Estimating vocal-tract length (VTL) from vowel formants can aid speaker normalization, but few methods have been benchmarked against an anatomical reference in the same speakers. We combined acoustic pharyngometry (APh) and speech data from 42 adults to benchmark eight widely used formant-based VTL estimators against incisors-to-glottis length and to test an interpretable two-stage bias-corrected linear estimator. Across more than 400 000 central frames with valid F1-F4, traditional quarter-wave, odd-harmonic, and dispersion-type estimators correlated with VTLAPh but showed poor out-of-sample anatomical recovery and strong calibration compression. Re-estimated one-stage linear models reduced mean absolute error (MAE; median ≈1.0 cm) but still overestimated shorter tracts and underestimated longer tracts. A two-stage model markedly improved calibration and agreement, outperforming one-stage linear and nonlinear alternatives (median per-vowel MAE 0.39 cm, median out-of-sample R2=0.83). Front and front-rounded vowels were the most informative. Speaker-level 95% limits of agreement were about ±0.9 cm, indicating that the method is better suited to aggregated tract-scale estimation than to direct anatomical measurement. These results identify calibration bias as a central limitation of standard formant-based VTL estimators and provide a practical, interpretable route to tract-scale estimation from similarly processed labeled-vowel data under matched conditions.
Structural racism is an important determinant of health inequities. Recent studies have operationalized structural racism using latent construct approaches to capture its multidimensionality instead of relying on single indicators as structural racism proxies. However, such studies have only captured multidimensional structural racism at larger geographies, not census tract level. A latent profile model used unidimensional indicators across the domains of criminal justice, economic status, education, employment, and housing/segregation to construct a multidimensional measure of structural racism (MMSR) for 2219 NYC census tracts from 2018-2022. The indicators were derived from publicly available datasets and reflect differences between Black and non-Hispanic White New Yorkers. We assessed the MMSR's utility by testing its association with fatal and nonfatal community firearm violence in 2018-2022, using a global Wald test and pairwise comparison z-tests. The analysis identified five multidimensional structural racism profiles in NYC. Two profiles were more advantaged across the indicators, while the other three were more disadvantaged. Census tracts in the advantaged profiles had above the NYC average of non-Hispanic White residents and above median income, while disadvantaged profiles had above average non-Hispanic Black residents and below median income. Community firearm violence significantly differed across the five profiles-the disadvantaged profiles had the highest prevalence of firearm violence. Maps visualized that disadvantaged profiles co-occurred in census tracts that also experience high levels of violence. This analysis confirms the need to capture the complexity of structural racism across multiple domains, including the heterogeneity of structural racism at a small geography in a large city.
Respiratory disorders and tail biting represent common issues in pig husbandry. Dietary supplementation with a combination of microbes and herbal extracts could offer welfare benefits. The aim of this study was to investigate the effect of a fermented herbal extract (FHE), a blend of fermented herbs, lactobacilli and yeasts, on behavior, aspects of health and productivity in rearing and fattening pigs. Two commercial Austrian welfare label farms, raising pigs with intact tails, were included over three batches covering all seasons. Animals were kept from weaning to slaughter in control (CON; n = 11 and 9) and treatment pens (FHE; n = 11 and 9) during rearing and fattening, respectively. Behavior as well as body, tail and ear lesions were assessed at the end of the rearing and at the middle and end of the fattening period, productivity data was measured on farm while slaughter data were additionally recorded at the abattoir. Data were analyzed using (generalized) linear mixed models. One main finding of this study was the significantly lower prevalence of the indicator "tail shorter" of FHE-fed pigs compared to control (CON) pigs at the end of rearing (FHE = 7.2 %, CON = 38.8 %; p = 0.012). The higher prevalence of intact tails in the FHE group may suggest a beneficial effect of the supplement on behavior, with a possible reduction in tail-biting activity in rearing pigs. During fattening, FHE pigs also coughed and sneezed less during behavioral observations on farm (p = 0.026). Nevertheless, slaughter findings concerning the respiratory tract did not differ. Overall, the present results suggest a potential of FHE to avert abnormal behavior and promote aspects of respiratory health in rearing and fattening pigs, which warrants further investigation.
No comprehensive characterization of the respiratory tract (RT) microbiota has been done in people with tuberculosis (TB), a leading global cause of death. 16S rRNA gene sequencing was done on upper RT (URT; oral-washes, naso- and oro-pharyngeal swabs, supraglottic fluid), sputum and lower RT [LRT; bronchoalveolar lavage fluid (BALF) and protected specimen brushings] specimens from HIV-negative people with Xpert MTB/RIF-confirmed TB (cases; n=17) and healthy controls (n=11). In addition to their diseased lobe, cases had their non-diseased lobe sampled. The LRT had the lowest α-diversity and β-diversity differed compared to other respiratory compartments. In cases, Mycobacterium relative abundance was highest in the diseased lobe 1.537% (CI 0-3.114), followed by the nasopharynx 0.059% (0.012-0.105), non-diseased lobe 0.054% (0-1.620), oropharynx 0.003% (0-0.010) and sputum 0.002% (0-0.004). Compared to the URT and sputum, cases' LRTs were Mycobacterium- and Moraxella -enriched ( Erythromicrobium -enriched versus sputum only). In paired comparisons of diseased versus non-diseased lobes in cases, the only differential taxon was Mycobacterium . Amongst non-diseased lobes, those of cases versus controls had reduced α-diversity with Mycoplasma -enrichment and Moraxella- and Klebsiella- depletion. Compared to healthy people, those with TB have a less diverse LRT microbiota, characterized by Mycobacterium -enrichment (within the diseased lobe and surprisingly least so in sputum) and depletion of taxa associated with healthy people. In people with TB, most microbial DNA is not mycobacterial within the diseased lobe and even the non-diseased lobes of cases are microbially distinct from controls. These findings provide a foundation for understanding respiratory tract host-microbiome interactions in TB.
Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are recommended in Japan for patients with cardiovascular disease (CVD), heart failure (HF), or chronic kidney disease (CKD) due to their organ-protective effects, leading to increased use in high-risk populations. However, whether urinary tract infection (UTI) risk associated with SGLT2Is differs according to the presence of these factors remains unclear. This study aimed to estimate UTI risk among SGLT2I users and treatment selection factors and examine whether these factors modify risk. We selected dipeptidyl peptidase-4 inhibitors (DPP4Is) as the comparators. This retrospective cohort study used DeSC claims data from patients with diabetes mellitus who received their first prescription for either an SGLT2I or a DPP4I between October 2014 and February 2023. The analysis focused on data from 2019 to 2022. Hazard ratios (HRs) for UTI incidence were estimated using Cox proportional hazard regression. A total of 66,968 SGLT2I users and 170,678 DPP4I users were aged 65 years or older. UTI incidence among SGLT2I users was 2.04% in those with treatment selection factors and 0.84% in those without. Compared with DPP4I users, the HR for UTI was 0.80 in patients with treatment selection factors and 0.51 in those without treatment selection factors. SGLT2I use was not associated with an increase in UTI risk, regardless of treatment selection factor status. These findings suggest a favorable safety profile for SGLT2Is even among high-risk populations, supporting their use following clinical guidelines.
The metabolic landscape of biliary tract cancer (BTC) remains poorly characterized. This study aimed to identify tumor-specific metabolic alterations in BTC using paired tumor and adjacent normal tissues. Metabolomic profiling was performed on paired tumor and adjacent normal tissues from 71 patients with BTC using capillary electrophoresis time-of-flight mass spectrometry. Differential metabolites were identified using paired statistical analysis with false discovery rate correction. Pathway enrichment analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes database. Seventeen metabolites were significantly altered between tumor and normal tissues. Pathway analysis identified glycerophospholipid metabolism as the most enriched pathway, driven by water-soluble precursor and intermediate metabolites, including phosphorylcholine, CDP-choline, and ethanolamine phosphate. Hierarchical clustering demonstrated partially distinct metabolic patterns between tumor and normal tissues, with substantial inter-sample variability observed among tumor samples. Metabolites related to amino sugar and nucleotide sugar metabolism were also increased in tumor tissues. Additional pathways, including nicotinate and nicotinamide metabolism and arginine and proline metabolism, were also enriched. Principal component analysis showed partial separation between tumor and normal samples, indicating global metabolic differences between the two groups. These findings indicate metabolic alterations across multiple pathways in BTC. Paired tissue metabolomics revealed coordinated metabolic alterations in BTC involving choline phospholipid precursor metabolism, amino sugar and nucleotide sugar metabolism, and additional amino acid-related pathways. These results highlight the presence of broad metabolic reprogramming in BTC and underscore the importance of tissue-based metabolomic profiling for characterizing tumor metabolism.
BATMAN (balloon-assisted translocation of the mitral anterior leaflet) is an increasingly adopted technique to modify the anterior mitral leaflet (AML) and prevent left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). The aim of this study was to evaluate the feasibility, efficacy, and safety of the BATMAN technique during transseptal TMVR. This was an international, multicenter cohort study of all consecutive patients at high risk for LVOT obstruction undergoing transseptal BATMAN TMVR for valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) at 22 structural heart disease centers in North America and Europe. The primary efficacy endpoint was the rate of successful TMVR free from LVOT obstruction and procedural death. The primary safety endpoint was the in-hospital composite of death, stroke, or major cardiac structural complications. A total of 83 patients were included: 24 undergoing ViV, 39 ViR, and 19 ViMAC procedures. Technical success was achieved in all but 1 case (98.8%) that was converted to tip-to-base LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction). Pre-emptive mechanical cardiocirculatory support was used in 28.9% of cases. The primary efficacy endpoint was met in 95.1% of cases (100% in ViR, 95.8% in ViV, and 84.2% of ViMAC; P = 0.03). The primary safety endpoint occurred in 7.3% of patients and was higher in the ViMAC group (0% in ViR, 8.3% in ViV, and 21.1% in ViMAC; P = 0.02). There was 1 major cardiac structural complication directly attributed to BATMAN in a ViMAC patient. BATMAN was associated with high technical success and effectiveness in preventing LVOT obstruction and appeared to be safe in ViR and ViV procedures. Adverse events were higher in ViMAC.
Urinary tract infections (UTIs) in men, though less frequent than in women, represent a significant clinical challenge due to their increasing incidence with age and distinct microbiological profiles. This expert review analyzed data of urine cultures in men with community-acquired UTIs, collected from emergency departments of 15 french hospitals, from the private laboratory group Atoutbio (21 sites in Meurthe-et-Moselle and the Vosges French departments, alongside primary care records from the AntibioClic tool and the PRIMO database, to characterize the bacterial epidemiology of community-acquired male UTIs in France. Escherichia coli (39-40%) dominated, followed by Enterococcus faecalis (13-15%), Klebsiella pneumoniae (6-8%), and Proteus mirabilis (5-6%). Resistance rates were as follows amoxicillin (47-53.5%), amoxicillin-clavulanate (24-35.7%), trimethoprim-sulfamethoxazole (25.4-31.5%), and fluoroquinolones (16.3-20.2%). Resistance to third-generation cephalosporins (6.6-9.3%) and mecillinam (6.8-8.9%) was lower, while fosfomycin (1.4-1.5%) and nitrofurantoin (0.4-0.7%) retained high susceptibility. Extended-spectrum β-lactamase (ESBL)-producing E. coli ranged from 2 to 8.4%, with carbapenemase producers remaining rare (0.1%). Resistance was higher in men >65 years, particularly in nursing homes, where 3GC resistance reached 15-18%. « Emerging uropathogens » (Aerococcus urinae 1-1.1%, Actinotignum schaalii 0.1-0.4%) were rare. This study highlights the greater microbial diversity in male UTIs compared to women and underscores the need for systematic urine culture, susceptibility testing, and empirical therapy tailored to resistance patterns, age, and risk factors.
Outcome after surgical hematoma evacuation for intracerebral hemorrhage (ICH) depends on hematoma location. As corticospinal tract (CST) integrity affects motor recovery after stroke, we hypothesized that CST integrity drives heterogeneity in surgical outcomes and investigated this in a secondary analysis of MISTIE-III participants. Risk of CST injury was categorized into four levels, based on the interaction between the CST, the hematoma, and perihematomal edema (PHE) on automatically segmented stability CT: no risk, PHE infiltration, hematoma infiltration, and complete interruption of the CST. Associations with outcome were tested using multivariable linear regression for motor National Institutes of Health Stroke Scale (NIHSS) at day 180 and ordinal regression for modified Rankin Scale (mRS) at day 365, introducing an interaction term between CST risk and treatment group. Day 180 motor NIHSS was significantly lower for 'no risk' (b:-3.77, [95% confidence interval [CI]: -5.8 to -1.70], p =0.0003) and 'PHE infiltration' (b:-2.3, [95%CI: - 3.5 to -1.1]; p =0.0002) vs. 'complete interruption'. Surgery was associated with lower Day 180 motor NIHSS in participants with hematoma infiltration (b:-2.07, [95%CI: -3.8 to -0.4], p =0.016). Compared to complete interruption, 'no risk' (adjusted odds ratio [aOR]:0.27, [95%CI: 0.10 to 0.74], p =0.01) and 'PHE infiltration' (aOR:0.41, [95%CI: 0.23 to 0.74]; p =0.003) were associated with lower odds of unfavorable day 365 mRS. Surgery was associated with lower mRS in participants with no risk (aOR:0.23, [95%CI: 0.05 to 0.97, p =0.045). Increasing CST risk is associated with worse motor recovery (day 180) and disability (day 365). CST risk modifies the effect of the MISTIE-III procedure on motor recovery and disability. NCT01827046 ( https://clinicaltrials.gov/study/NCT01827046 ).
This was a single-center, retrospective study that analyzed the epidemiological characteristics of respiratory tract infections (RTIs) in the Second People's Hospital of Changzhou from December 2023 to November 2025. Briefly, pharyngeal swabs from 24,380 cases were harvested and subjected to RT-PCR to detect influenza A and B viruses (Flu A and B), adenovirus (ADV), human rhinovirus (HRV), respiratory syncytial virus (RSV), and Mycoplasma pneumoniae (MP). The total positive rate is 47.00% (11,459/24380). HRV (13.27%) was the predominant pathogen for RTIs, and HRV combined with ADV and other pathogens primarily accounted for co-infections. The overall detection rate of RTIs showed a significant sex-related relevance (χ2 = 17.606, p < 0.001), and the positivity for each of the six respiratory pathogens differed across age groups (p < 0.001). Individuals at 12-17 years (11.97%), 18-45 years (6.83%), 6-11 years (24.14%), <1 year (22.35%), 3-5 years (21.36%), and 6-11 years (27.48%) were more likely to be affected by FluA, FluB, ADV, RSV, HRV, and MP, respectively. In our center, FluA caused seasonal peaks in winter and autumn, and HRV activity peaked in autumn and spring. Infections by the remaining respiratory pathogens were sporadic. Additionally, outpatients were more likely to be affected by RTIs than inpatients. However, this relationship may be reversed for RSV infection and MP infection as age was considered. In conclusion, RTIs caused by the six common respiratory pathogens in this local institution were associated with sex, age, seasonality and patient status.
To define the incidence and predictors of metachronous contralateral recurrence in upper tract urothelial carcinoma and develop a risk score for tailored surveillance. We analyzed 3024 patients surgically treated with curative intent from a multi-institutional registry (ROBUUST 3.0). A composite risk score assigned one point each for prior bladder cancer, tumor multifocality, and estimated glomerular filtration rate at discharge <60 mL/min/1.73m2. Patients were stratified into low- (0 points), intermediate- (1-2 points), and high-risk (3 points). Cumulative incidence was estimated using competing risks regression models, accounting for death and distant metastasis, and internally validated using a cause-specific proportional hazards model. Twenty patients (0.7%) developed contralateral recurrence over a median 26.5 months. Recurrence was significantly associated with prior bladder cancer (80% versus 31.5%, p<0.001), tumor multifocality (55% versus 20%, p=0.001), and lower estimated glomerular filtration rate at discharge (39 mL/min/1.73m2 versus 48 mL/min/1.73m2, p=0.01). Three-year cumulative incidence rates were 0.7% (low-risk), 0.9% (intermediate-risk), and 10.5% (high-risk) (p<0.001). High-risk patients faced an estimated 17-fold increased hazard versus low-risk patients. The model demonstrated excellent discriminative accuracy (Concordance Index 0.81). Contralateral recurrence is rare but heavily dependent on prior bladder cancer, multifocality, and impaired renal function. Our internally validated risk score accurately stratifies patients, facilitating surveillance de-escalation for low-risk individuals and intensive monitoring for high-risk patients.
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Many men referred from primary care entering magnetic resonance imaging (MRI)-based prostate cancer (PCa) pathways have an MRI without abnormalities, highlighting the need to improve MRI risk stratification. Optimising this process in primary care could reduce unnecessary referrals and MRIs. This study aimed to develop a prediction model incorporating the International Prostate Symptom Score (IPSS) to improve MRI risk stratification and reduce hospital referrals and MRIs in biopsy-naïve men with suspected PCa in primary care. We prospectively identified men with suspected PCa referred from primary care to a Dutch teaching hospital in 2022-2023. Standard work-up included IPSS and upfront biparametric MRI. Study outcomes included Prostate Imaging Reporting and Data System (PI-RADS) ≥ 4, the number of potentially reduced hospital referrals and subsequent MRIs, and missed PCa cases. Men with an abnormal digital rectal examination (DRE) were excluded from model development, as they have a direct indication for MRI according to current guidelines. Multivariable logistic regression identified predictors of PI-RADS ≥ 4. Model performance was assessed using the area under the curve (AUC), and clinical utility was evaluated with decision curve analysis using a predefined threshold probability of 20%. Of 409 men, 334 without abnormal DRE were included in the model development cohort; 30% (101/334) had PI-RADS ≥ 4, of whom 59% (60/101) had significant PCa (International Society of Urological Pathology [ISUP] grade group ≥ 2). Prostate-specific antigen (PSA) and IPSS were independent predictors of PI-RADS ≥ 4. The model showed fair discrimination (AUC = 0.68; 95% confidence interval [CI] = 0.62-0.74). Decision curve analysis showed greater net benefit than 'treat none' across all thresholds and greater net benefit than 'treat all' between 17% and 30%. At a 20% threshold, 23% of MRIs could be avoided, while 3.9% of all patients would not be referred despite having a positive MRI (13% of positive MRI findings), including eight cases of missed significant PCa. Limitations include the lack of external validation. Incorporating IPSS in primary care for biopsy-naïve patients with suspected PCa improves risk stratification for MRI and offers an easily available parameter to optimise diagnostic pathways.
Eosinophils have long been recognized as terminal effector cells in type 2 immunity; however, emerging evidence positions them as central regulators of intestinal homeostasis, immune modulation, and tissue adaptation. This review provides a comprehensive overview of gastrointestinal eosinophils, integrating recent advances in their development, regulatory mechanisms, functional subsets, and pleiotropic roles across tissues. The developmental and homing pathways that guide eosinophils to the gut are first discussed, with an emphasis on niche-derived signals that control their survival and localization. The functional heterogeneity of intestinal eosinophils is then highlighted, revealing marked transcriptional and spatial diversification. The diverse functions of gut eosinophils are further summarized, including their contributions to pathogen defense, tissue repair, mutual regulation with the microbiota, anti-tumor, and interactions with immune cells. Finally, the cross-tissue orchestration of eosinophil behavior is examined, with a focus on the gut-immune axis. By synthesizing current knowledge, this review aims to present a holistic picture of gastrointestinal eosinophil biology and to inspire new perspectives for understanding and treating eosinophil-associated intestinal disorders.
Obsessive-compulsive disorder (OCD) is characterized by disturbing thoughts (obsessions) that initiate anxiety-reducing thoughts or behaviors (compulsions). For patients with treatment-resistant OCD (tr-OCD), neuromodulation techniques, like capsulotomy (a lesion in the anterior limb of the internal capsule) and deep brain stimulation (DBS), have emerged as interventions that likely regulate connectivity between the prefrontal cortex (PFC) and subcortical targets. Three patients (Cap-DBS1-3) underwent a failed capsulotomy followed by successful DBS. Here, we aimed to understand the brain connections disrupted by failed capsulotomy vs modulated by successful DBS. We used diffusion-weighted magnetic resonance imaging (dMRI) tractography in a control cohort with tr-OCD (n=12) and in two of the Cap-DBS patients themselves to determine connectivity profiles of the capsulotomy, volume of tissue activated (VTA), and potentially necessary tracts (VTA minus capsulotomy tracts). We used whole-brain, PFC-focused, and subcortically-focused tractography algorithms to fully explore the space of possible connections. Capsulotomy regions-of-interest (ROIs) connected with a variety of PFC and subcortical regions. VTA ROIs and potentially necessary tracts had limited and inconsistent PFC connectivity but substantial subcortical connectivity. While correlated to the average OCD connectome (r = 0.214, 95% CI [0.177, 0.251]; r = 0.756, 95% CI [0.739, 0.772]), the Cap-DBS connectomes had many edges that were stronger (z-score > 3). The connectivity profile of potentially necessary tracts for successful DBS treatment after failed capsulotomy revealed a surprising proportion of subcortical regions and inconsistent PFC involvement, highlighting an often-ignored set of connections that may be critical to effective DBS. What is already known on this topic: OCD has been conceptualized as a disorder of cortico-striato-thalamo-cortical (CSTC) circuits. Treatment targets have largely involved connections to the PFC.What this study adds: Our study shows that potentially necessary tracts for DBS treatment after failed capsulotomy involve connections to subcortical regions and not PFC.How this study might affect research, practice, or policy: This evidence of primarily subcortical involvement in treatment should encourage the use of more detailed subcortical atlases in neuromodulation circuit research and suggests that local circuit remodeling may be a mechanism of neuromodulatory OCD treatment.
Pelvic inflammatory disease (PID) is a common condition among women of childbearing age, referring to a group of infectious diseases of the upper female reproductive tract, tubo-ovarian abscess, and pelvic peritonitis, primarily caused by sexually transmitted infections (STIs). Delays in diagnosis and treatment can lead to sequelae associated with PID reproductive tract infections such as tubal factor infertility, ectopic pregnancy (EP), and chronic pelvic pain. This study assessed the global burden, trends, and cross-national disparities in PID among women, with projections extending to 2046. Estimates and the corresponding 95% uncertainty intervals (UI) for the prevalence and years lived with disability (YLDs) of PID were extracted from the GBD (the Global Burden of Disease) 2021 Study. We described the epidemiology of PID at the global, regional, and national levels; analyzed trends in its burden from 1990 to 2021 on overall, local, and multidimensional scales; evaluated time trends using estimated annual percentage changes (EAPCs); and predicted changes in PID burden over the next 25 years by using Bayesian age-period-cohort (BAPC) analysis. From 1990 to 2021, an increase in the age-standardized prevalence rate (ASPR) (EAPC=-0.02, 95% confidence interval (CI): -0.07 to 0.02) was observed in PID. Although our findings show an EAPC of -0.02 and stable incidence rates (ASR), the global burden continues to grow because of several factors. In 2021, the estimated number of PID cases was 1,089,544 (95% UI: 815,164 to 1,405,520), with a corresponding ASPR of 13.38 (95% UI: 10.02 to 17.28) per 100,000 population. The burden of PID varied widely across countries, with the highest ASR for prevalence and YLDs recorded in Guinea. Our predictions indicate that the prevalence and YLDs of PID will continue to rise over the next 25 years. PID remains a major global women's public health concern, with its burden rising from 1990 to 2021. This study highlights the persistent challenges in managing PID, and its unequal distribution, offering insights for more effective resource allocation and age-inclusive care strategies.
Longitudinal changes in white matter (WM) microstructure from acute underweight to early weight restoration in anorexia nervosa (AN), and their underlying mechanisms, remain largely unexplored. Thus, this study aims to examine the relationship between microstructural alterations across WM regions and neurofilament light (NF-L), a marker of axonal injury; brain-derived neurotrophic factor (BDNF), a neuroprotective molecule; and leptin, a neuroplasticity-promoting hormone, during acute underweight and following short-term weight restoration. Diffusion-weighted MRI scans from 101 predominantly adolescent female participants with acute AN before and after short-term weight restoration and from 147 female healthy participants were used. Alterations in microstructural WM integrity assessed by fractional anisotropy (FA) were tested using linear mixed-effects models across groups. Additional analyses were used to investigate relationships of FA with NF-L, BDNF, and leptin. We found a mixed, mostly elevated FA signature at the acutely underweight stage, followed by incomplete normalization with weight gain. Subsequent analyses identified that change in FA was positively associated with reductions in NF-L levels above and beyond the effect of weight gain in one WM tract. Leptin increase accompanying short-term weight restoration mediated the effect of weight gain on FA decrease across four WM tracts (estimated average causal mediation effects range: -0.0050 to - 0.0026; confidence intervals within - 0.01 to 0.0). The results suggest that a decrease in FA may indicate rehabilitation of WM integrity in acute AN. In addition to nutritional rehabilitation, the increase of leptin levels during weight gain may be relevant for the normalization of specific WM tracts.
Granulomatosis with polyangiitis (GPA) is a rare systemic necrotizing vasculitis, typically involving the upper and lower respiratory tract and kidneys. Urogenital manifestations are uncommon (< 2%) and frequently mimic malignancy. We describe a female patient in whom GPA initially presented with urogenital manifestations and review the available literature regarding urogenital involvement in the course of GPA. We describe the case of a 58-year-old woman with granulomatosis with polyangiitis initially presenting as a bladder mass, leading to radical cystectomy before the autoimmune etiology was recognized. Over time, the disease evolved to include typical manifestations. Despite multiple relapses under conventional immunosuppression therapy, sustained remission was achieved with rituximab. A literature search of PubMed, Scopus, Embase and Directory of Open Access Journals was performed using predefined keywords related to GPA and urogenital involvement. Exclusion criteria included article language other than English, male patients and kidney involvement. Data were extracted on clinical presentation, diagnostic approach, treatment, and outcomes. We identified 40 female patients with GPA involving the urogenital tract, including our case. The cervix (45%), bladder, and urethra were the most commonly affected sites. In 48 of cases, urogenital involvement was the first manifestation of GPA, frequently mimicking gynecologic or urologic malignancy. Unnecessary surgical interventions were reported in 43% of patients. Corticosteroids and cyclophosphamide were the most commonly used therapies, while rituximab was effective in refractory disease. Urogenital involvement in GPA is rare, often misdiagnosed as malignancy, and associated with significant diagnostic and therapeutic challenges. Heightened awareness of this atypical presentation and early rheumatologic evaluation is crucial to prevent unnecessary invasive procedures. Rituximab represents an effective treatment option in relapsing or refractory cases.
Indwelling urinary catheter (IUC) placement is a significant risk factor for catheter-associated urinary tract infections (CAUTI). Most prior studies of CAUTI include both male and female patients, resulting in heterogenous generalizable cohorts. However, male patients have distinct anatomical differences and sex-specific justifications for IUC placement. This study aimed to exclusively characterize the common indications for in-hospital IUC placement in male patients and identify risk factors associated with CAUTI in this cohort. This is a retrospective single-center study at a tertiary academic medical center. A total of 1000 male patients aged ≥18 y with an intraurethral IUC placed during their hospital course were included, and those who developed CAUTI during hospitalization were identified. A multivariable logistic regression model was used to identify independent risk factors for CAUTI. Among 1000 male patients, the most common indications for IUC placement were acute urinary retention (32%), strict ins/outs monitoring (24.3%), and postoperative monitoring (18.5%). Of all included patients, 7.7% developed a CAUTI. On multivariable analysis, benign prostatic hyperplasia (odds ratio [OR] = 1.99, P = 0.027), history of frequent UTIs (OR = 9.04, P < 0.001), and a urinary catheter present on admission (OR = 3.86, P < 0.001) were associated with increased risk of CAUTI development. In our study, the most common indication for IUC placement in male hospitalized patients was acute urinary retention. CAUTI occurred in nearly 8% of male patients with IUC. Benign prostatic hyperplasia, history of frequent urinary tract infections, and presence of an existing indwelling catheter on admission were independent risk factors for CAUTI development. These findings may inform strategies for inpatient IUC management, especially in patients with prior urologic diagnoses.
Spontaneous gastrocutaneous fistula (SGCF) is an extremely uncommon clinical condition. In modern practice, most gastro-abdominal fistulas are acquired, typically arising from iatrogenic causes, major abdominal trauma, or direct invasion by advanced gastrointestinal malignancies. SGCF resulting exclusively from benign chronic gastric ulcer penetration is rarely reported and is generally regarded as a historical curiosity. An 81-year-old man presented with persistent enteric-like drainage after traumatic disruption of a subcutaneous abdominal nodule that had been stable for approximately three decades. Comprehensive imaging and endoscopic investigations confirmed the presence of an SGCF originating from a benign gastric ulcer. Laparoscopic exploration demonstrated dense, localized fibroinflammatory adhesions anchoring the stomach to the anterior abdominal wall. Definitive management consisted of en bloc excision of the fistulous tract combined with a laparoscopically assisted subtotal gastrectomy, which was completed successfully. Although rare, benign penetrating gastric ulcers may give rise to chronic fistulous tracts involving the abdominal wall. In the present case, the imaging, operative, and histopathological findings supported a chronic localized fistulizing process in which the formation of dense adhesions may have limited free perforation. After careful exclusion of malignancy, mature fibrotic fistulas of this type generally require definitive en bloc surgical resection.