Understanding how leaf water relations integrate with carbon economy is central to plant physiological ecology and to predictions of vegetation responses to environmental change, yet the degree of their coordination remains debated. We investigated relationships between leaf pressure-volume (PV) traits (leaf-specific capacitance at full turgor per dry mass (C*ft,mass), osmotic potential at the turgor loss point (πtlp), and other PV traits) and leaf economics spectrum (LES) traits (leaf nitrogen content, specific leaf area, and photosynthetic capacity) across temperate, subtropical, and tropical forests. These two suites of traits exhibited statistically partial coordination: C*ft,mass was tightly coupled with LES traits, whereas πtlp was independent of the LES framework, and this partial coupling was primarily driven by leaf saturated water content. Notably, coordination was strongest at the subtropical site, where conservative strategies strengthened the integration between PV and LES traits, thereby improving resource-use efficiency. This partial coupling provides insights into the multidimensional nature of plant functional strategies and the mechanisms underpinning species coexistence across forest types.
To evaluate the efficacy of partial orbital lobe dacryoadenectomy (POLD) in patients with refractory epiphora. Prospective interventional study. Tertiary eye care institute. Consecutive patients with refractory epiphora due to proximal lacrimal outflow system obstruction, multiple failed dacryocystorhinostomy, and postdacryocystectomy. All patients underwent preoperative assessment with Munk score, Schirmer-I Score, tear breakup time, corneal fluorescein staining, anterior segment OCT (AS-OCT), and CT scans of the orbit. Partial removal of the lacrimal gland orbital lobe under local anesthesia. Reduction in epiphora. Objective and subjective evaluation was repeated at postoperative 1-week, 1-month, and 3-month visits. Out of 17 patients enrolled, one had congenital punctal agenesis, three had acquired punctal effacement, and 13 had proximal bicanalicular obstruction. The mean age was 48.8 ± 18.6 years. All patients underwent POLD, with removal of 50-60% of the orbital lobe of the lacrimal gland. The mean follow-up duration was 5.7 months. At 3-month follow-up visit, the average reduction in Munk score was 60%, the average reduction in Schirmer-I value was 35.2%, and the average reduction in tear film height on AS-OCT was 35.9% (all statistically significant, P < 0.05), from the initial visit. None of the patients developed signs and symptoms of dry eye disease. POLD is an effective and safe procedure for patients with refractory epiphora in the short term. Further studies are needed to establish efficacy in the long term.
Partial anomalous pulmonary venous drainage is an uncommon condition representing 0.6% of all congenital malformations that may be associated with an atrial septal defect. In the present report, we describe a modification of the Warden technique for surgical repair of partial anomalous pulmonary venous drainage with atrial septal defect by using a superior vena cava flap and a right atrial appendage flap to create a new tension-free cavoatrial continuity (neo right superior vena cava), along with redirection of the anomalous pulmonary veins to the left atrium through the atrial septal defect using an autologous pericardial patch. The patient had a favorable postoperative course, with no evidence of residual shunt or obstructive gradient across the anastomosis, and was discharged on postoperative day six. El drenaje venoso pulmonar anómalo parcial es una enfermedad poco frecuente que representa el 0,6% de todas las malformaciones congénitas; puede estar asociado a un defecto septal atrial. En el presente reporte describimos una modificación de la técnica de Warden para la reparación quirúrgica del drenaje venoso pulmonar anómalo parcial con defecto septal auricular, mediante la utilización de un colgajo de vena cava superior y de un colgajo de apéndice auricular derecho, para crear una nueva continuidad cavo-atrial sin tensión (neovena cava superior derecha), además del redireccionamiento de las venas pulmonares anómalas a través del defecto atrial mediante un parche de pericardio autólogo. El paciente presentó una evolución posoperatoria favorable, sin evidencia de cortocircuito residual ni gradiente obstructivo en la anastomosis, siendo dado de alta al sexto día posoperatorio.
Randomized controlled trial has shown that dexmedetomidine does not significantly reduce postoperative acute kidney injury (AKI) in general partial nephrectomy (PN) populations. However, evidence remains limited in patients with high susceptibility to renal ischemia, such as those with a solitary kidney or pre-existing chronic kidney disease (CKD). We conducted a single-center retrospective cohort study including adult high-risk PN patients between 2015 and 2023. Eligible high-risk patients were those with a solitary kidney or pre-existing CKD. The study cohort was divided into dexmedetomidine-exposed and non-exposed groups. To balance baseline characteristics, inverse probability of treatment weighting (IPTW) was applied. The primary outcome was AKI incidence within 24 hours postoperatively, defined by KDIGO creatinine criteria. The study included 274 patients, with 82 assigned to the dexmedetomidine-exposed cohort and 192 to the non-exposed cohort. After IPTW adjustment, all baseline covariates were well balanced. Dexmedetomidine exposure was associated with significantly lower AKI incidence (23.9% versus 38.6%, P = 0.025), with a trend toward milder AKI staging. Intraoperative urine output was higher in the dexmedetomidine group (341 ± 183 versus 282 ± 188 mL, P = 0.022). Length of postoperative hospital stay, postoperative complications, ICU admission rate, percentage decrease in eGFR from baseline at 6-month follow-up, and incidence of a >20% decrease from baseline eGFR at 6-month follow-up did not differ significantly between the two groups. In high-risk PN patients with a solitary kidney or pre-existing CKD, intraoperative dexmedetomidine was associated with a clinically meaningful reduction in postoperative AKI. These findings suggest a potential renoprotective role of dexmedetomidine in this vulnerable surgical population, although this early renal benefit did not translate into long-term improvements in renal function.
While partial splenic artery embolization (PSE) has been effectively employed in treating portal hypertension, cirrhosis, and idiopathic thrombocytopenia, its combination with hepatic artery infusion chemotherapy (HAIC) for the management of chemotherapy-induced hypersplenism (CIH) has not been previously explored. This retrospective study aims to provide clinical insights into this potential therapeutic approach. We conducted a retrospective analysis involving patients with colorectal cancer liver metastases (CRLM) who received PSE in conjunction with HAIC (utilizing the FOLFOX regimen) to manage thrombocytopenia due to hypersplenism. Tumor response assessment followed the response evaluation criteria in solid tumors, while adverse reactions were categorized using the Common Terminology Criteria for Adverse Events (version 5.0). The primary objective was to attain a platelet (PLT) count of 100 × 10 9 /L, with secondary objectives encompassing evaluation of adverse events related to the combined therapy and its efficacy against liver metastases. From January 2018 to May 2023, 20 patients with CRLM and CIH were consecutively enrolled in this investigation, each undergoing PSE and HAIC. In total, PSE was performed 25 times. Median pre- and post-PSE PLT counts were 51 × 10 9 /L and 116 × 10 9 /L, respectively, with 80% of participants reaching the primary endpoint of a PLT count of ≥100 × 10 9 /L. Abdominal pain emerged as the most frequent postoperative complication, affecting 11 patients (44%). The objective response rate stood at 25%, while the disease-control rate was reported at 80%. The median progression-free survival was measured at 3.9 months, with a median overall survival of 13.8 months. The combination of PSE and HAIC (FOLFOX regimen) represents a safe and effective strategy for managing CIH and CRLM, demonstrating favorable outcomes in PLT count restoration and disease control.
Mutations in Transglutaminase 6 (TG6) have been linked to a genetic form of spinocerebellar ataxia, namely SCA35. In recent years, several mutations associated with this disease have been identified. While some of them did not alter TG6 enzymatic activity, others induced a dominant-negative loss-of-function and altered subcellular localization. We previously observed that mutations identified in patients, which showed detrimental effects on neuronal viability in vitro, including mislocalization and activation of the unfolded protein response, were consistently characterized by a loss of TG6 enzymatic function. To investigate this effect in vivo, we re-derived Tgm6 knockout mice from the EMMA repository and performed behavioral characterization. We measured body weight and assessed motor performance using the rotarod, elevated beam/beam balance test, and ladder test, beginning at 1 month of age and continuing through 16 months of age. Here, we report that TG6 loss-of-function impairs motor coordination in male mice, suggesting a sex-specific function for this enzyme.
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The relationship between cortical morphology and intelligence during adolescence has been widely studied, with existing literature reporting varying degrees of association across different modeling approaches. This study provides a comprehensive comparison of model performance in investigating the association between crystallized intelligence and cortical surface area using data from 11,351 subjects in the Adolescent Brain Cognitive Development (ABCD) study. We evaluate ten widely used models ranging from linear regression to graph convolutional networks across three covariate adjustment formulations: full (no adjustment), partial (age and sex adjusted), and total surface area (TSA) partial (age, sex, and TSA adjusted). Using bootstrap resampling with 50 iterations, we estimate the fraction of variance explained (FVE) for each model. Our results suggest that more complex models do not lead to higher FVE, with LASSO having the highest FVE of 15.9% (full formulation), Ridge at 10.5% (partial formulation), and Principal Component Regression (PCR) with 102 PCs at 2.5% (TSA partial formulation). Our results also reveal that the relationship between cortical surface area and crystallized intelligence is predominantly driven by global factors age, sex, and TSA, rather than by localized cortical surface area.
The adoption and acceptance of parental control apps (PCAs) are threatened by many factors, even though mobile applications are at the forefront of mobile computing technologies. Existing studies indicate that PCA adoption can be improved by understanding users' behavioral intention and mindsets. Several adoption studies show that task features are among the most influential factors influencing users' perceptions of mobile applications. The role of PCA features, such as digital etiquette, cyberbullying, child tracking, and family values, remains largely unexamined in current research. Thus, by using task-technology fit (TTF) theory, this study examines how task-technology features and characteristics affect the behavioral intention of parents toward PCA adoption within the context of Saudi Arabia. To empirically test the proposed theoretical model, data were collected from 388 parents in Saudi Arabia. A multistage analysis, which consists of partial least squares structural equation modeling (PLS-SEM), partial least squares prediction algorithms (PLS-predict), and artificial neural networks (ANN), was employed to examine the outcome of PCA behavioral adoption. The results demonstrate that digital etiquette, cyberbullying, family values, and parental mediation significantly and positively influence TTF, whereas mobility, child tracking, and inappropriate online content do not have a significant impact. Furthermore, TTF was found to be a significant predictor of parents' behavioral intention toward PCA adoption. These findings can be utilized to enhance the design of PCAs and thus the user experience for both parents and children. Moreover, this study extends and contributes to the understanding of task features in the context of PCAs through the TTF model.
Dual-targeted therapy (DTT) combines medications with different anti-inflammatory mechanisms to manage immune-mediated conditions. We describe our experience of adding guselkumab (GUS) to upadacitinib (UPA) in complex inflammatory bowel disease (IBD). We reviewed our real-world registry of adult patients with IBD who had GUS added to UPA. Prospectively collected outcomes included clinical remission (Harvey-Bradshaw Index (HBI) < 5 or Simple Clinical Colitis Activity Index (SCCAI) < 3), biochemical remission (normalization of fecal calprotectin (FCP)/CRP), corticosteroid-free remission, and adverse events (AEs). Patient-reported activity of extraintestinal manifestations (EIMs) was retrospectively reviewed. We identified 11 patients with Crohn's disease (CD) and 4 with ulcerative colitis (UC) who added GUS to UPA for luminal inflammation (n = 12) and/or EIMs (n = 5). Five of nine patients with active CD achieved biochemical remission. Of the four with symptomatic CD (HBI > 5), two achieved clinical remission. Four patients received DTT for CD-associated EIMs and two had partial improvement of symptoms after GUS. All 3 patients who started DTT for active UC achieved clinical remission and one with active enteropathic arthropathy had partial improvement of symptoms after DTT. AEs included minor skin irritation, fatigue, and headaches. 14/15 patients remain on DTT after median 6 months' follow-up. The addition of GUS to UPA led to clinical remission in 50% and 100% of patients with CD and UC, and biochemical remission in 55.6% and 66.7% of patients with CD and UC, respectively. 60% noted improvement of their EIMs after adding GUS. No serious AEs were reported highlighting the safety of this DTT strategy.
The application of fungi in forensic investigations remains limited, particularly in cases involving dismembered human remains. In this study, we characterized the mycobiome of a decomposing human body and a detached upper limb recovered from different locations using culture-dependent methods. A total of 23 fungal species were identified across four culture media and three incubation temperatures, including 20 species from the body and ten from the upper limb. The dominant taxa included Yarrowia lipolytica, Yarrowia deformans, Mucor hiemalis, and Geotrichum candidum. Notably, seven species were shared between the body and the detached limb, indicating partially preserved fungal signatures despite environmental differences. These findings suggest that fungal community profiles may serve as a complementary tool for associating separated human body parts and for assessing postmortem relocation. Additionally, 11 fungal species were identified on human remains for the first time (Acaulium album, Acaulium caviariforme, Akanthomyces lecanii, Dialonectria ullevolea, Fusarium acuminatum, Fusarium falsibabinda, Fusarium oxysporum, Fusarium redolens, Fusarium sacchari, Linnemannia hyalina, and Penicillium clavigerum), expanding current knowledge of postmortem fungal colonization in temperate climates. KEY POINTS: • The regional postmortem mycobiome of a corpse and a severed upper limb • Shared fungal species suggest partial preservation of mycobiome signatures • Fungal profiles as potential indicators for the identification of dismembered body parts.
Elevated muscle sympathetic nerve activity (MSNA) at high altitude is associated with blunted transduction of sympathetic signals to blood pressure in lowlanders and indigenous Andean highlanders. However, it is unclear whether this is due to reduced adrenergic communication or other factors (e.g. augmented dilatory signaling). Therefore, we quantified the contribution of α-adrenoreceptor activity to 1) resting systemic sympathetic transduction and 2) pressor responses to sympathoexcitation in acclimatizing lowlanders (9M, 4F) and Andean highlanders (15M) at 4,300m. MSNA (microneurography) and mean arterial pressure (MAP; finger photoplethysmography) were measured at rest, during maximal voluntary apnea, and with an α1-adrenergic agonist (phenylephrine) prior to and following partial α-adrenergic blockade (phentolamine). Sympathetic transduction was quantified as the slope of the relationship between MAP and total MSNA associated with sequences of sympathetic bursts. Transduction was attenuated in both lowlanders (0.0041±0.0037 to 0.0017±0.0017mmHg∙%-1, P=0.026) and highlanders (0.0033±0.0024 to 0.0008±0.0007mmHg∙%-1, P=0.005) under α-adrenergic blockade (main effect P<0.001) and was not different between groups (main effect P=0.276). However, pressor responses to apnea (lowlanders, +25±5mmHg; highlanders, +22±7mmHg) were unchanged following phentolamine (lowlanders, +25±8mmHg; highlanders, +20±8mmHg; main effect P=0.174) despite unchanged MSNA responses between conditions (main effect P=0.162). Highlanders exhibited reduced MSNA responses compared to lowlanders regardless of condition (main effect P=0.014). Partial α-adrenergic blockade reduced sympathetic transduction similarly in both groups. Yet, apnea responsiveness was maintained, achieved through lesser sympathoexcitation in highlanders. This suggests that resting blood pressure control is modulated primarily through α-adrenergic receptors in both populations, but pressor responses to stress may result from alternative mechanisms.
The influence of repair of congenital heart defect (CHD) via a right subaxillary thoracotomy (RSAT) on postoperative pulmonary function and prognosis in small infants is a key consideration. Data were collected from infants who underwent ventricular septal defect (VSD) repair or VSD and atrial septal defect (ASD) between March 2020 and September 2024. Based on propensity score matching, 80 small infants (weight <5 kg and age <6 months) were selected, of which 40 underwent VSD repair or VSD, and ASD repair through an RSAT, while 40 underwent VSD repair or VSD and ASD repair through a standard median sternotomy (SMS). Perioperative respiratory parameters, morbidity, and mortality were compared to assess the influence of the RSAT approach on pulmonary function and postoperative outcomes in small infants. Primary outcome: there were no significant differences (p > 0.05) in the perioperative oxygenation index and alveolar-arterial oxygen gradient between the two surgical approaches. No significant differences were also observed between the two groups in the other respiratory parameters, including peak airway pressure, partial pressure of oxygen, and partial pressure of carbon dioxide. The operating time (150 ± 20 min vs. 163 ± 28 min; p < 0.05) was shorter in the RSAT group compared to the SMS group. There were no deaths in either group. The complication rate was low in both groups, with no significant difference between the groups (p > 0.05). Compared with SMS, the RSAT approach for the repair of congenital heart defects does not increase the risk of postoperative respiratory insufficiency and yields comparable outcomes in low-weight small infants.
Therapeutic cancer vaccines can generate measurable antigen-specific immune responses in humans, yet tumor regression is often incomplete, inconsistent, or short-lived. In immunologically cold tumors, this pattern may reflect not an absolute inability to prime immunity, but difficulty advancing induced immunity through the full sequence required for tumor control. Peripheral blood responses may be real and still be biologically inadequate if they contract early, fail to acquire productive trafficking programs sufficient for tissue entry, lose functional competence under chronic antigen stress, or remain constrained by the suppressive tumor microenvironment. The manuscript advances a sequential, feedback-guided adjuvant framework in which peptide vaccination remains the backbone but is preceded and followed by distinct support phases. A Phase 0 immune-readiness step, potentially using IL-7 (e.g., CYT107), is intended to improve the baseline substrate before antigen exposure. Phase 1 priming uses peptide vaccination on a commonly used adjuvant backbone such as Montanide ISA-51 or poly-ICLC (Hiltonol), while radiation and/or STING-based strategies are treated as context-dependent enhancers rather than replacements for priming. IL-15-centered consolidation is then used to support expansion and persistence. A formal trafficking assessment follows so that blood-only success is not overinterpreted. IL-21 is positioned later as a persistence- and quality-support cytokine when response quality declines. The framework also addresses why otherwise rational protocols can fail at the chemokine-trafficking step: CXCR3-dependent tumor entry is not interchangeable with generic inflammation, CCR5 biology is context dependent, and IL-12, although biologically attractive and previously tested as a vaccine adjuvant, is best viewed here as an optional, context-specific amplifier rather than a universal backbone. Although organized as sequential phases, the framework is intended as a bottleneck-guided and iterative design logic in which phases may overlap, repeat, or be entered in partial parallel depending on the dominant biologic constraint. The central hypothesis is that vaccine programs that progress beyond priming into trafficking-competent and functionally sustained states are predicted to correlate more closely with disease control than programs judged mainly by early blood immunogenicity.
Dupuytren disease (DD) is a fibroproliferative disorder that can result in progressive hand contractures and functional impairment. Multiple treatment options are available, ranging from minimally invasive procedures to surgical interventions. Current long-term trends in treatment utilization and reimbursement remain incompletely characterized. Understanding these trends is essential for clinical decision-making and resource allocation. A retrospective longitudinal analysis was conducted using Medicare data from 2005 to 2024. Treatment utilization and reimbursement data were extracted for current procedural terminology codes corresponding to percutaneous needle fasciotomy (PNF), open fasciotomy, collagenase Clostridium histolyticum injection (CCH) with manipulation, and fasciectomy-based procedures. Annual procedure volumes were normalized to Medicare enrollment. Reimbursement values were adjusted for inflation using the US Consumer Price Index. Temporal trends were assessed using the 2-tailed Mann-Kendall trend test. Utilization of surgical procedures declined significantly over the study period, whereas PNF and CCH demonstrated no individual temporal trends. When grouped as minimally invasive procedures, PNF and CCH showed an overall increase in utilization. A transient decline in utilization across all procedures occurred in 2020, followed by partial recovery in subsequent years. Normalized annual procedure volumes for DD demonstrated no significant temporal trend. Inflation-adjusted Medicare reimbursement per service declined significantly by 38% over the study period; fasciectomy-based procedures remained the highest reimbursed interventions and showed no significant temporal change. In contrast, reimbursement for PNF and CCH declined significantly over time. Over the past 2 decades, minimally invasive treatment of DD has become more common, whereas fasciectomy has been declining. Nevertheless, fasciectomy remains the most commonly performed treatment for DD. Decreasing inflation-adjusted reimbursement highlights growing economic pressures on health care and providers. Economic decision and analysis IV.
Optimizing plant height to enhance lodging resistance and facilitate mechanized harvesting is a critical breeding objective for cultivated hybrid sugarcane. However, the genetic dissection of this trait has been impeded by the complexity of the aneuploid sugarcane genome. To address this issue, we performed a k-mer-based genome-wide association study (GWAS) of 603 re-sequenced sugarcane accessions. We identified 138 quantitative trait loci (QTLs) linked to plant height. These included well-known regulators in the gibberellin and brassinosteroid pathways (e.g., GID1, DWF1) and genes involved in less-studied processes that might contribute to differences in plant height, such as sucrose and fatty acid biosynthesis (e.g., SUS6, ACC2). Using transcriptome data, we documented widespread, stable, allele-specific expression of plant height-related genes and unequal contributions among alleles: 35.02% of alleles accounted for 80% of total gene expression. We also detected substantial imbalances in both gene copy number and expression between the two progenitor-derived subgenomes. The expression bias between subgenomes was typically much smaller than the imbalance suggested by copy number alone, indicating partial buffering at the expression level. Crucially, at the population level, changes in both the dominant allele and subgenome bias of specific genes were associated with differences in plant height in cultivated sugarcane. Finally, we inferred an expression-based regulatory network for plant height-related genes and identified hub genes with possible direct and indirect roles in regulating plant height. Our findings shed light on the regulation of plant height in cultivated sugarcane and offer breeding targets for improved plant architecture.
Tricuspid valve (TV) pouch is a rare entity associated with ventricular septal defect (VSD). It is even rarer to cause right ventricular (RV) inflow obstruction. A 43-year woman presented with exertional palpitations for 2 years, diagnosed with a large TV pouch causing significant RV inflow obstruction without pulmonary arterial hypertension (PAH). Cardiac magnetic resonance revealed a large perimembranous VSD with bidirectional flow into the TV pouch, which had no effective communication with the right ventricle, preventing a significant left-to-right shunt and PAH. Surgical correction involved partial excision of the pouch and closure of the VSD, preserving the TV integrity. This case highlights a rare hemodynamic presentation of the TV pouch and its potential to cause RV inflow obstruction and prevent PAH in a large VSD. Follow-up (at least every 3-4 years) for these cases where VSDs are spontaneously closed by TV or aneurysmal membranous septum would be beneficial.
Stress granules (SGs) are dynamic, membrane-less ribonucleoprotein assemblies that form through liquid-liquid phase separation to prioritize stress-survival proteostasis. Through reanalysis of a Drosophila genome-wide RNAi screen, we identified a set of conserved SG suppressor genes and validated the top candidate, Tsc2, in both mouse and human cell lines. We illustrate that the complete loss of Tsc2 leads to spontaneous, canonical, and translation-dependent SGs driven by mTORC1 hyperactivation in mouse embryonic fibroblasts (MEFs). In addition, the Tsc2 -deficient MEFs also sensitized to endoplasmic reticulum stress, delaying SG clearance. In human cell lines, the siRNA-mediated partial reduction of TSC2 in U2OS cells, and in human tuberous sclerosis patient fibroblasts, does not induce spontaneous SGs. Instead, the sensitivity to ER stress, translation perturbation, and delay in clearance correlate with the remaining levels of TSC2, suggesting that TSC2 functions as a threshold-dependent regulator of SG assembly. Together, our findings provide a comprehensive list of novel conserved SG regulators and establish TSC2 as a key regulator of SG dynamics.
This study examined whether intrinsic spirituality was associated with nurses' perceptions of their work environment and their quality of work life. Nurses work in demanding settings that may shape perceptions of the work environment and quality of work life. Intrinsic spirituality may be an internal resource linked to these appraisals. A cross-sectional study in Türkiye (n = 378) was reported in line with STROBE. Data were collected using the Intrinsic Spirituality Scale, Work Environment Scale, and Quality of Work Life Scale for Nurses. Analyses were performed using regression-based mediation with 5,000 bootstrap resamples within a generalized linear modelling framework. Intrinsic spirituality was positively associated with perceived work environment (B = 0.660, β = 0.549, p < 0.001). Perceived work environment and intrinsic spirituality were both positively associated with quality of work life (B = 0.647, β = 0.507, p < 0.001, and B = 0.357, β = 0.233, p < 0.001, respectively). Bootstrap mediation indicated a significant indirect association of intrinsic spirituality with quality of work life through perceived work environment (B = 0.427, p < 0.001), consistent with a partial mediation pattern. The findings provide preliminary evidence that both individual spiritual resources and organizational factors are relevant to nurses' professional well-being. Supporting intrinsic spirituality may be associated with more favourable perceptions of the work environment and a higher quality of work life among nurses. Addressing nurses' spiritual resources and workplace conditions may support well-being. Policies that support spiritual well-being initiatives and working conditions may be relevant to healthier environments and quality of work life; further longitudinal research is needed.
Inflammatory bowel disease can profoundly affect the joints and tendons of the hand. We present here the first published case of an atraumatic rupture of the A3 pulley of the right second digit in a 27-year-old woman with ulcerative colitis. The patient presented with pain and functional compromise of the second digit as well as a 90° flexion contracture at the proximal interphalangeal joint. Imaging revealed rupture of the A3 pulley and bowstringing of the flexor digitorum profundus tendon despite no history of hand or finger trauma. Multidisciplinary conservative management and adjustment of antirheumatic medication resulted in partial resolution of the flexion contracture and return of pain-free function.