Bacillus species are prolific producers of biosurfactants with promising environmentally sustainable applications. In this study, biosurfactant production by the wheat endophytic Bacillus sp. WL2-23, isolated in a previous study, was optimized using a Taguchi orthogonal array design. Eighteen media formulations were evaluated by varying carbon and nitrogen sources, pH, and temperature. The optimal medium (glycerol and peptone at pH 8 and 30 °C, 120 rpm) yielded maximum biosurfactant production utilizing a 2% (v/v) inoculum. The crude biosurfactant exhibited high emulsification indices (> 80%) against various hydrocarbons (toluene, hexane, kerosene, and petrol) and demonstrated the highest oil displacement activity. Furthermore, the biosurfactant maintained stability across broad pH (4–9) and temperature (4–100 °C) ranges, although activity declined under saline conditions, completely disappearing at 7% NaCl. Preliminary structural characterization using Thin Layer Chromatography (TLC) and Fourier Transform Infrared Spectroscopy (FTIR) suggested the presence of lipid and peptide moieties, indicating a lipopeptide-like nature. Additionally, Bacillus sp. WL2-23 exhibited substantial growth in medium containing diesel as the sole carbon source. Supplementation with its partially purified biosurfactant (30 µg mL⁻¹) significantly enhanced this bacterial growth. The results highlight the robust biosurfactant-producing potential of the wheat endophyte Bacillus sp. WL2-23 and suggest its potential utility in supporting microbial growth in hydrocarbon-contaminated environments.
Accuracy and duration of ocular pursuit of a target object have been linked to interceptive performance. Yet, previous assessments have not examined this relationship in the context of fatigue. We assessed the relationship between ocular pursuit and interceptive performance under peripheral and central + peripheral fatigue conditions. We determined ventilatory thresholds in n = 17 soccer experts using a ramp incremental protocol to individually tailor 45 minutes of cycling in the heavy exercise domain. Throughout the central + peripheral fatigue exercise, participants completed a modified Stroop task, known to induce subjective central fatigue and task performance decrements after 45 minutes. We used mobile eye-tracking to measure ocular pursuit accuracy and duration, and two external cameras to determine 3D positions of the ball and foot during an interceptive soccer task before and after exercise using deep learning algorithms. Using linear mixed models, we found a positive relationship between ocular pursuit accuracy and interceptive performance on a trial-by-trial basis before exercise. This relationship disappeared following exercise, suggesting a fatigue-driven change in gaze strategy. Despite this change in the gaze-performance relationship, interceptive performance on the soccer-specific task was maintained after exercise irrespective of addition in exercise cognitive demands.
To evaluate the clinical efficacy of probing with or without bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children at least 3 years of age and to identify factors influencing surgical success. The medical records of children treated between 2014 and 2024 at Health Sciences University Beyoğlu Eye Training and Research Hospital were reviewed retrospectively. All patients underwent probing with or without bicanalicular silicone intubation (BCI) using the square knot technique. Surgical success was defined as resolution of symptoms and a normal fluorescein dye disappearance test. A total of 95 children (116 eyes) were included. Mean patient age was 4.57 ± 1.98 years (range, 3-14). Mean follow-up was 15.5 ± 15.4 months. BCI was performed initially in 102 eyes. Mean tube retention was 66.8 ± 43.0 days. Overall success was 87%, increasing to 95% after reprobing and BCI in failed cases. Age, sex, obstruction type, canalicular stenosis, Rosenmüller's valve hypertrophy, and inferior turbinate infracture were not significantly associated with success (P > 0.05). Tube retention for 45-90 days was significantly associated with higher success compared with retention <45 days (P = 0.013; OR = 12.75; 95% CI, 1.72-94.48). In our study cohort of children undergoing surgery for CNLDO at 3 years of age and older, probing and BCI achieved high success, especially if the tube was successfully retained for at least 45 days. Reintubation in failed cases can improve outcomes.
Discrete choice experiments (DCEs) are widely used in healthcare to estimate willingness-to-pay (WTP) but may be affected by hypothetical bias (HB), especially in morally sensitive contexts. While cheap-talk is proposed as a mitigation strategy, its effectiveness in health-related DCEs involving moral trade-offs remains unclear. This study examines how cheap-talk influences WTP in such settings. A split-sample DCE on organ transplantation policies was conducted, involving trade-offs between cost and morally salient outcomes: saving lives ("being alive") and improving quality of life ("having a life"). Respondents (N = 651) were randomly assigned to one of three survey arms: control (no manipulation), cheap-talk, or cheap-talk with follow-up question. Multinomial logit model in WTP space with a Taboo Trade-off Aversion (TTOA) specification was used to estimate treatment effects and interactions with religiosity. Exposure to the cheap-talk script reduced WTP for saving lives, indicating increased attention to financial considerations. WTP for quality-of-life improvements and avoiding taboo trade-offs remained unchanged. Religious respondents reported higher WTP to avoid taboo trade-offs in the control arm, but this gap disappeared under cheap-talk, showing that deliberation moderates monetary expressions among religious individuals without altering underlying convictions. Cheap-talk promotes more reflective decision-making in morally sensitive health-related choices, particularly among individuals with strong moral or religious convictions. It reduces elevated WTP for taboo trade-offs, while its effect on other respondents is limited. Future research should combine stated and revealed preference data and explore models that account for non-compensatory moral decision rules to better capture complex moral preferences DCEs.
The development of sustainable polymers from renewable resources has attracted growing attention as an alternative to petroleum-based monomers. In this study, a renewable methacrylate monomer derived from protected d-glucose (MA-IPT-GF) was synthesized and copolymerized with methyl methacrylate (MMA) via UV-induced radical photopolymerization using benzophenone as the photoinitiator. The monomer structure was confirmed by FT-IR and NMR spectroscopy, verifying the successful introduction of the methacrylate functionality into the glucofuranose framework. Photopolymerization of MA-IPT-GF with MMA produced GF-MMA copolymers, which were characterized in terms of their structural, thermal, and morphological properties. Spectroscopic analyses revealed the disappearance of the methacrylate vinyl signals after polymerization, confirming effective copolymer formation. Thermal analysis by TG/DTG and DSC demonstrated that incorporation of the glucofuranose-derived monomer slightly reduced the onset thermal stability compared with PMMA and introduced a multistep degradation profile associated with cleavage of protecting groups and subsequent backbone decomposition. A decrease in glass transition temperature was observed, which was attributed to the presence of bulky carbohydrate side groups that disrupt efficient chain packing and increase free volume within the polymer matrix. SEM analysis revealed heterogeneous surface morphology with dispersed domains within a PMMA-rich matrix, while EDX analysis confirmed the presence of chlorine-containing protecting groups in the copolymer structure. XRD results further indicated that the copolymer maintains a predominantly amorphous structure with increased structural disorder due to the incorporation of the sugar-based monomer. Overall, the results demonstrate that glucose-derived methacrylate monomers can be incorporated into MMA-based copolymers through photopolymerization, providing renewable photocurable polymer systems.
Accessory cavitated uterine malformation (ACUM) is a congenital Müllerian duct developmental anomaly. Clinically, it is commonly observed in young women presenting with progressive lower abdominal pain. Due to the small size of the lesions and insufficient awareness of this condition among clinicians, the rates of missed diagnosis and misdiagnosis are relatively high, often leading to delayed treatment. This study aims to explore the clinical characteristics, diagnostic and therapeutic approaches, and prognosis of ACUM, summarize relevant clinical experience, and provide references for clinical diagnosis and management. A retrospective analysis was conducted on the clinical data of 16 patients with ACUM who were admitted to the Department of Gynecology, the Third Xiangya Hospital of Central South University from May 2023 to November 2025. The collected data included age, clinical manifestations, medical history, menstrual and reproductive history, tumor markers, imaging findings, treatment methods, pathological results, and prognosis. The Kappa test was used to evaluate the diagnostic consistency between two auxiliary imaging modalities. The age at diagnosis ranged from 23 to 53 years [(32.00±7.56) years], and the disease duration ranged from 5 months to 12 years. All 16 patients presented with lower abdominal pain, including left lower abdominal pain in 6 cases, right lower abdominal pain in 3 cases, and ipsilateral pelvic pain in 2 cases. Dysmenorrhea occurred in 10 patients, pain initially associated with menstruation that later became non-menstrual pain occurred in 1 patient, and non-menstrual pain occurred in 5 patients. All 16 patients underwent gynecologic color Doppler ultrasonography. Lesions were located within the myometrium beneath the uterine cornual region of the left anterior uterine wall in 12 cases and the right anterior uterine wall in 4 cases. The nodules showed hypoechoic signals in 4 cases and mixed echogenicity in 12 cases. Clear boundaries were observed in 13 cases, while indistinct boundaries were observed in 3 cases. The maximum diameter of the nodules ranged from 17 to 38 mm [(28.31±6.04) mm] and the maximum diameter of the anechoic area within the cyst ranged from 5 to 29 mm [(18.63±6.77) mm]. Endometrium-like echoes within the cyst wall were detected in 12 cases. All 16 patients underwent pelvic magnetic resonance imaging (MRI) with plain and contrast-enhanced scans. The nodular lesions showed short T1 and long T2 signals in 7 cases, slightly shorter T2 signals with equal T1 values in 5 cases, equal T1 and T2 signals in 1 case, long T1 and short T2 signals in 2 cases, and long T1 and long T2 signals in 1 case. Among them, short T1 and long T2 signals were indicated within the nodules in 7 cases. The diagnostic coincidence rate for ACUM was 81.25% with gynecological ultrasonography and 56.25% with pelvic MRI. The agreement between the 2 diagnostic modalities was weak (Kappa=0.186, P=0.375). A total of 13 patients underwent cancer antigen 125 (CA125) testing, with values ranging from 12.90 to 91.80 U/mL. Among them, 10 cases had CA125≤35 U/mL and 3 cases had CA125> 35 U/mL. A total of 15 patients underwent laparoscopic resection of uterine lesions (including hysteroscopy in 6 cases), while 1 patient underwent laparoscopic total hysterectomy with bilateral salpingectomy due to advanced age and no reproductive requirement. Based on pathological examination combined with clinical and imaging findings, all 16 patients were diagnosed with ACUM, including 3 cases suspected of concomitant focal adenomyosis. The postoperative follow-up duration ranged from 2 to 28 months [(13.50±8.12) months]. Postoperative pain symptoms disappeared in 15 patients and were significantly relieved in 1 patient. 1 patient achieved full-term vaginal delivery after surgery. ACUM is a special type of obstructive disease that can easily be confused with cystic adenomyosis or cystic degeneration of uterine fibroids. When young women present with progressive lower abdominal pain, especially unilateral pain accompanied by referred pelvic pain, ACUM should be highly suspected. Three-dimensional gynecological ultrasonography and pelvic MRI are recommended for auxiliary diagnosis. Laparoscopic resection of uterine lesions is the preferred treatment for radical management of this condition, and hysteroscopy may be performed when necessary for differential diagnosis. 目的: 子宫附腔畸形(accessory cavitated uterine malformation，ACUM)是一种先天性苗勒管发育异常，临床上多见于年轻女性，常发生进行性下腹痛，由于病灶较小、医师对此类疾病缺乏充分的认识，漏诊及误诊率高，常导致治疗延误。本研究旨在探讨子宫附腔畸形的临床特征、诊治方式及预后情况，总结相关经验，为临床诊治提供更多参考依据。方法: 回顾性分析2023年5月至2025年11月在中南大学湘雅三医院妇科收治的16例ACUM患者的临床资料，包括年龄、临床表现、既往史、月经及生育史、肿瘤标志物、影像学检查、治疗方式、病理检查及预后情况等。采用Kappa检验进行2种辅助检查诊断的一致性检验。结果: 16例患者确诊年龄为23~53(32.00±7.56)岁，病程为5个月~12年。临床表现为下腹痛16例，其中左下腹痛6例、右下腹痛3例、伴同侧盆腔痛2例;月经期疼痛10例，经期疼痛后改为非经期疼痛1例，非经期疼痛5例。16例患者均行妇科彩色超声检查，病灶位于子宫左前壁宫角下方肌层内12例，位于子宫右前壁宫角下方肌层内4例，结节呈低回声4例，混合回声12例，边界清晰13例，边界欠清晰3例，结节最大径为17~38(28.31±6.04) mm，囊内无回声区最大径为5~29(18.63±6.77) mm，囊壁内可探及类内膜回声12例。16例患者均行盆腔磁共振成像(magnetic resonance imaging，MRI)平扫+增强检查，结节病灶呈短T1长T2信号7例，等T1稍短T2信号5例，等T1等T2信号1例，长T1短T2信号2例，长T1长T2信号1例，其中结节内呈短T1长T2信号7例。16例患者首先考虑诊断为ACUM的妇科超声的符合率为81.25%，盆腔MRI的符合率为56.25%，2种检查方法的判断一致性强度较弱(Kappa值=0.186，P=0.375)。13例行癌抗原125(cancer antigen 125，CA125)检测，数值为12.90~91.80 U/mL，其中≤35 U/mL的10例，>35 U/mL的3例。15例患者采用腹腔镜下子宫病损切除术(其中6例同时行宫腔镜检查)，1例因年纪大且无生育需求行腹腔镜下全子宫+双侧输卵管切除术。结合病理检查及临床、影像学资料，16例患者均诊断为ACUM，其中3例考虑合并局灶腺肌症。术后随访时长为2~28(13.50±8.12)个月，术后疼痛症状均消失15例，疼痛明显减轻1例，术后妊娠足月顺产1例。结论: ACUM是一种特殊的梗阻性疾病，容易与囊性腺肌病、子宫肌瘤囊性变等混淆，当临床上出现年轻女性进行性下腹痛，特别是偏侧性疼痛及伴随盆腔牵涉痛时，需高度怀疑ACUM，推荐采用三维妇科超声、盆腔MRI进行辅助诊断，首选腹腔镜下子宫病灶切除术来根治此类疾病，必要时行宫腔镜检查来鉴别诊断。.
Group A Streptococcus (GAS) infections are common in children, ranging from mild to life-threatening invasive disease. Large-scale descriptions of changes in pediatric invasive GAS infections in the United States, particularly during the COVID-19 pandemic, are limited. We used CDC's Active Bacterial Core surveillance (ABCs), a multistate, population- and laboratory-based surveillance system, to assess changes in pediatric (<18 years old) invasive GAS incidence, clinical presentation, and bacterial strain characteristics from 2004-2023. Interrupted time series analysis was used to compare observed versus expected GAS incidence during 2020-2023, informed by trends before the COVID-19 pandemic (2004-2019). During 2004-2023, 2,856 invasive GAS cases were identified. Incidence remained stable from 2004-2019 (mean incidence 1.9 per 100,000), decreased in 2020 (1.0) and 2021 (0.6), and rebounded in 2022 (1.5) and 2023 (4.4). ICU admission increased from 2011 to 2023; case fatality remained stable. Penicillin resistance was not detected. Clindamycin non-susceptibility doubled from 2011 (3.8%) to 2022 (7.5%), before slightly decreasing in 2023 (6.4%). Infections due to emm1, the most frequently identified emm type in children with severe disease, almost disappeared in 2021 but surged in late 2022. After remaining stable for more than a decade, pediatric invasive GAS incidence declined during the COVID-19 pandemic and rebounded in 2022, more than doubling 2004-2019 incidence in 2023. While case fatality remained low, ICU admissions increased over time, highlighting the need for effective preventive measures such as vaccines. Increasing clindamycin non-susceptibility bears continued monitoring.
Anomalous aortic origin of the right coronary artery (AAoRCA) is a rare anomaly associated with sudden cardiac death, especially with an interarterial course. Coronary artery bypass grafting (CABG) is a treatment option, but graft occlusion from competitive native flow is a concern. In our series, transit-time flow measurement often showed systolic reverse flow, which disappeared after proximal right coronary artery ligation. Coronary artery bypass grafting achieved excellent long-term outcomes. These findings suggest CABG is a suitable treatment for AAoRCA, particularly when proximal ligation is appropriately performed.
The Upper Guinean forests of West Africa are a major global hotspot for primate diversity, yet many areas remain understudied and insufficiently protected. Southeastern Côte d'Ivoire illustrates this conservation gap. Once home to several of West Africa's most threatened primate species, the region has experienced extensive deforestation, habitat fragmentation, and hunting pressure over recent decades. Consequently, many primate populations have declined or disappeared from large parts of their former range. The Tanoé-Ehy Forest, a swamp forest ecosystem located along the Côte d'Ivoire-Ghana border, is now one of the last refuges for several endangered primates in the region. Since 2006, a long-term conservation initiative led by Ivorian scientists, in partnership with local communities, has aimed to protect this forest and its biodiversity through a community-based conservation approach. This article presents the Tanoé-Ehy conservation initiative as a case study demonstrating how locally led conservation efforts can support both biodiversity protection and community empowerment while contributing to changes in conservation practice in African primatology. Over nearly two decades, the project has combined ecological research, participatory governance, and socio-economic initiatives. Community members actively participate in wildlife monitoring, forest surveillance, environmental education, and livelihood diversification programs designed to reduce pressure on forest resources. Beyond biodiversity protection, the initiative highlights the importance of strengthening national scientific leadership and recognizing local communities as central actors in conservation governance. The Tanoé-Ehy experience shows that effective and sustainable conservation in biodiversity-rich regions depends on integrating local knowledge, equitable partnerships, and long-term community engagement.
Chronic acromioclavicular joint instability (ACJI) remains challenging, and the optimal surgical technique is debated. Weaver-Dunn reconstruction is widely used, but modifications have been made to improve horizontal and vertical stability. This study addressed the clinical outcomes of a modified Weaver-Dunn procedure reinforced with a double EndoButton construct. This retrospective single-center study included 23 patients undergoing modified Weaver-Dunn reconstruction for chronic ACJI between 2012 and 2024, with a minimum follow-up of 12 months. Indications included symptomatic Rockwood grade 3 or higher after failed conservative management. Surgery was performed arthroscopically in most cases; five cases used an open approach. Clinical assessment included Constant-Murley score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) for pain, ROM, piano-key sign, and clavicular drawer test. Radiographic evaluation included coracoclavicular distance, alignment, and loss of reduction. Complications and revisions were documented. At a mean follow-up of 79 months, pain improved significantly (VAS 2.9 to 0.4, p = 0.001). Constant score increased from 60 to 87 (p = 0.001), and SSV improved significantly. Forward flexion improved from 159° to 175° (p = 0.015), and abduction from 163° to 175° (p = 0.03). Clinical stability improved, with disappearance of the piano-key sign and drawer sign in 82% and 91% of cases. Four patients (17%) showed recurrent grade 3 or higher dislocation. Complications occurred in five patients (22%), including one coracoid fracture and one EndoButton migration. Modified Weaver-Dunn reconstruction using two EndoButtons provided significant improvements in pain, function, ROM, and clinical stability with acceptable recurrence and complication rates.
Recently, the etiopathogenetic role of rotational activity (RotAct) in atrial fibrillation (AF) has been proposed. We designed a prospective multicenter study using CARTO Finder to evaluate the presence/distribution of RotActs in persistent AF (persAF), pulmonary vein isolation (PVI)influences on RotActs, and the impact of its elimination on top of PVI on procedural outcomes. For this study, 76 patients with pers AF ablation were enrolled. Procedural steps involved (1) using a CARTO-Finder map to look for RotActs (physician blinded); (2) PVI; (3) using a new map to look for residual/new RotActs; (4) ablation of RotActs, if present; (5) and finally using a new map to confirm RotAct elimination. Populations were divided based on the presence or absence of structural heart disease (Group I and II) and the presence or absence (R+ and R-) of RotActs before PVI. Presence, number, and distribution of RotAct at STEP 1, the impact of PVI on RotAct at STEP 3, and maintenance of sinus rhythm (SR) during follow-up were evaluated. 56 AF patients undergoing standard ablation protocol were included as a control group. RotAct was identified in 29 (38%) patients at STEP1. RotAct did not differ between GI and GII patients. PVI significantly modified the number and localization of RotActs (p = 0.012). RotActs which were present at STEP 1 were different after PVI, with disappearance in 18 and new appearance in 5 patients. 71 patients completed a mean 13 ± 6 months follow-up and 91.5% were in stable SR. No difference in relapses was seen between R + and R- and GI and GII. RotAct ablation significantly reduced arrhythmia relapse during the follow-up compared to the control group (freedom from arrhythmia 91.5% vs. 78.6%, p = 0.025). RotAct was present in 38% in persAF patients. PVI influenced the number and distribution of RotActs. A tailored ablation strategy provided a high success rate (91.5%) at the follow-up.
This cross-sectional study aimed to investigate whether vitamin B intake (thiamine, riboflavin, niacin) influences different hypertension subtypes and which subtype exhibits a more profound effect. The objective was to determine whether different vitamins should be supplemented according to specific hypertension subtypes. This cross-sectional study encompassed data from twenty-five years spanning 1999-2023, focusing on individuals with hypertension who possessed complete 24-hour dietary intake records and clinical assessments. Their total intake was disaggregated into two dimensions-'food sources' and 'supplement sources'-for separate estimation. Multivariable logistic regression models were employed to determine the odds ratios (OR) and 95% confidence intervals (95% CI) for associations between thiamine (vitamin B1), riboflavin (vitamin B2), and niacin (vitamin B3) intake and hypertension subtypes in subjects with hypertension versus those without. The relationship between nutrient intake and hypertension subtype risk was assessed using multivariable logistic regression models. To balance baseline characteristics, propensity score weighting was applied, followed by logistic regression. Logistic regression identified inflection points, with threshold effects assessed through piecewise logistic analysis. Inflection points were verified using likelihood ratio tests and bootstrap resampling. Heterogeneity and interactions between subgroups were evaluated via logistic regression models and likelihood ratio tests, respectively. Analysis of NHANES data revealed significant demographic and dietary pattern differences between distinct hypertension subtypes. Multivariate regression analysis indicated that the initial positive association between dietary B vitamins and isolated systolic hypertension (ISH) largely disappeared upon adjustment, suggesting confounding effects from covariates such as age and comorbidities. Conversely, a strong independent positive association was observed between high riboflavin intake and systolic-diastolic hypertension (SDH). In the fully adjusted model, each unit increase in riboflavin was associated with a 25% increase in SDH risk (OR=1.25, 95% CI 1.05-1.49), exhibiting a significant dose-response trend. A potential threshold effect was observed near a 6 mg/day dose, beyond which the risk increment levelled off. Thiamine exhibited a potential non-linear association with SDH risk across quartiles, whereas no significant association was observed for niacin. Subgroup analyses indicated that the association between the three B vitamins and ISH risk was stronger among non-smokers and was influenced by gender (thiamine) and BMI (niacin). This study reveals subtype-specific hypertension risk factors. Whilst crude analyses indicated an association between B-vitamin intake and hypertension, multivariate adjustment revealed only riboflavin exhibited a significant independent positive correlation with the SDH subtype, suggesting it may represent a unique dietary-related factor for this subtype. The initial association with the ISH subtype was primarily attributable to confounding factors. The findings underscore the necessity for comprehensive adjustment and subtype stratification in nutritional epidemiology. The identified interaction with smoking status indicates that lifestyle factors play a crucial moderating role in dietary risk associations. The plateauing of SDH risk at high riboflavin levels suggests the need to further investigate potential threshold effects. These findings deepen our understanding of the relationship between diet and hypertension, emphasising that associations are not universally applicable across all manifestations of hypertension but are context-dependent. These findings suggest a complex relationship between riboflavin intake and hypertension subtypes, underscoring the need for personalized dietary approaches rather than universal supplementation. This study highlights the importance of maintaining balanced nutrition for cardiovascular health.
Previous studies have reported that joint immobilization and non-weight-bearing after anterior cruciate ligament reconstruction (ACLR) exacerbate muscle atrophy. However, it remains unclear whether the combination of these interventions worsens muscle atrophy additively. In addition, it is also unclear whether the muscle atrophy induced by immobilization and non-weight-bearing following ACLR recovers with remobilization and reloading. We investigated the recovery of muscle atrophy following short-term joint immobilization and non-weight-bearing after ACLR. ACLR rats were divided into four groups: no intervention, joint immobilization, non-weight-bearing, and joint immobilization plus non-weight-bearing. Joint immobilization and non-weight-bearing were performed for two weeks after ACLR, and then, all rats were reared without intervention. Age-matched untreated rats were used as controls. At 2, 4, and 12 weeks post-surgery, atrophy in the rectus femoris, semitendinosus, and gastrocnemius was assessed by measuring fiber cross-sectional area. ACLR alone did not induce a significant decrease in muscle fiber cross-sectional area in all examined muscles. Two weeks of immobilization or non-weight-bearing individually induced muscle atrophy in the rectus femoris and/or gastrocnemius, but there were no apparent additive effects with their combined use. Atrophy of the rectus femoris and gastrocnemius induced by immobilization and non-weight-bearing persisted until two weeks after remobilization and reloading, but disappeared within 10 weeks after remobilization and reloading. In conclusion, the combined use of immobilization and non-weight-bearing after ACLR did not have adverse additive effects on muscle atrophy. Muscle atrophy induced by two weeks of immobilization and non-weight-bearing after ACLR recovered within 10 weeks after remobilization and reloading.
The objective of this study was to examine the prevalence, risk factors, and response to quinolones of BK virus-associated hemorrhagic cystitis (BKV-HC) after hematopoietic stem cell transplantation (HSCT) in children. Patients with HC were divided into two groups according to whether their hematuria was BKV-related or not: BKV-associated-HC in Group 1 (n = 27), non-BKV-HC in Group 2 (n = 10). In Group 1, the subgroup analysis was performed as quinolone response for BKV (Ciprofloxacin-subgroup-1a, n = 15 and Levofloxacin-subgroup-1b, n = 10). The clinical, virological, and quinolone responses were recorded. Hemorrhagic cystitis has been identified in 37 (18.5%) of 200 children undergoing HSCT. Of them, 27 (13.5%) were BKV-HC in Group 1, while the remaining 10 (5%) were associated with other viruses (EBV, CMV, and Adenovirus) in Group 2. For BKV-HC, fifteen patients (55%) treated with ciprofloxacin and ten patients (37%) treated with levofloxacin showed complete clinical and virological responses. The two remaining unresponsive patients to quinolones (8%) died. Individuals in subgroup-1a had significantly delayed the disappearance of macroscopic and microscopic hematuria, as well as negative BKV-PCR titers, compared to those in subgroup-1b (p < 0.05). Risk variables for BKV-HC included male donors, unrelated donors, use of anti-thymocyte globulin, steroid dose (≥ 2 mg/kg), and steroid duration (> 2 weeks) (p < 0.05). Our findings indicate that BKV-HC is more common than other viruses-HC, that identifying risk factors, particularly steroid dose and duration, can be helpful in BKV-HC prevention, and that levofloxacin may be an alternate treatment for BKV-HC if ciprofloxacin is ineffective in children undergoing allogeneic HSCT.
Pseudo-Meigs syndrome (PMS) is a rare condition in which the primary tumor is most commonly ovarian teratoma, struma ovarii, ovarian metastatic tumor, or leiomyoma. Cases of PMS associated with ovarian borderline mucinous tumors or early-stage mucinous cystadenocarcinomas are exceedingly rare, with only two reported to date. This article presents the cases of two young women in 30s who sought medical attention due to progressively worsening dyspnea or abdominal distension. Preoperative serum tumor marker levels and imaging suggested advanced ovarian cancer; however, pathological examination of tissue and effusion fluid showed no evidence of malignancy. Postoperative pathological examination revealed stage IA ovarian borderline mucinous cystadenoma and stage IIB ovarian mucinous cystadenocarcinoma (microinvasive carcinoma). Postoperatively, the pleural effusion disappeared within a few months and there were no signs of recurrence. Primary borderline mucinous ovarian tumors or early mucinous cystadenocarcinomas associated with PMS are rare and can be easily confused with advanced ovarian cancer. To avoid unnecessary chemotherapy, it is essential to obtain histological or liquid-based cytological confirmation of malignant tumors before treatment. This case report highlights the importance for clinicians to consider the possibility of low-grade ovarian malignant mucinous tumors associated with PMS.
In 2022, the United Network for Organ Sharing (UNOS) revised the liver transplant allocation policy to calculate the median MELD at Transplant minus 3 points (MMaT-3) around the donor hospital instead of the transplant center, aiming to reduce disparities among MELD exceptions candidates. We evaluated the impact of this revised policy on waitlist outcomes in patients with or without hepatocellular carcinoma (HCC). Using the OPTN/UNOS registry, we identified all adult transplant candidates between October 8, 2015, and March 31, 2024, and stratified by policy eras: Pre-MMaT-3 (n=25,580), MMaT-3 Recipient (n=13,311), and MMaT-3 Donor (n=10,027). Fine-Gray competing risk models were performed to estimate waitlist removal due dropout (death or removal due to clinical deterioration), due clinical improvement, or transplantation by HCC status. During Pre-MMaT-3, candidates with HCC had a significantly higher probability of transplant than those without HCC (adjusted subdistribution hazard ratio [aSHR] 2.03, 95% CI: 1.95-2.12, p<0.001). This advantage declined in the MMaT-3 Recipient era (aSHR 1.39, 95% CI: 1.31-1.47, p<0.001) and disappeared in the MMaT-3 Donor era (aSHR 0.98, 95% CI: 0.88-1.09, p=0.73). Waitlist dropout, initially similar for HCC candidates than non-HCC (aSHR 0.93, 95% CI: 0.86-1.01, p=0.08), increased following MMaT-3 Recipient (aSHR 1.21, 95% CI: 1.07-1.36, p=0.01) and Donor (aSHR 2.06, 95% CI: 1.64-2.60, p<0.001) eras. Importantly, within-HCC cohort, waitlist mortality analysis improved after the MMaT-3 Donor era ( aSHR 0.79, p=0.01), while maintaining reduced wait times and stable transplant rates. The MMaT-3 Donor policy effectively deprioritized HCC for transplantation, while improving waitlist mortality within the HCC group. Ongoing evaluation is essential to guide equitable liver allocation.
In the context of the recent coronavirus pandemic, we wanted to highlight the importance of vaccination as one of the greatest medical achievements and the most effective preventive measure for protecting the population from infectious diseases. Over 200 years ago, the pioneer of vaccination in Dubrovnik, Luko Stulli, one of the most renowned physicians of the early 19th century, proudly and enthusiastically wrote about it. Immediately after the discovery of vaccination and inspired by this new medical method, he wrote a Latin poem in 1804 titled “Vaccinatio, carmen elegiacum” (Vaccination, an elegiac poem). This is probably one of the few poems in Croatian literature dedicated to a medical theme, and one of the last written in Latin. So far, three original printed copies have been found, and recently a fourth, printed in 1828, was discovered. Recent events related to the COVID-19 pandemic have once again sparked interest in Stulli’s Elegy, brought it into focus in discussions of vaccination and quarantine, and reaffirmed the value and universality of the views and messages expressed in this Latin poem, written in the spirit of classical poetics and the canon. Exactly 220 years have passed since the printing of the Elegy, yet doubts about the value and usefulness of scientific discoveries have not disappeared, nor has the distrust in medical science and vaccination as a civilizational achievement. U kontekstu recentne pandemije koronavirusom htjeli smo istaknuti važnost cijepljenja kao jedno od najvećih medicinskih dostignuća i najučinkovitiju preventivnu mjeru u zaštiti populacije od zaraznih bolesti. O tome je prije više od dvjesto godina s ponosom i oduševljenjem pisao dubrovački pionir cijepljenja Luko Stulli, jedan od najpoznatijih liječnika u Dubrovniku početkom 19. stoljeća. Neposredno nakon otkrića vakcinacije i pod dojmom nove liječničke metode, napisao je 1804. latinsku poemu Vaccinatio, carmen elegiacum (Vakcinacija, elegijska pjesma). Riječ je vjerojatno o jednoj od rijetkih pjesama posvećenoj medicinskoj temi u hrvatskoj književnosti i jednoj od posljednjih pisanih na latinskom jeziku. Do sada su bila pronađena tri originalna tiskana primjerka, a nedavno je pronađen i četvrti primjerak tiskan 1828. Recentna događanja vezana uz pandemiju COVID-19 ponovno su pobudila i usmjerila zanimanje na Stullijevu Elegiju, stavila u fokus rasprave i mišljenja o cijepljenju i karanteni te iznova potvrdila vrijednost i univerzalnost Stullijevih stavova i poruka iskazanih u ovoj latinskoj poemi u duhu klasicističke poetike i kanona. Prošlo je točno 220 godina od tiskanja Elegije, a sumnje u vrijednosti i korisnost znanstvenih otkrića nisu nestale, kao ni nepovjerenje u medicinsku znanost i cijepljene kao civilizacijski doseg.
Objective: To report a rare case of pulp space tissue growth in a mature mandibular molar with severe endo-periodontal involvement after conservative endodontic treatment and to discuss the possible biological explanations, including regeneration and granulation tissue healing. Severe endo-periodontal lesions are challenging, particularly as endodontic regeneration is usually observed in immature teeth, while revascularization in mature teeth, especially in cases of advanced periodontal disease, is rare, as demonstrated in this case. Methods: This study reports a rare case of tissue regeneration versus granulation tissue healing in the pulp space, occurring alongside periodontal healing, in a mature mandibular molar with necrotic pulp and severe periodontal involvement. A 52-year-old patient presented with a mature mandibular molar (tooth #19) exhibiting necrotic pulp with severe endo-periodontal involvement, including grade-3 mobility, tenderness to percussion, a 12 mm probing depth, and extensive periradicular radiolucency. The tooth was diagnosed with necrotic pulp and symptomatic apical periodontitis and was deemed hopeless, with extraction planned. Results: Following patient refusal, endodontic treatment was initiated, including cleaning, shaping, and placement of the intracanal medicament, Ledermix. The patient canceled the extraction due to symptom resolution and disappeared for 12 months. On return, the patient presented with spontaneous pain exacerbated by thermal stimuli, consistent with symptoms of irreversible pulpitis. Clinical examination revealed significant clinical and radiographic improvements, including reduced probing depth (3 mm), no mobility, resolution of apical translucency, radiographic findings suggestive of canal narrowing, and a positive pulp sensibility response. Re-entry elicited profuse bleeding with newly formed vital tissue beneath the medicament. Sodium hypochlorite irrigation failed to achieve hemostasis; inflamed tissue was removed; root canals were cleaned, shaped and obturated; and treatment was completed with placement of a permanent coronal resin composite restoration. A forty-month follow-up showed an asymptomatic tooth with clinical and radiographic healing. Conclusions: This case demonstrates that conservative endodontic management may result in favorable clinical and radiographic outcomes in mature teeth with severe endo-peroidontal involvement, influencing extraction decisions. It provides clinical evidence suggestive of tissue regeneration and periodontal healing in a mature tooth with necrotic pulp and severe periodontal compromise, challenging conventional prognosis. The observed pulp space tissue growth may be suggestive of regeneration; however, alternative explanations, including granulation tissue healing or repair processes, cannot be excluded. Healing by granulation tissue in the pulp space remains possible. Root canal treatment in advanced endo-perio lesions can yield favorable outcomes and may influence extraction decisions. Further clinical and histological studies are needed to clarify underlying mechanisms and optimize treatment strategies.
Entropy rate (ER) and sample entropy (SE) are two metrics that have been used to quantify the syntactic complexity of electroencephalography (EEG) microstate sequences. We here present a theoretical and numerical comparison of these two metrics and apply them to a resting-state EEG dataset from individuals with Alzheimer's disease (AD) and a control group. We first derive theoretical ER and SE estimates for first-order discrete Markov processes, providing a null hypothesis for statistical testing of higher-order syntax properties. Under the first-order syntax null hypothesis, we find a close mathematical relationship between both metrics that can be expressed by the microstate transition probability matrix. An inequality is derived that shows ER to be an upper bound to SE under the Markov approximation. We quantify accuracy and precision of the theoretical ER and SE estimates on EEG microstate sequences from the healthy control group. We then show that ER and SE identify significant higher-order syntax properties in microstate sequences from the control and AD groups. We investigate continuous and jump microstate sequences. In the former, each time point is labelled with the best matching microstate label, and in the latter, duplicate labels are removed, exclusively retaining transitions between non-identical microstates. Group comparison demonstrates that continuous microstate sequences from the AD group have lower entropy values (ER, SE), whereas jump sequences from the AD group have higher entropy values compared to control. Finally, we introduce a new syntax metric that normalizes ER and SE values with respect to their first-order syntax levels, to assess differences that only depend on syntax order. This metric revealed no differences between control and AD groups for either continuous or jump microstate sequences. This study provides further insights into higher-order microstate syntax and how it can be quantified with respect to the underlying first-order syntax. Similarities and differences between ER and SE as syntax metrics are highlighted and exemplified on experimental data. Our results show that (i) EEG microstate sequences from control and AD subjects show higher-order syntax properties across the tested syntax levels, (ii) continuous and jump sequences from control and AD groups are syntactically different, and (iii) differences between the control and AD groups disappear when higher-order syntax properties are normalized to the group-specific Markov level.
The near-disappearance of single-author publications in scientific literature represents one of the most dramatic shifts in academic publishing over the past two decades. While this trend is often attributed to increased scientific collaboration and research complexity, substantial evidence suggests that systemic publication pressures and metric-based evaluation systems have created incentives for "strategic co-authorship"-practices including honorary authorship, gift authorship, and publication cartels that violate established authorship criteria. This article synthesizes empirical evidence documenting the decline of single-author publications, the prevalence of authorship misconduct, and the systemic drivers underlying these practices. Drawing on bibliometric analyses, prevalence surveys, and studies of academic culture, evidence-based synthesis indicates that addressing authorship requires fundamental reforms to institutional assessment systems, enhanced editorial vigilance, and cultural change in how the academic community values research contributions. The integrity of the scientific record depends on honest attribution of intellectual work, yet current incentive structures systematically undermine this foundational principle.