Reflex syncope is the most frequent cause of transient loss of consciousness in the pediatric population. A structured diagnostic approach based on clinical evaluation and 12-lead ECG is mandatory to exclude the cardiac causes of syncope. Additional cardiac investigations, such as echocardiography, a stress test, or 24H Holter ECG monitoring, are needed in case of suspected cardiac syncope at initial evaluation. Cardiovascular autonomic function assessment, including ambulatory blood pressure monitoring and a tilt test, is useful for phenotyping syncope (hypotensive or bradycardic mechanism). In case of unexplained syncope after a comprehensive evaluation and high-risk criteria, an implantable loop recorder is indicated. The management is primarily based on reassurance, education, hydration, increased salt intake, and counter-pressure maneuvers. Pharmacological therapies and intervention strategies may be considered for patients with recurrent or disabling forms that are not responsive to lifestyle modifications.Conclusion: Reflex syncope in the pediatric population should be managed through a structured diagnostic pathway focused on excluding cardiac causes and guiding mechanism-based treatment. Education and lifestyle measures remain the cornerstone of management, while pharmacological or invasive strategies should be reserved for selected patients with recurrent or disabling symptoms. What is Known: • Reflex syncope is the most common cause of transient loss of consciousness in children and adolescents, and initial evaluation should rely on careful history taking, physical examination, and a 12-lead ECG to exclude cardiac causes. • Most pediatric reflex syncope can be managed conservatively through education and reassurance, together with adequate hydration, increased salt intake, and physical counter-pressure maneuvers. What is New: • This review proposes a structured stepwise diagnostic pathway that starts with clinical evaluation and ECG and escalates only when cardiac syncope is suspected or the presentation is high-risk. • It emphasizes the role of brief cardiovascular autonomic assessment (ambulatory blood pressure monitoring and tilt testing) to distinguish hypotensive from bradycardic mechanisms and guide individualized management.

Clinical evaluation of the efficacy and safety of nasturtium herb and horseradish root versus placebo in the continuous prophylaxis of recurrent uncomplicated cystitis: a double-blind randomised clinical trial.

Atrial cardiomyopathy (AtCM) is increasingly recognized as a distinct pathological entity characterized by structural, functional and electrical abnormalities that may predispose to atrial fibrillation, heart failure and other adverse cardiovascular outcomes. Early identification and longitudinal monitoring of atrial remodelling are therefore crucial to improve risk stratification, guide therapeutic decisions, and assess treatment response. However, clinical evaluation alone is often insufficient to capture the complexity and temporal evolution of atrial disease. Multimodality cardiac imaging plays a central role in the detection, characterization and surveillance of AtCM and atrial failure, the latter representing the advanced stage of this continuum. This scientific statement synthesizes the current evidence supporting the use of imaging techniques for monitoring AtCM across diverse clinical scenarios. The strengths and limitations of echocardiography, cardiac magnetic resonance, cardiac computed tomography and nuclear imaging are discussed with respect to atrial size, function, tissue characterization and substrate assessment, with particular emphasis on advanced imaging markers. Furthermore, pragmatic imaging-based algorithms are proposed for the evaluation and follow-up of AtCM in preclinical and overt heart failure, atrial fibrillation, cardiomyopathies, valvular heart disease, and peri-procedural settings. Knowledge gaps, unmet clinical needs and future research priorities are also highlighted. By integrating available evidence into a structured framework, this document aims to support a more standardized - yet personalized - approach to imaging-guided management of AtCM in clinical practice.

Background Although traditional rehabilitation training can partially improve motor function in patients with post-stroke motor disorders, its impact on neural plasticity remains limited. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive method targeting the auricular branch of the vagus nerve, represents a promising neuromodulatory approach. This prospective study aimed to assess the therapeutic effects of taVNS on functional recovery in this population. Methods A total of 147 patients with post-stroke motor disorders were consecutively enrolled between February 2023 and November 2024. After excluding 8 dropouts, 139 patients were randomly assigned via a random number table to either an electrical stimulation group (taVNS group) or a rehabilitation group (conventional training). The taVNS group initially included 73 patients, with 3 dropouts yielding a final sample of 70. The rehabilitation group initially included 74 patients, with 5 dropouts resulting in 69 participants. All participants underwent comprehensive assessments at baseline and following a 4-week intervention period. Outcome measures encompassed neuroelectrophysiological parameters (motor evoked potential latency and amplitude), clinical functional evaluations (Action Research Arm Test, Fugl-Meyer Assessment for Upper Extremity, Modified Barthel Index), serum biomarker levels (brain-derived neurotrophic factor, S100 calcium-binding protein β), and systematic documentation of adverse events. Based on post-treatment Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores, patients were further categorized into improvement and non-improvement subgroups for additional comparative analysis. Pearson correlation analysis was utilized to examine potential relationships between functional scores, neurophysiological data, and biomarker concentrations. Results Baseline characteristics were comparable between groups ( p > 0.05). Post-intervention, the taVNS group showed significantly superior outcomes: shorter MEP latency ( p < 0.05), higher MEP amplitude ( p < 0.05), improved scores on ARAT, FMA-UE, and MBI (all p < 0.05), increased levels of BDNF ( p < 0.05), and decreased levels of S100-β ( p < 0.05). Within-group analysis indicated that MEP latency decreased only in the taVNS group, while amplitude improved in both groups. In the rehabilitation group, post-treatment MEP latency showed no significant difference from baseline ( p > 0.05). Both groups exhibited significant post-treatment improvements in ARAT, FMA-UE, and MBI scores. However, the magnitude of improvement in clinical scores and biomarkers was substantially greater in the taVNS group after treatment. The pre-to post-treatment changes in MEP latency and MEP amplitude were larger in the taVNS group compared to the rehabilitation group ( p < 0.001). Similarly, the changes in ARAT, FMA-UE, and MBI scores, as well as in BDNF and S100-βlevels, were all greater in the taVNS group than ( p < 0.001). Adverse reaction incidence did not differ significantly between groups (taVNS 11.43% vs. rehabilitation 8.70%, p > 0.05). ARAT, FMA-UE, and MBI scores were negatively correlated with MEP latency and S100-β levels, and positively correlated with MEP amplitude and BDNF levels (all p < 0.05). These correlations were consistent for baseline values, post-treatment values, and pre-post change values. Conclusion taVNS is an effective and safe adjunctive therapy for post-stroke motor recovery. It enhances neuroelectrophysiological function, improves motor and daily living abilities, and favorably modulates biomarkers of neural injury and repair. The consistent correlations among functional, neurophysiological, and biochemical outcomes highlight an integrated recovery pathway, supporting the integration of taVNS into standard neurorehabilitation protocols.

Knee injuries are one of the most common complaints in sports medicine. Magnetic resonance imaging is an essential adjunct to clinical evaluation for many traumatic injuries and overuse conditions. Given the heavy use of knee magnetic resonance imaging, developing faster magnetic resonance imaging acquisition methods and deployment in clinical practice would be valuable. In this article, we illustrate a spectrum of knee abnormalities from our clinical practice, utilizing a recently developed, publicly available sub-5-minute knee magnetic resonance imaging protocol with super-resolution image reconstruction based on deep learning. We review common traumatic injuries and overuse conditions of the knee and illustrate cases with this novel fast knee magnetic resonance imaging protocol.

Prenatal diagnosis and clinical evaluation of fetuses with structural X chromosome abnormalities: a ten-year single-center retrospective study.

Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some patients requiring multiple office visits. We sought to determine factors associated with multiple postpartum blood pressure visits among patients with HDPs.We retrospectively identified patients with HDPs who delivered at our maternity center in 2019 and compared factors between patients who attended a single blood pressure follow-up appointment without requiring further clinical evaluation for hypertension and patients who required multiple postpartum clinical evaluations for persistent hypertension. Univariate logistic regression models were used to identify factors associated with increased odds of having multiple clinically indicated postpartum visits for blood pressure monitoring.We identified 328 patients with HDPs, of whom 260 (79.3%) attended an initial postpartum blood pressure follow-up appointment and were included in further analyses. Of the 260 patients, 70 (26.9%) had multiple blood pressure visits. Factors associated with multiple blood pressure visits included delivery between 34 and less than 37 weeks of gestation (odds ratio [OR], 3.62; 95% CI, 1.07-12.30), systolic blood pressure before discharge of 140 mm Hg or higher (OR, 5.02; 95% CI, 2.57-9.82), and discharge with blood pressure medication (OR, 3.42; 95% CI, 1.82-6.41).Patients with HDPs who deliver preterm, have persistent hypertension before discharge, or are discharged with antihypertensive medication require continued close postpartum observation and continuity of care. · Postpartum follow-up care for patients with HDPs should be tailored to the patient.. · Preterm delivery, persistence of hypertensive blood pressure at discharge, and discharge with antihypertensive medication are associated with multiple postpartum ambulatory office visits.. · High-risk patients should be diligently monitored with postpartum continuity of care..

Clinical evaluations of large language models (LLMs) have rapidly expanded since 2022, yet their evidence base remains opaque. The overwhelming volume of studies creates challenges for manual curation and review. However, LLMs themselves offer the scalability and capability to evaluate the ever-growing evidence base. This LLM-assisted review identified 4,609 peer-reviewed studies in clinical medicine between January 2022 and September 2025, equating to roughly 3.2 papers per day. Only 1,048 studies used real-world patient data and of these only 19 were prospective randomized trials; most addressed simulated scenarios (n = 1,857) or exam-style tasks (n = 1,704). ChatGPT and related OpenAI models constitute 65.7% of evaluated models, with Gemini/Bard a distant second constituting 13.1% of evaluated models. Patient-facing communication and education comprised 17% of tasks, followed by knowledge retrieval, and education and assessment simulation. Across 1,046 head-to-head comparisons, LLMs outperformed humans in 33% of comparisons, with a strong dependency on task realism and level of training. At least 25% of studies had sample sizes less than 30. Despite the growth of LLMs in medicine, rigorous, patient-centered evidence remains scarce, underscoring the need for larger prospective trials before clinical adoption.

<b>Introduction:</b> Some viral pharyngitis can mimic streptococcal pharyngitis. The clinical similarity of infectious mononucleosis (IM) and streptococcal pharyngitis makes differential diagnosis based on the clinical picture alone tricky, and patients with IM may be treated empirically with antibiotics (ATBs). <br><br><b>Aim:</b> To assess prehospital ATB use in adult patients with IM admitted to the hospital. In addition, to compare antibiotic-treated individuals and patients not treated with ATBs using selected demographic, clinical, and laboratory parameters. <br><br><b>Materials and methods:</b> Medical records of patients with a laboratory-confirmed IM diagnosis (2006-2023) from one center in Poland were analyzed. <br><br><b>Results:</b> Out of one hundred and forty-four patients, 119 (82.6%) were treated with ATBs in the prehospital period. Many patients (n = 59) received more than one ATB. The most common choices were amoxicillin/clavulanate (46.2%), cefuroxime (27.7%), and macrolides (26.1%). One-fourth of patients had palpebral edema (more commonly in subjects treated with ATBs). The enlarged spleen was found in almost 90% of individuals with an available abdominal ultrasound assessment (113/127). A significant proportion of patients (43.1%) were given steroids (more commonly in subjects treated with ATBs). <br><br><b>Conclusions:</b> More severe IM in young adults is a common cause of ATB therapy. Broad-spectrum ATBs are often prescribed. Meticulous clinical evaluation supported by simple and widely available diagnostic tools could reduce the use of antimicrobials in such a patient population.

Skin colour measurement is common and essential to clinical evaluation, especially for product efficacy evaluation and research on skin tone and pigmentary disorders. Among multiple evaluation methods, full-face imaging analysis has become increasingly valuable thanks to attractive visuals, trackability, algorithm optimization, etc. Today, numerous imaging devices are available on the market, employing diffuse light or cross-polarized light. While most systems control their light source output during manufacturing, lack of precise colour calibration and variations between devices remain the key barriers for product efficacy evaluation for skin tone. This research aims to enhance the reliability of colour measurement by validating two representative full-face imaging devices for clinical objective evaluation. Using a ColorChecker during image capture will allow colour calibration to standardized lighting conditions, thus mitigating device-specific variations and improving the reliability of skin colour measurements. A 4-week clinical study investigated two imaging devices employing different light sources. A ColorChecker was included in each image capture. Initial analysis of each colour patch assessed the inherent colour accuracy and stability of both devices. Subsequently, image colour calibration was applied to standardize colours to a reference colour under standard light source. Further analysis then evaluated whether this calibration improved the devices' capabilities in measuring skin tone. There is a disparity in the colour measurement capabilities of the two investigated devices. By incorporating a standard ColorChecker within the field of view and implementing image colour calibration through use of a polynomial regression model, colour accuracy and system stability has been enhanced, thus improving the reliability of colour assessment in clinical evaluation and reducing the inconsistencies between devices. This study offers insights into colour measurement for skin tone evaluation, demonstrating the value of using a ColorChecker and colour calibration to ensure reliable and accurate skin tone measurements.

Machine Learning-based Radiomic Model for Early Diagnosis of Male Urethral Injury in Pelvic Fracture Patients.

Development of a universal real-time PCR TaqMan assay for fowl aviadenovirus diagnosis.

Relationship between symptom assessment and cardiopulmonary exercise testing in patients with obstructive hypertrophic cardiomyopathy.

Rethinking Lower Limb Peripheral Artery Disease Management Through Digital Therapeutics: A PESTEL and SWOT/TOWS Analyses.

As total ankle arthroplasty becomes an increasingly common treatment for end-stage ankle arthritis, managing failing implants is becoming a growing challenge for orthopaedic surgeons. The UK National Joint Registry reports a 13-year cumulative revision rate of 17.01% in patients aged under 65 years, and 3.22% in those aged over 75 years. These complex cases are challenging to manage and require a structured, multidisciplinary approach. Key factors influencing management include implant and hindfoot alignment, infection, bone stock, and implant stability. Recent advances in implant design, imaging methods, surgical planning, and revision techniques have expanded the armamentarium available to orthopaedic surgeons. This article aims to provide an overview of the algorithmic assessment and management of the failing ankle arthroplasty, highlighting the importance of thorough clinical evaluation, appropriate imaging, and early identification or exclusion of periprosthetic joint infection, along with tailored treatment strategies for each underlying pathology.

Integrating multi-omics and artificial intelligence fuels advanced target identification and drug discovery.

Serum pharmacochemistry and network pharmacology reveal multi-pathway mechanisms of Ela Tablet against renal fibrosis in diabetic nephropathy.

Clinical evaluation of the remineralizing potential of biomimetic scaffolds on enamel white spot lesions: A 12-month randomized controlled trial.

PGM2L1 gene variants are associated with developmental delays, seizures, and various neurological and physical symptoms. This study aims to report the clinical features and genetic findings in a male patient with developmental delay, regression, and seizures. Whole-exome sequencing (WES) was performed on the patient to identify the genetic etiology of the patient. Sanger sequencing was used for variant confirmation. Clinical evaluations were conducted, including cerebrospinal fluid analysis, cranial MRI, EEG, and neurological assessments. The patient is a 1-year-old male who presented with psychomotor delays and developed seizures and impaired consciousness at 1 year of age. Cranial MRI revealed bilateral frontotemporal subarachnoid widening. Developmental regression was observed shortly after the onset of seizures. The EEG results showed diffuse slow background activity and epileptiform discharges. WES identified a rare homozygous variant in the PGM2L1 gene (OMIM: 611,610, NM_173582.6: c.1673delC, p.Thr558Ilefs*19), which was inherited from both parents. Sanger sequencing confirmed the presence of the variant, and it was evaluated as a likely pathogenic variant according to American College of Medical Genetics and Genomics (ACMG) guidelines. Our study was the second report of a PGM2L1 gene variant associated with early-onset developmental delay and seizures, further expanding the genetic spectrum of this disorder.

Chondroid lipoma is a rare benign soft-tissue tumour characterised by the presence of both mature adipose and chondroid-like extracellular matrix components. We present the case of a 34-year-old male who reported a slow-growing, painless swelling on the plantar aspect of the right foot evolving over two years, with a history of preceding trauma. The swelling was associated with sharp, pricking pain exacerbated by walking and relieved on rest in the last eight months. The patient had no similar lesions elsewhere and was newly diagnosed with diabetes without other comorbidities. Clinical evaluation and imaging are crucial for diagnosis, given the rarity and non-specific presentation of this tumour, especially at the uncommon plantar foot location, which can mimic other soft tissue masses. Magnetic Resonance Imaging (MRI) plays a significant role in delineating the tumour's extent and composition, aiding in surgical planning. Histopathological examination confirms the diagnosis by revealing a biphasic pattern of mature adipocytes mixed with chondroid areas devoid of malignant features. Complete surgical excision is the treatment of choice, with an excellent prognosis and a low likelihood of recurrence. This case underscores the importance of considering chondroid lipoma in the differential diagnosis of slow-growing, painful swellings in the foot, especially post-trauma, to avoid misdiagnosis and ensure appropriate management. Awareness of this rare entity enables clinicians to differentiate it from more aggressive neoplasms and tailor treatment accordingly, leading to better patient outcomes.