 42 fellows were screened, and 21 have been enrolled (15 Cardiology, 3 Radiology, 3 Vascular Surgery), representing 35% of the target sample (21/60). All 21 enrolled participants completed the full simulation training protocol, with radiation protection parameters recorded for all sessions. Enrollment and data collection are expected to be completed by June 2026, with full results anticipated for publication thereafter. This protocol describes the first comparative study evaluating the impact of high-fidelity simulation on peripheral angioplasty performance across three distinct specialties. Findings are anticipated to provide novel evidence regarding specialty-specific learning trajectories and may inform the development of standardized, specialty-tailored training pathways for complex peripheral interventions.
Limited data are available on long-term outcomes after percutaneous coronary intervention (PCI) of coronary drug-eluting stent (DES) in-stent restenosis (ISR) depending on clinical presentation with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Thus, the aim of this observational, retrospective study was to address this lack of evidence. Between January 2007 and February 2021, a total of 3,511 patients with 5,497 ISR lesions were treated at 2 large-volume centers in Munich, Germany, of which 1,029 (29.3%) were treated for ACS. Endpoints of interest were the rates of cardiac death, myocardial infarction (MI), repeat revascularization, and stent thrombosis (ST). Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed. After ten years, the rates of cardiac death were 42.5% in patients with ACS and 33.3% in patients with CCS (HR 1.63 [95% CI, 1.41-1.88], p < 0.001). 17.4% of ACS patients and 9.5% of CCS patients experienced MI (HR 2.04 [95% CI, 1.65-2.50], p < 0.001). The rates of ST were 3.6% in patients with ACS and 1.2% in patients with CCS (HR 3.18 [95% CI, 1.92-5.24], p < 0.001). The rates of repeat revascularization of target lesion, target vessel and non-target vessel did not differ significantly between both groups in the long-term. In the long-term, the rates of cardiac death, MI and ST after PCI of DES-ISR are significantly higher in ACS patients than in CCS patients.
Glucagon is a key regulator of amino acid metabolism, and elevated levels are frequently observed in maintenance hemodialysis (MHD) patients. Yet, the relationship between plasma glucagon levels, nutritional parameters, and prognosis in MHD patients remains unclear. We evaluated whether glucagon levels in MHD patients are associated with normalized protein catabolic rate (nPCR), glucagon-like peptide-1 (GLP-1), nutritional status, and all-cause mortality. In this prospective observational study, plasma hormone levels were measured alongside clinical, biochemical, anthropometric, bioimpedance-derived nutritional markers, and inflammatory indices. Mortality was assessed using Kaplan-Meier and Cox regression analyses. This study included 82 prevalent MHD patients. Patients were followed for 18.0 ± 4.9 months. Glucagon correlated positively with nPCR (r = 0.25, p = 0.03) and inversely with phase angle (PhA) (r =  - 0.24, p = 0.03) after adjustment. Additional correlations with GLP-1 became marginal after adjustment. The subgroup with high glucagon and low nPCR showed the lowest PhA (p = 0.03), and remained significant after multivariable adjustment. Patients with glucagon ≥ 120 pg/mL (ROC-derived cutoff) had higher mortality (log-rank p = 0.05); however, the discriminative power of this cutoff was limited (AUC 0.63). In multivariable models, the association persisted after adjustment for age and diabetes but was attenuated after further controlling for PhA, GLP-1, or MIS. Elevated glucagon in MHD patients was modestly associated with altered protein metabolism, impaired nutritional integrity, and borderline higher all-cause mortality. The independent prognostic value of glucagon remains uncertain, and a concept of a glucagon resistance phenotype is speculative.
Antimicrobial resistance (AMR) by Pseudomonas aeruginosa, within urinary tract and nosocomial infections, involves biofilm formation and quorum sensing (QS) constituting a major clinical challenge. The chemical composition of Pelargonium graveolens essential oil (EO) was determined by gas chromatography-mass spectrometry (GC-MS). Antibacterial activity of the EO and its major constituents, citronellol and geraniol, was evaluated against clinical and reference P. aeruginosa strains using disk diffusion and broth microdilution assays. Antibiofilm activity was assessed at concentrations ranging from 2×MIC to sub-MIC levels. Interference with quorum-sensing-associated phenotypes was investigated using Chromobacterium violaceum CV12472 and CV026 biosensor strains. Swarming and swimming motility assays were performed. Molecular docking and ADMET analyses were conducted to explore potential target interactions and pharmacokinetic properties. Citronellol (34.29%) and geraniol (18.62%) were the predominant constituents of the EO. Antibacterial activity yielded inhibition zones of 10-14 mm and MIC values ranging from 1% to 0.031% (v/v), with geraniol showing the lowest MIC (0.031%). The EO, citronellol, and geraniol inhibited biofilm formation, reaching 87.28% inhibition at 2×MIC while retaining activity at sub-MIC concentrations. All treatments reduced violacein production in C. violaceum biosensors and inhibited bacterial motility, with maximum reductions of 82.6% (swarming) and 74.3% (swimming). Geraniol generally exhibited the strongest activity. Docking analysis revealed binding affinities of - 6.08 and - 5.83 kcal/mol for citronellol and geraniol, respectively. P. graveolens EO, citronellol, and geraniol exhibited promising anti-virulence properties against multidrug-resistant uropathogenic P. aeruginosa, supporting their potential as complementary agents for controlling biofilm- and motility-associated infections.
The severity of chronic kidney disease (CKD) stage 5D complications increases with hemodialysis (HD) vintage, leading to elevated mortality risk. Calibrating the cumulative risk of HD patients against the baseline aging rate in the general population enables a quantitative assessment of dialysis-related accelerated aging. To develop the NephroAge framework for quantifying accelerated aging in patients on maintenance HD. The study included 5356 patients aged ≥ 40 years initiating first-time maintenance HD. Baseline hazard function was estimated using the Human Mortality Database life tables. Age-standardized expected survival was calculated using a plug-in estimator conditional on age at HD initiation. The cumulative incidence of death was estimated using the Aalen-Johansen estimator. For each patient, we calculated an equivalent age in the general population at which the cumulative hazard matched that observed on HD. NephroAge was defined as age at HD start plus HD vintage plus Δ, where Δ represents dialysis-attributable "added years" of aging. Added years showed a strongly nonlinear pattern with both HD vintage and age at initiation, reflecting the nonadditivity of their effects. Patients who started HD at very advanced ages (75-80 years) had NephroAge values close to or below their chronological age, consistent with strong survival selection in this highly resilient subgroup. NephroAge condenses age at HD initiation and treatment vintage into a single, interpretable metric of premature aging. Younger patients accumulate substantially more added years per year on HD than their older counterparts, highlighting pronounced "biological cost" of long-term dialysis in younger individuals.
Dorsal wrist ganglia are the most common benign soft tissue tumors of the wrist, often necessitating surgical intervention due to symptoms or esthetic concerns. Both open and arthroscopic techniques are established treatment options but comparative data on recurrence and functional outcomes remain limited. This retrospective cohort study evaluated patients who underwent dorsal wrist ganglion excision between 2017 and 2022. Standardized clinical and ultrasound follow-up was available for 19 patients and formed the basis of the outcome analysis. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) questionnaire, and Mayo Wrist Scores. Recurrence was determined clinically and via high-resolution ultrasound imaging. No significant differences were observed between groups regarding clinical recurrence rates or functional outcomes; however, ultrasound-detected recurrence was significantly more frequent in the open surgery group (89% vs. 30%, p = 0.0198), with patients in this group having 15.4-fold higher odds of subclinical recurrence. Functional scores DASH, PRWE, Mayo Wrist) were comparable between groups, indicating similar recovery in terms of pain and upper limb function. Arthroscopic and open excision yielded comparable clinical outcomes in this cohort. Ultrasound detected a higher frequency of recurrence, particularly after open excision. The clinical relevance of these findings requires confirmation in larger prospective studies.
Colonic interposition is the preferred option for alimentary tract reconstruction when a gastric conduit pull-up is not feasible. Aim of this study was to evaluate perioperative outcomes of patients undergoing colonic interposition for various indications in our tertiary-care center over a 15-year period. Following institutional board approval, all consecutive patients who underwent colonic interposition for esophageal replacement were identified from a prospectively maintained database. Comprehensive chart review and descriptive statistical analyses were performed. Ninety-three patients (62 men, 31 women, median age 65 years, IQR 55.5-72) underwent colonic interposition between January 2009 and December 2023. Benign disease was present in 17.2%, whereas malignancy accounted for 82.8%. A hand-sewn cervical anastomosis was performed in 96.8% of patients. The colonic graft, predominantly based on the left colic artery (89.2%) was routed through the posterior mediastinum in 51.6% and via the retrosternal route in 47.3%. Median operative time was 303 min (IQR 247.5-364). Major complications included anastomotic leakage (28%), anastomotic stenosis (30.1%), pleural empyema (11.8%), and postoperative bleeding (10.8%). The reoperation rate was 38.7%, with a median hospital stay of 29 days (IQR 20-63). In-hospital mortality was 18.3%. Colonic interposition after esophagectomy is associated with substantial morbidity and mortality, particularly in the salvage and secondary reconstruction setting, and should be confined to experienced, high-volume centers. FMS_D_007.23-I-1.
Pulmonary function tests (PFTs), particularly spirometry, are the reference standard for assessing airflow limitation in respiratory diseases such as chronic obstructive pulmonary disease (COPD) and interstitial pulmonary disease. However, spirometry requires substantial patient cooperation and may be unreliable in children, the elderly, and patients with cognitive impairment, and its use was further limited during the COVID-19 pandemic. Dynamic chest radiography (DCR), which captures sequential thoracic images during respiration at low radiation dose, has emerged as a promising modality for evaluating respiratory dynamics, but its potential to quantitatively estimate pulmonary function through radiomic analysis remains insufficiently explored. This study aimed to determine the potential of radiomic features of the lung on DCR to predict pulmonary function (FEV1, forced expiratory volume in the first second; FVC, forced vital capacity) and to classify patients at high risk (FEV1/FVC). We retrospectively analysed data from 151 patients. The DCRs at end-inspiration (EI), end-expiration (EE), and the respiratory phase of maximum variation in the lung area from EI to EE (insp2expvmax) or from EE to EI (exp2inspvmax) were defined based on the lung area. A respiratory motion map was also calculated. To combine the defined DCR and respiratory motion map, feature extraction was performed, followed by the least absolute shrinkage and selection operator (LASSO). Predictive regression and classification models with various radiomic feature combinations (nos. 1-6) were constructed for pulmonary function. Pearson's correlation coefficients (R) were calculated for FEV1 and FVC, and the area under the curve (AUC) was calculated for FEV1/FVC. Our predictive models were compared using the conventional formula. We constructed a predictive regression and classification model for FEV1, FVC, and FEV1/FVC ratio using DCR images and a respiratory motion map. The model accuracy with DCR at each respiratory phase and the respiratory motion map-based radiomic features was better than that of the conventional method. In this single-center retrospective study, radiomic features extracted from DCR at multiple respiratory phases combined with respiratory motion maps showed promise for estimating pulmonary function, outperforming conventional demographic-based prediction. External validation in multi-center cohorts is warranted before clinical translation.