The insula helps regulate affective distress and plays a critical role in maintaining tobacco use disorder. Task-based functional connectivity underlying cognitive performance during affective distress has previously distinguished between current smoking and long-term ex-smoking behavior. In the current study, we investigated whether individual differences in distress-related functional connectivity corresponded to short-term quit attempt outcomes. Participants performed a distress tolerance task while undergoing magnetic resonance imaging and planned a quit attempt a few days later. Participants completed five follow-up visits across 10 weeks to verify smoking status. Participants were then grouped based on quit outcomes (e.g., ≥ 7 consecutive days Abstained n = 13, ≥ 7 days Reduced cigarettes/day n = 18, or Smoked n = 27). In the right anterior insula and left posterior insula, there was a stepwise pattern of distress-related connectivity across groups (Abstained < Reduced < Smoked). The Smoked group had the strongest positive distress-related connectivity and this was associated with their negative mood and task accuracy. Stronger distress-related connectivity with the insula may represent increased cognitive-affective effort needed to tolerate distress during cognitive performance. The relationship across Abstained, Reduced, and Smoked groups suggests this measure of distress tolerance plays a role in the ability to quit smoking. This insula connectivity could be a modifiable target for neuromodulation to help reduce the cognitive-affective effort needed to refrain from smoking during stress-induced craving.

Adherence to anti-Tuberculosis treatment during the COVID-19 pandemic: a single-centre, retrospective analysis.

Autoimmune disease is associated with heightened long COVID risk but prior immunization is protective.

Association between dietary protein intake and frailty index among home-dwelling older adults; an 8-year follow-up study.

A Value Analysis of the National Accreditation Program for Breast Centers on Prices for Breast Care.

Facioscapulohumeral muscular dystrophy (FSHD) is a muscle disease that leads, among other manifestations, to facial weakness. This weakness can severely impact communication and quality of life, yet it remains under-researched with limited objective clinical measures. Current manual scoring methods are subjective and exhibit suboptimal inter-observer agreement. This study aimed to develop and validate a deep learning-based facial weakness score (DLFWS) as an objective clinical outcome measure for facial weakness in FSHD. One hundred and twenty-two genetically confirmed FSHD patients and 56 controls were recruited. Sixty-four patients had a 5-year follow-up visit. Video recordings of participants performing seven facial exercises, each repeated three times, were analyzed using a convolutional neural network. The deep learning-based facial weakness score (DLFWS) was trained by comparing start and end frames from these exercises with the manual facial weakness scores (MFWS) assigned by three experienced observers. Pearson correlation coefficients and intraclass correlation coefficients (ICC) were used to evaluate the DLFWS's performance and reliability. The DLFWS showed a strong correlation with the MFWS across exercises, with a mean Pearson correlation of 0.79 and a maximum of 0.85 for individual exercises. The DLFWS demonstrated excellent test-retest reliability, with an ICC of 0.90. Over a 5-year follow-up period, no significant progression of facial weakness was detected. The DLFWS provides a reliable and objective assessment of facial weakness in FSHD patients. This automated tool holds potential for widespread clinical and research applications, enabling standardized assessment of facial weakness in FSHD.

Public Insurance Is Associated With Increased Emergency Visits After Craniosynostosis Surgery.

A longitudinal and explainable 2.5D deep learning framework for Alzheimer's disease progression using ADNI MRI.

Esketamine in treatment-resistant depression with and without comorbid borderline personality disorder: A real-world longitudinal study of suicidal ideation and self-harm.

Systemic Immunosuppressant Cessation/Tapering Linked to MGD Progression Post-HSCT.

The toddler milk intervention trial (ToMI): A randomized controlled trial on the effect of protein content in young child formula on BMI and growth.

To investigate changes in the pupil size and accommodation following prophylactic peripheral laser retinopexy (PPLR). This prospective self-controlled study enrolled patients who underwent unilateral PPLR. The photopic and mesopic pupil diameters (PPD and MPD), accommodative amplitude (AA), and central corneal sensation (CCS) were measured at baseline and 1 week, 1 month, and 3 months post-PPLR in both the treated eye and the untreated fellow eye. Standard ophthalmic examinations were also performed at each follow-up visit. Longitudinal changes were analysed by using baseline-adjusted linear mixed-effects models comparing the treated and fellow eye over time. Associations between pupillary or accommodative changes and baseline characteristics were evaluated with multivariable regression. A total of 98 patients (98 treated and 98 fellow eyes) were analysis. Both the PPD and MPD increased significantly at 1 week post-PPLR compared with those at baseline. By 1 month, the dilation of the PPD and MPD had decreased but remained significant. At 3 months, neither the PPD nor the MPD significantly differed from baseline at the group level. A higher laser dose was strongly associated with the development of pupil dilation. Compared with that at baseline, the AA in the treated eyes significantly decreased at 1 week and 1 month after PPLR, with the difference no longer reaching statistical significance at 3 months. No significant differences in CCS were detected at any follow-up visit. PPLR resulted in significant but transient increases in the PPD and MPD, along with a temporary reduction in accommodation. A higher number of laser spots was significantly associated with postoperative pupil dilation. These potential effects should be discussed with patients prior to treatment, particularly with those scheduled for refractive surgery.

Urinary tract endometriosis affects fewer than 6% of patients with endometriosis, with ureteral involvement representing the second most common site of disease (9-23%). The condition is often asymptomatic, which may result in silent loss of renal function. Surgical intervention is required in cases of ureteral obstruction. Ureteroneocystostomy is indicated for distal ureteral disease, particularly when ureterolysis is insufficient or vascular compromise is present. The Lich-Gregoir technique is an extravesical approach to ureteral reimplantation into the bladder. To present a step-by-step demonstration of robot-assisted ureteral reimplantation using the Lich-Gregoir technique following excision of a parametrial and vaginal endometriosis nodule. A 47-year-old nulliparous woman presented with dysuria, deep dyspareunia, and dyschezia. Imaging revealed a left parametrial endometriosis nodule extending to the vagina, causing distal ureteral obstruction and grade III hydronephrosis. This narrated video demonstrates the surgical management of severe ureteral endometriosis, including ureterolysis, safe nodule excision, and ureteral reimplantation using the Lich-Gregoir technique. Reimplantation was preferred to segmental resection or ureterolysis due to distal stenosis, proximity to the bladder, and the depth of disease infiltration. The patient remained asymptomatic at follow-up visits at 1 and 6 months. Retrograde cystography performed 3 weeks postoperatively showed no leakage. Robot-assisted Lich-Gregoir ureteral reimplantation represents a feasible and reproducible option for distal ureteral endometriosis. The robotic platform may facilitate precise and complex reconstructive procedures. The case illustrates the role of robotic surgery in complex pelvic endometriosis, demonstrates the feasibility of integrating ureteroneocystostomy with simultaneous excision of parametrial and vaginal endometriosis.

Metabolic instability can affect cognitive function, but the mechanisms are largely unknown. To address this, we investigated the association between metabolic parameter variability, brain volume, cerebral blood flow (CBF), and cognitive performance, and evaluated whether CBF and brain volume mediate this relationship. Participants were prospectively included from the Kailuan study. Between 2006 and 2020, the variability in metabolic parameters such as systolic blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, and body mass index was evaluated using the coefficient of variation (CV). Starting in 2020, brain MRI and the Montreal Cognitive Assessment (MoCA) were performed continuously as part of the seventh follow-up visit and subsequent assessments. Generalized linear regression models were used to analyze the associations between metabolic variability, CBF, brain volume, and cognitive performance. Mediation analysis was performed to evaluate the mediation effects of CBF or brain volume. A total of 1894 participants (mean age, 55.4 ± 10.9 years; 51.8% male) were included. High variability scores of metabolic parameters were associated with lower CBF in total brain (β [95% confidence interval]: -2.02 [-3.73, -0.30]), total white matter (WM) (-3.04 [-4.72, -1.37]), temporal lobe (-1.82 [-3.60, -0.03]), and hippocampus (-1.91 [-3.65, -0.17]), as well as decreased volume in both total gray matter (GM) (-5.64 [-11.24, -0.04]) and temporal lobe (-1.70 [-3.16, -0.25]). High variability in metabolic parameters was associated with reduced MoCA scores (-0.98 [-1.75, -0.20]). After multiple comparison correction, the association with total WM CBF remained significant. Decreased brain volume and CBF were associated with reduced MoCA scores (P < 0.05). Mediation analysis revealed that the association between variability in metabolic parameters and MoCA scores was mediated by total WM CBF, total GM volume, and temporal lobe volume, accounting for 7.518%, 5.619%, and 6.864% of the effect, respectively. Reduced total WM CBF, GM volume, and temporal lobe volume mediated the association between elevated metabolic variability and cognitive decline, with total WM CBF showing the most robust mediating effect.

Standardized workflows supporting primary care provider (PCP) detection and management of obesity and its comorbidities are lacking in resource-poor settings. We evaluated the use of technological and visual aids to support PCP documentation, assessment, and management of comorbidities in youth with overweight and obesity. A prospective electronic medical record (EMR) chart review evaluated the impact of technological (EMR SmartPhrases) and visual (graphic and written reminders) aids, as well as provider training, on standardizing provider documentation and management of overweight- and obesity-related comorbidities during health care maintenance visits. Baseline intervention (T0) and postintervention (T1, T2, and T3) assessments were conducted from March 2022 to June 2023. Patient charts of children aged 5-12 years with overweight and obesity were reviewed for PCP identification of comorbidities, relevant laboratory orders, plans, and 3-month follow-up. T1, T2, and T3 measures were compared with T0 measures using Fisher's exact test and t-test for categorical and continuous variables, respectively. Of 100 baseline and 300 postintervention charts reviewed, 3-month follow-up visits increased significantly in patients with overweight and class 1 obesity (3%-27% and 14%-40%, respectively, from T0 to T3; p = 0.02). Planned lifestyle changes increased significantly in patients with class 1 obesity (8% at T0 versus 30% and 40% at T1 and T2; p = 0.02 and p = 0.002), respectively, but not in patients with overweight. Initial increases in the use of aids were not sustained. Technological and visual aids, along with PCP training, may support the adoption of standardized provider documentation, assessment, and management of weight-related comorbidities in youth with overweight and obesity in resource-poor settings.

To evaluate the outcomes of a street medicine intervention offering syphilis testing and treatment to people experiencing homelessness in South Los Angeles, California-a population disproportionately affected by syphilis and underserved by traditional healthcare systems. From September 2024 to January 2025, a multidisciplinary street medicine team provided testing and treatment for syphilis during outreach visits to patients experiencing homelessness. A total of 99 patients were tested using the reverse syphilis testing algorithm. Demographic data included gender, race/ethnicity, substance use disorder, mental illness and HIV status. χ2 tests were used to evaluate associations between syphilis diagnosis and each demographic characteristic. Thirty-six (36.4%) of the 99 patients had reactive syphilis test results, with 94.4% (n=34) classified as late-stage infections. Of those diagnosed, 72.2% (n=26) were treated during follow-up visits. Statistically significant associations were found between syphilis diagnosis and gender (p=0.002), substance use disorder (p=0.008) and HIV status (p=0.020). Patients identifying as female or transgender female, and those with cooccurring substance use disorder or HIV, were more likely to be diagnosed with syphilis. This study demonstrates the feasibility and outcomes of delivering sexually transmitted infection care through street medicine. The high prevalence of late-stage syphilis and its syndemic overlap with substance use disorder and HIV underscores the need for low-barrier, community-based services. Street medicine interventions should be recognised and resourced as essential tools in public health responses to rising syphilis rates, particularly among unhoused populations.

Objective To investigate the association between lead exposure and anthropometric indicators in school-aged children.Methods Data were derived from a cohort of children in a district of Chongqing, Southwest China. At baseline, a self-administered questionnaire was used to collect information on date of birth, sex, parental education, household income per capita, residence, birth weight, and feeding practices during the first six months. Anthropometric measurements were conducted at baseline and during three follow-up visits. Urinary lead levels were quantified using inductively coupled plasma mass spectrometry (ICP-MS). Linear mixed-effects models were employed to evaluate the impact of urinary lead concentrations on anthropometric outcomes.Results A total of 699 children (423 boys and 276 girls) with a mean age of 7.92 ± 0.88 years were included. Urinary lead levels were negatively associated with body weight (β = -1.83; 95% CI: -3.14, -0.51), BMI (β = -0.70; 95% CI: -1.26, -0.14), WC (β = -2.16; 95% CI: -3.81, -0.51), HC (β = -1.69; 95% CI: -3.08, -0.30), WtHR(β = -0.01; 95% CI: -0.02, 0.00), and BF% (β= -1.75; 95% CI: -3.43, -0.08). Longitudinal analysis indicated that, over each six-month interval, higher urinary lead levels were associated with an accelerated increase in BF% within a certain range.Conclusion Lead exposure in school-aged children is negatively associated with body weight, BMI, WC, HC, and BF%.These findings underscore the importance of minimizing lead exposure in children as early as possible.

Distal penile urethral loss with preserved intact glans penis represents an exceptionally rare clinical scenario in pediatric urology, with many experienced surgeons encountering only a handful of such cases throughout their careers. This unique anatomical presentation-characterized by a well-formed glans with viable distal pouch and proximal penile urethral discontinuity-has traditionally been managed with multi-stage procedures requiring dismantling of the existing glans architecture. This study evaluates a novel single-stage technique that preserves the intact glans while achieving tension-free anastomosis, and compares outcomes and complications with conventional multi-stage approaches. Thirty-two pediatric patients (median age: 5 years; IQR: 3.5-8 years) with anterior urethral defects underwent reconstruction using complete mobilization of the corpus spongiosum, including both penile and bulbar urethra, through a T-shaped incision. Progressive urethral traction was applied to achieve a wide, tension-free anastomosis, covered by healthy skin without overlapping suture lines. Functional and cosmetic outcomes were assessed clinically by the operating surgeon. Successful outcomes defined by the absence of fistula, stricture, or recurrent discontinuity. Caregiver-reported satisfaction was measured using a 10-point Likert scale at follow-up visits. Among the 32 included patients, 26 cases (81.3%) resulted from failed hypospadias repair and 6 cases (18.7%) followed traumatic penile injury. The median urethral gap was 1.4cm (IQR: 0.9-1.8cm). All patients underwent successful glans preservation with no need for glans dismantling. At a median follow-up of 28 months, 27 patients (84.4%) achieved successful outcomes. Early complications included urethrocutaneous fistula (9.4%), stricture (6.3%), scrotal hematoma (12.5%), and minor wound dehiscence (6.3%). No cases of penile curvature were observed. Caregiver satisfaction was high, with a median score of 9 (IQR: 9-10). By avoiding dismantling of well-formed structures and eliminating grafting or multi-stage requirements, the technique offers a promising single-stage alternative for complex cases of penile urethral reconstruction post-hypospadias repair and penile trauma. It ensures proper alignment and tension-free anastomosis, potentially reducing the risk of complications.

Pediatric mild traumatic brain injury (mTBI) is common and can potentially lead to novel psychiatric disorders (NPDs). However, the psychiatric sequelae of mTBI in community-dwelling children require further study. NPDs were characterized during the first 2 years following injury in children with a first lifetime mTBI between 9 and 11 years of age in the Adolescent Brain Cognitive Development study (n = 99), compared with orthopedically injured (n = 380) and noninjured (n = 374) controls. Outcomes were defined as NPD-Any (NPD-A), which included all NPDs with onset during the study period, and NPD-Current (NPD-C), which included only those NPDs that were still active at the follow-up study visit. Possible confounders, including injury and non-injury-related factors, were also considered. NPDs were common at the year 2 study visit, particularly anxiety disorders, but rates were similar across injury groups. Mild TBI was not associated with differential odds of NPD. However, family psychiatric history predicted greater odds of NPD (for NPD-C, odds ratio [OR] = 1.345; 95% confidence interval [CI] = 1.124-1.615; p < 0.001; for NPD-A, OR = 1.217; 95% CI = 1.078-1.375; p = 0.002), and pre-injury psychiatric disorder was associated with increased risk of NPD at year 2 (for NPD-C, OR = 1.557; 95% CI = 1.022-2.346; p = 0.037; for NPD-A, OR = 1.568; 95% CI = 1.198-2.055, p = 0.001). In this representative community-dwelling sample of children in the United States who experienced a first lifetime mTBI between 9 and 11 years of age, mTBI was not associated with risk for NPDs in the first 2 years following injury. However, non-injury-related factors, including family psychiatric history and pre-injury psychiatric disorders, were associated with NPDs.

The benefits of initial palliative care (PC) consultation for patients with amyotrophic lateral sclerosis (ALS) have been previously described. The aim of this study was to explore the evolution of PC needs of patients with ALS over time through analysis of PC follow-up visits. Patients followed at a multidisciplinary ALS clinic received PC consultations and follow-ups between October 2020 and April 2022. All patients who received at least one PC follow-up visit were included in this study. Physician documentation of the visits was analyzed for sub-themes and topics. Topics discussed during visits and visit frequency were examined in the context of patient variables. The 26 patients had at least one PC follow-up visit (range 1-12 visits). Topics of discussion varied by individual rather than disease status and were often discussed repeatedly. Compared to initial consultations, follow-up visits featured more frequent discussion of sialorrhea and less frequent discussion of constipation, pain, and prognosis (all p < 0.05). Care coordination was discussed in 82% of follow-ups. Time between follow-up visits shortened as the disease progressed. Medical assistance in dying (MAID) was discussed by 31% of patients either at initial consultation or follow-up. Each individual with ALS has unique PC needs. PC specialist resource planning should anticipate higher frequency visits for patients later in the disease course. Given the importance of care coordination and the scarcity of PC specialists, we recommend further study of effective models of care coordination. We recommend that PC specialists be comfortable counseling patients on MAID.