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Protein-losing enteropathy (PLE) is a rare syndrome characterized by excessive, nonspecific loss of serum proteins through the gastrointestinal tract. More than 60 distinct conditions across organ systems have been associated with PLE. The presentation is often nonspecific-manifesting as edema, diarrhea, or malnutrition-leading to delayed recognition. Protein-losing enteropathy arises through mucosal injury or lymphatic dysfunction. Evaluation requires exclusion of hepatic, renal, and nutritional causes, followed by targeted testing with stool α1-antitrypsin and upper or lower endoscopy. Early identification enables prompt management of nutritional, immune, and thrombotic complications while also facilitating the detection of secondary causes that may be treatable or reversible. This review provides a practical overview of PLE's pathophysiologic mechanisms, clinical features, diagnostic approach, and indications for subspeciality referral.
Protein-losing enteropathy (PLE) is a rare but serious complication of the Fontan procedure in patients with single-ventricle physiology. It results from excessive loss of plasma proteins into the gastrointestinal tract, leading to hypoalbuminemia, edema, and ascites. We report the case of a 10-year-old girl with hypoplastic left heart syndrome who underwent staged surgical palliation including the Norwood procedure, bidirectional Glenn shunt, and extracardiac Fontan completion. She presented with progressive abdominal distension, peripheral edema, and severe hypoalbuminemia (albumin 2.3 g/dl). Echocardiography and cardiac catheterization demonstrated a patent Fontan circuit with normal pulmonary artery pressures and no significant obstruction, although the inferior vena cava pressure was mildly elevated at approximately 16 mmHg. The patient was managed with intravenous albumin replacement, diuretics, anticoagulation, sildenafil, and oral budesonide. This case highlights the diagnostic challenges of PLE and emphasizes the importance of early recognition and multidisciplinary management, even in the absence of significant Fontan circuit obstruction, as elevated systemic venous pressure and lymphatic dysfunction may both contribute to disease development. Protein-losing enteropathy is a rare but potentially life-threatening complication of Fontan circulation. It should be suspected in patients with a history of Fontan palliation who present with unexplained hypoalbuminemia, edema, or ascites, even when no significant Fontan circuit obstruction is identified, as elevated systemic venous pressure and lymphatic abnormalities may contribute to disease development. Early recognition and multidisciplinary management are essential to improve clinical outcomes and guide further evaluation of underlying lymphatic abnormalities.
The purpose of this study was to describe the experiences of women with pelvic congestion syndrome (PCS). We aimed to (1) explore the experiences before receiving a PCS diagnosis, (2) describe the experience of being diagnosed and living with PCS, and (3) identify challenges with ongoing pelvic pain after PCS treatment. A descriptive qualitative design with a purposive sampling method was used. Women with PCS were recruited from a Facebook PCS support group between October 2023 and February 2024. Participants completed a demographic survey, then participated in a semi-structured interview via Zoom. Data were transcribed verbatim and verified for accuracy. A modified iterative seven-step descriptive data analysis method was used to examine data, compare codes, challenge patterns, and inductively and deductively develop themes. Nine women completed the study. Six essential themes characterized the experience of living with CPP after treatment for PCS: (1) life before diagnosis; (2) diagnosis journey; (3) pain descriptors and co-occurring symptoms; (4) impaired quality of life; (5) being a burden to family and friends; and (6) losing all faith in women's healthcare and the system. This was the first qualitative study of women with ongoing and recurring pelvic pain after treatment for PCS. Findings highlighted the significant challenges women faced even after treatment for PCS, indicating a need for improved assessment strategies that better capture the severity and complexity of PCS symptoms.
The generation of highly plastic cell states in colorectal cancer that are prone to metastatic dissemination involves complex epigenetic reprogramming, rather than new genetic traits. Goto et al.1 implement a serial orthotopic organoid transplantation framework to uncover the idea that losing Gata6, a guardian of the colonic lineage, promotes metastatic competence.
Continuity of care with a family physician (FP) is a core attribute of effective primary care and is associated with improved health outcomes, reduced service use and lower healthcare costs. In Canada, an ageing FP workforce has led to an increasing number of patients losing their FP, raising concerns about access to care and disruptions in care trajectories. While the benefits of continuity are well documented, evidence on the consequences of discontinuity in primary care, particularly from the patient perspective, remains limited. Relational discontinuity occurs when there is a disruption in the relationship between an FP and a patient, which may be related to the FP's retirement or relocation or to the closure of a clinic. This study aims to assess the effects of a disruption in the relational continuity with an FP on patient's experience and their patterns of healthcare service use. A descriptive cross-sectional survey will be administered to adults residing in Quebec, Canada's second most populous province. A total sample of 1000 respondents will be recruited, including approximately 500 individuals who have lost their FP within the past 3 years, and 500 individuals currently registered with an FP. The questionnaire covers sociodemographic characteristics, health status, access to care, use of healthcare services, out-of-pocket costs and perceived impacts of discontinuity. Descriptive and regression analyses will be used to compare experiences and perceived effects between groups and to explore equity-related differences. The study has received ethical approval from the Research Ethics Board involving human participants at Université Laval. Findings will be shared with policymakers and healthcare stakeholders to inform them on the patient-reported consequences of primary care discontinuity and support the development of strategies to mitigate its impacts.
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In this narrative medicine essay, a psychiatric resident tries to process the loss of a patient to suicide.
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This study examined bidirectional longitudinal associations between grit dimensions (consistency of interest [CI] and perseverance of effort [PE]) and problematic smartphone use (PSU) and tested cognitive flexibility as a mediating mechanism. A sample of 1,641 Chinese university students (55.2 percent female; Mage = 20.1 years) completed measures at two time points 6 months apart. A four-variable cross-lagged panel model revealed that CI and PSU negatively predicted each other over time, whereas PSU unidirectionally predicted decreased PE. Cognitive flexibility partially mediated the PSU-to-PE pathway (indirect effect = -0.004, 95 percent bootstrap CI [-0.010, -0.0001]). Competing models analysis confirmed this directionality: the forward mediation (PSU → cognitive flexibility → PE) was significant, whereas the reverse was not. These findings demonstrate that grit dimensions exhibit distinct longitudinal patterns with PSU and identify cognitive flexibility as a cognitive mechanism through which PSU specifically undermines effort persistence. Implications for dimensional approaches to grit and targeted interventions are discussed.
Taking photos is a ubiquitous everyday activity, woven into social life from classrooms and meetings to travel and social gatherings. Photography is known to impair memory for photographed experiences, a phenomenon termed the photo-taking impairment effect (PTIE), but prior work has focused solely on the photographer. The present research introduces and tests a social extension of this phenomenon: One person's photo-taking activity can impair a nearby companion's memory for the same event, which we term the companion-PTIE. Across four experiments spanning controlled laboratory tasks and a simulated art exhibition, we show that photo-taking reduces a nonphotographing companion's subsequent memory to a degree comparable to taking photos oneself. Mechanistically, we dissociate cognitive offloading from attentional disengagement. Instructing photographers to delete each photo immediately, thereby removing any expectation of later access, left both the self- and companion-PTIE unchanged, arguing against cognitive offloading as a primary driver. By contrast, preventing a nonphotographing companion from seeing the act of photo-taking with an opaque barrier abolished the companion-PTIE, implicating attentional disengagement as the causal pathway. Robust Bayesian meta-analyses estimated a reliable companion-PTIE with no meaningful difference in magnitude from the self-PTIE. These findings reframe the PTIE as a social phenomenon: The memory costs of ubiquitous photography extend beyond photographers to copresent others, revealing how everyday technologies reshape collective memory for shared experiences. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
This study aimed to describe the phenomenon of losing human life by suicide, based on the lived experiences of suicide survivors and professionals. Phenomenological participatory action research was conducted, comprising 50 group sessions with 51 participants including suicide survivors, registered nurses, response police officers, and general practitioners. The essence of losing human life through suicide is characterized by profound emotional vulnerability when confronted with an existential tragedy. This means a powerlessness and an abrupt shift in existence, awakening the instinct to escape and the responsibility to act. Being the messenger of death is a heavy burden, and a sense of abandonment arises when survivors are left alone. Simply being together as human beings awakens a sense of vulnerability and a strong impulse to uphold human dignity. These findings underscore that everyone involved is vulnerable to existential challenges following suicide and provide insight into the fragility of humanity. Professionals need awareness of their own vulnerability and moral courage to encounter survivors as fellow human beings. Support for survivors should acknowledge that grief and existential suffering do not follow fixed timelines. The methodological combination of phenomenology and participatory action research proved fruitful, generating rich insights and offering a promising approach for future studies.
Failing Fontan is an increasingly recognised complication after total cavopulmonary connection, yet longitudinal biomarker data remain scarce. We aimed to characterise the incidence, biomarker trajectories, and prognostic determinants of failing Fontan. All patients who underwent primary total cavopulmonary connection (n = 650) or conversion to total cavopulmonary connection (n = 19) at our centre between 1994 and 2022 were reviewed. Lymphocyte count, N-terminal pro-brain natriuretic peptide and its zlog value, and Fibrosis-4 index were assessed at 1 year before, 6 months before, at onset, and at last follow-up. Patients were classified into protein-losing enteropathy/plastic bronchitis and heart failure phenotypes. Failing Fontan developed in 78 primary total cavopulmonary connection patients (12.0%) and 12 conversion patients (63.2%). Conversion patients developed failing Fontan earlier (P < 0.001), but survival after onset survival was comparable. Lymphocyte counts declined before onset (2.49 to 0.89 ×10³/µL, P < 0.001) and Fibrosis-4 index increased (0.060 to 0.330, P < 0.001). Phenotypes showed divergent profiles: zlog-N-terminal pro-brain natriuretic peptide at onset was 0.71 in protein-losing enteropathy/plastic bronchitis versus 5.34 in heart failure (P < 0.001). Lymphocytopenia predicted mortality early (hazard ratio 6.77, P = 0.013) but appeared protective at last follow-up (hazard ratio 0.18, P = 0.049), reflecting a phenotypic shift. On multivariable analysis, lower lymphocyte count independently predicted mortality (hazard ratio 2.44, P = 0.041), while stent implantation was independently associated with lower mortality (hazard ratio 0.32, P = 0.040). Lymphocyte counts and Fibrosis-4 index change progressively before clinical onset and may serve as early warning biomarkers. The prognostic interpretation of lymphocytopenia depends on the underlying phenotype, underscoring the need for phenotype-aware monitoring.
Cancer disrupts AYAs' school/work-related opportunities during a developmental phase when learning-related experiences are central to AYAs' growth and future outcomes. The National Comprehensive Cancer Network (NCCN) recommends clinics implement school/work support, but guidance is needed on what types of support to implement feasibly. We aimed to understand AYAs' needs by comparing narrative accounts from AYAs, parents, and clinicians. A secondary thematic analysis was conducted on two interview study datasets combined to compare three stakeholder groups' experiences: Parents of diagnosed AYAs (age 15-29), AYAs, and clinicians. Data from each group were inductively analyzed and triangulated to capture similarities/differences. 32 interviews represented three stakeholder groups: 10 AYAs, 15 parents, 7 clinicians. All groups described school/work-related challenges in four areas: advocating for accommodations, losing extracurricular activities, navigating disrupted expected trajectories, and losing peer social connection. Parents and AYAs stressed a positive impact (school/work promoting empowerment) heightening the importance of protecting school/work experiences. Findings highlighted specific supports to implement in each area, with distinct insights made by each stakeholder group. Findings offer a roadmap to implementing the NCCN's "educational and career services" directive by identifying the types of supports to implement and how. AYAs and families would benefit from oncology teams providing accommodation guidance with integrated clinical advocacy tools, flexible practices that prioritize AYAs' socialization, and psychosocial support for grief coping, social skill development, and career decision making. Prioritizing school/work-related supportive care can be a feasible, patient-centered way to improve quality of life across the AYA cancer trajectory.
Insulin edema syndrome is a rare and underrecognized complication of insulin initiation or intensification, characterized by peripheral or generalized edema. Its pathophysiology is multifactorial, involving renal salt retention, increased capillary permeability, and vasodilation, and it is often a diagnosis of exclusion. We report the case of a 41-year-old man with newly diagnosed type 2 diabetes mellitus presenting with hyperglycemia (772 mg/dL) and marked weight loss. After initiation of insulin glargine and lispro, he developed rapid-onset generalized edema, including scrotal and lower extremity swelling, weight gain of 32 pounds, dyspnea, and pleural effusions. An extensive workup excluded cardiac, renal, hepatic, infectious, autoimmune, and protein-losing enteropathy etiologies. The edema worsened with higher insulin doses despite treatment with diuretics and corticosteroids. Transition to NPH (neutral protamine Hagedorn) and regular insulin, with adjunct dapagliflozin, resulted in rapid resolution of the edema, allowing discontinuation of the diuretics. Risk factors for insulin edema include newly diagnosed diabetes, rapid glycemic correction, low body weight, and high insulin doses. While generally self-limiting, severe or refractory cases may require diuretics or modification of the insulin regimen. Recognition is critical to avoid unnecessary interventions and to manage symptoms effectively. Insulin edema syndrome should be considered in patients presenting with unexplained edema after insulin initiation. Dose adjustment or switching insulin analogs, combined with supportive management, can lead to rapid improvement. Awareness of this condition may help prevent misdiagnosis and unnecessary invasive procedures.
Between 1953 and 1987, the ground water at Marine Base Camp Lejeune in North Carolina was contaminated. Service members and their families living at the camp were exposed to volatile organic compounds which have been linked to several health conditions. Legislation offers reimbursement to families of service members who lived at the camp and were diagnosed with conditions related to the toxicants. A sample of service members based at Camp Lejeune between 1975 and 1985 were surveyed and interviewed to characterize their family members' experiences with exposure-related health conditions. The survey was online, voluntary, and cross-sectional; semistructured interviews were conducted by telephone. A total of 1,073 surveys and 22 semistructured interviews were completed. Of the 12% who reported having a spouse on base and provided a response, 33% reported that their spouse developed an exposure-related health condition. Of the 14% who reported having a child on base, 28% reported that their child(ren) developed an exposure-related condition. The most frequently reported conditions for spouses and dependents included miscarriage and neurobehavioral effects (20.4%, 9.9%, 7.1%, and 13.0%), respectively). Qualitative data revealed that the grief of losing loved ones and coping with illnesses compounded with the financial burden of these conditions were stressors for family members. Service members reported that the Camp Lejeune contamination negatively impacted their family members as some developed exposure-related conditions leading to experiencing psychological and financial distress. Further research directly with family members is needed to determine the extent to which they were affected by these exposures.
Financial decision making (FDM) and awareness of one's own financial decision making abilities are both clinically and practically important constructs in older adults. Structural and functional neuroimaging may be useful to shed light on the neural mechanisms supporting these constructs and further help identify those at risk for making poor decisions and losing money. We used resting state (rs)-functional connectivity in the present study. We hypothesized that Frontoparietal-Salience (FP-SAL) between-network connectivity would be most strongly associated with FDM, while Default Mode Network-Salience (DMN-SAL) between-network connectivity would be more associated with financial awareness. Community-dwelling older adults (59% women, 67% White, 29% Black) were recruited with mean age=68.43 years (SD=5.14) and mean education=15.88 (SD=2.41). Primary outcomes included standardized measures of financial decision making, financial awareness metrics derived from metacognitive frameworks, and between-network connectivity values. After adjusting for demographic factors and individual within-network connectivity values, FDM was only associated with FP-SAL network connectivity. In contrast to the predictions of our hypothesis, higher between-network connectivity values were associated with lower FDM scores. No significant associations between DMN-SAL between network connectivity and financial awareness was found. Our preliminary findings suggest that the association between FP-SAL between network connectivity and FDM is not straightforward. Future studies using larger samples with alternate analytic approaches will be required to replicate these findings.
Synthetic MRI can generate multiple contrasts from a single acquisition, yet synthetic fluid-attenuated inversion recovery (FLAIR) generally shows lower quality than conventional FLAIR. We aimed to improve 3D synthetic FLAIR image quality using deep learning, without losing the scan-time advantage of synthetic MRI. We studied 55 adults with inflammatory demyelinating diseases who underwent 3T MRI. For each participant, five 3D quantification using an interleaved Look-Locker acquisition sequence with T2 preparation (3D-QALAS) source images and a conventional 3D-FLAIR image were acquired, and a synthetic FLAIR image was generated from the 3D-QALAS data. We trained a deep learning model in which a 3D U-shaped convolutional network (U-Net)-based attention network predicted voxel-wise weights for generating FLAIR images from the five 3D-QALAS source images, using conventional 3D-FLAIR images as the reference. The model was trained with a combined loss function of mean squared error, content loss, and style loss. Agreement with the reference was assessed using image similarity and error metrics, lesion overlap using the Dice similarity coefficient, and overall image quality and focal lesion visibility using blinded radiologist ratings. Synthetic FLAIR and the deep learning-generated FLAIR images were compared using 2-sided Wilcoxon signed-rank tests; P < 0.05 was considered statistically significant. The deep learning-generated FLAIR images showed significantly higher agreement with the reference image than synthetic FLAIR images (all P < 0.001). Lesion overlap was higher with the deep learning-generated FLAIR images (median [interquartile range]: 0.642 [0.528-0.711] versus 0.487 [0.344-0.641]). Qualitatively, the deep learning-generated FLAIR images improved overall image quality and focal lesion visibility, but reader scores remained lower than those for the reference conventional 3D-FLAIR images (all P < 0.001). A deep learning-based approach applied to five 3D-QALAS source images improved the image quality of 3D synthetic FLAIR. These improvements may increase the clinical utility of 3D synthetic MRI for neuroradiologic assessment.
The debate on whether to preserve or sacrifice the posterior cruciate ligament (PCL) during medial congruent (MC) total knee arthroplasty (TKA) is still ongoing. Currently, there is no comprehensive consensus due to the limited evidence on which approach yields better outcomes. This systematic review and meta-analysis aimed to compared the functional outcomes of PCL retaining (PR) versus PCL sacrificing (PS) in MC TKA. Two independent researchers to find relevant articles, with no time limit until 4 August 2025, searched PubMed/Medline, Scopus, Web of Science and Embase databases. Postoperative functional outcomes were compared between the PR and PS groups, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. The Cochran Q and I 2 tests were employed to assess heterogeneity between studies. Six cohort studies, including 903 patients, were included. The pooled estimate of the four studies demonstrated that at 3 months after surgery, the mean difference in postoperative KSS score between the PR and PS groups was 1.15, which was not statistically significant (95% CI: -1.11, 3.31). At 12 months after surgery, the mean Knee Society Score (KSS) reached statistical significance in favour of the PR group (MD: 1.97, p < 0.05); however, this difference did not exceed the minimal clinically important difference (MCID) of 5.3 points, indicating a lack of clinical significance There was no significant difference in the mean Oxford Knee Score (OKS) score at 3 and 12 months after surgery between the PR and PS groups. There appears to be no clinically meaningful difference in PR or PS during MC TKA in improving short-term clinical outcomes based on moderate-certainty evidence (Level IV). In the long term, preserving the PCL may lead to greater improvements in physical function compared to losing the PCL. However, no significant differences were noted in other clinical or functional outcomes, nor in complication rates, between the two groups. Level III.
Background: With the increase in the middle-aged population and sedentary lifestyle, a high incidence of obesity has been observed in humans and in animals. Obesity is consequent or correlated to multiple diseases, such as metabolic-dysfunction-associated fatty liver disease (MASLD), diabetes, dyslipidemia, etc. The attention of many researchers is focused on understanding the specific cellular mechanism and the role of inflammation, particularly chronic, in the development of this pathology as well as its link with dysmetabolic conditions, which seriously affect the survival of both humans and animals. Objective: The aim of this review is to discuss the mechanism responsible for obesity, the specific drugs used in the treatment of this disease, and, considering the link between obesity and inflammation, the possible employment of Palmitoylethanolamide (PEA), a natural lipidic mediator with anti-obesity activity in humans and animals. Materials and Methods: The selection of articles chosen for this review paper was performed through the most important electronic databases (PubMed, Scopus, Web of Science, and Google Scholar); the specific inclusion criteria were applied systematically each time to ensure that the selection of papers closely aligned. Results: The treatment of obesity is focused on the management of weight through dietary caloric restriction, sustainable nutritional behaviors and long life therapy, which are also useful to prevent comorbidities. Several specific drugs for the treatment of this pathologic condition are available in both human and veterinary medicine. However, considering the documented link between inflammation and obesity, the possible use of PEA, authorized in veterinary medicine as a food supplement, could represent a valid therapeutic strategy in the treatment of human obesity. Conclusions: From studies present in the literature on obesity and its therapeutic approach in both human and veterinary medicine, and considering the importance of natural molecules in health management, the use of PEA as a dietary supplement, for its anorexic and fat-losing properties, could be considered a valid tool to counteract overweight and obesity in humans and animals and to avoid the onset of consequent comorbidities.