To explore the ultrasound finding, pregnancy outcome, and follow-up of fetuses with 16p11.2 microdeletion/microduplication to provide a basis for genetic counseling. Thirteen fetuses with 16p11.2 microdeletion/microduplication detected by chromosomal microarray analysis (CMA) at the Genetic Testing Center of Women's and Children's Hospital Affiliated to Qingdao University between January 2021 and March 2024 were selected as study subjects. Prenatal ultrasound finding, results of genetic testing and family verification, pregnancy outcome, and postnatal conditions were retrospectively analyzed. Data were analyzed using descriptive statistical analysis. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: QFELL-YJ-2024-159). Among 4 985 fetuses undergoing prenatal diagnosis, 13 (0.26%) were detected with 16p11.2 microdeletion/microduplication. Among these, 8 were microdeletions with a size ranging from 0.174 Mb to 0.84 Mb, and 5 were microduplications with a size ranging from 0.59 Mb to 0.89 Mb. The main prenatal ultrasound findings included cardiovascular abnormalities, vertebral developmental abnormalities, and nuchal translucency thickening. Parental tracing was performed in 12 of the 13 fetuses, with five cases verified to have a de novo origin, and seven originated from a phenotypically normal parent. Following genetic counseling, eight couples had opted induced labor, one couple with twin pregnancy had selected reduction of the abnormal fetus, whilst four couples had chosen to continue with the pregnancy. At follow-up, the liveborn infants were aged between 16 and 26 months, with one diagnosed with congenital heart disease, one with infantile epilepsy, and two showing no abnormality in growth and development. CMA testing holds a significant value for the prenatal diagnosis of 16p11.2 microdeletion/microduplication. For fetuses with positive results, it is necessary to consult and conduct long-term follow-up in conjunction with prenatal ultrasound and parental tracing results in order to provide appropriate guidance for pregnancy decision and selection of reproductive methods.

Cerebral "dirty-appearing" or "diffusely abnormal" white matter (DAWM) represents subtle white matter abnormalities that are associated with progression of cerebral small vessel disease (cSVD), but the association with cognitive function and dementia is unclear. Our aim was to study the association between DAWM and cognitive function, long-term cognitive decline, and long-term dementia risk in community-dwelling older adults with limited baseline cSVD burden. Participants of the prospective Age-Gene/Environment Susceptibility-Reykjavik longitudinal cohort study underwent 1.5T brain MRI scans. DAWM was visually rated on baseline fluid-attenuated inversion recovery (FLAIR) MRI as a percentage of lobar white matter volume (0%, 0%-10%, 10%-25%, or >25% DAWM) per brain lobe. Baseline DAWM ratings and white matter hyperintensity (WMH) volumes were associated with memory, executive function, and processing speed cognitive domain z-scores at baseline and their change at follow-up (after 5.2 ± 0.2 years) and with dementia status assessed at long-term follow-up (after 10.3 ± 2.2 years). This was performed by statistical models adjusted for age, sex, vascular risk factors, and education (for the cognition analyses). From 4,163 included participants, 2,081 participants were selected based on limited baseline WMH volume on FLAIR MRI (determined by a median split) (mean age: 74.6 ± 4.9 years, 61% female). Baseline DAWM ratings were not associated with baseline cognition z-scores (memory: B = 0.01 [-0.03 to 0.04], p = 0.637; executive function: B = 0.02 [-0.05 to 0.01], p = 0.244; processing speed: B = -0.01 [-0.04 to 0.01], p = 0.383), nor with cognitive decline after 5 years (memory: B = 0.03 [-0.01 to 0.06], p = 0.119); executive function: B = 0.01 [-0.02 to 0.04], p = 0.508; processing speed: B = -0.01 [-0.03 to 0.02], p = 0.498), nor with increased risk of dementia after 10 years (hazard ratio [HR] 0.93 [0.84-1.03], p = 0.156). By contrast, baseline WMH volume was associated with baseline cognition z-scores (executive function: B = -0.09 [-0.16 to -0.02], p = 0.011; processing speed: B = -0.08 [-0.15 to -0.02], p = 0.007), cognitive decline in processing speed after 5 years (B = -0.06 [-0.12 to -0.01], p = 0.024), and with a higher dementia risk after 10 years (HR 1.35 [1.04-1.73], p = 0.025). In contrast to WMH, DAWM was not associated with baseline cognition, long-term cognitive decline, nor long-term dementia risk in community-dwelling older adults with limited cSVD burden. Although DAWM is associated with progression of cSVD, its role in the development of cognitive impairment and dementia remains unclear.

Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.

A decade of colpocleisis: a retrospective analysis of outcomes, complications, and long-term patient satisfaction.

Multimodality imaging features and surgical correlation of fetus in fetu: An retrospective study with long-term follow-up.

Saphenous vein graft (SVG) failure following coronary artery bypass grafting may require re-intervention, with current guidelines favoring percutaneous coronary intervention (PCI) of the bypassed native coronary artery over SVG-PCI. The Percutaneous Coronary Intervention of Native Coronary Artery versus Saphenous Vein Graft in Patients with Prior Coronary Artery Bypass Graft Surgery (PROCTOR) trial is the first randomized controlled trial comparing native coronary artery PCI with SVG-PCI. The study shows that at 1year, SVG-PCI was associated with significantly lower major adverse cardiac events than native vessel PCI. These findings question existing guideline recommendations, although longer-term follow-up is required.

Traumatic spinal cord injury (SCI) induces rapid and adverse changes in body composition, yet effective strategies to prevent excess fat accumulation are limited. This study aimed to evaluate the effect of an individualized dietitian-led nutrition intervention on change in fat mass and related markers of adiposity during the first year following SCI. In this single-center, open-label randomized controlled trial, adults with subacute traumatic SCI were randomized to an individualized dietitian-led intervention or usual care. The primary outcome was change in total fat mass (FM) over one year, assessed by multifrequency bioimpedance analysis. Secondary outcomes included fat mass index (FMI), visceral adipose tissue (VAT), waist circumference, fat-free mass, fat-free mass index, body weight, body mass index (BMI) and biomarkers (fasting glucose, 2-h oral glucose tolerance test, HbA1c, LDL, HDL and triglycerides). Intention-to-treat analyses used mixed-effects models adjusted for age, sex, and neurological severity. Sixty-two participants were randomized (32 intervention, 30 control). Participants were predominantly male (76%) with a mean age of 48 (SD 17) years. At 1 year, the adjusted between-group difference in FM change was -1.5 kg (95% CI -4.8 to 1.9; p = 0.39). Significant between-group differences were observed for VAT (-0.5 L; 95% CI -1.0 to -0.1; p = 0.02) and waist circumference (-4.0 cm; 95% CI -7.0 to -1.0; p = 0.01), with borderline significance for FMI (-1.6 kg/m2; 95% CI -3.2 to 0.0; p = 0.05). No significant between-group differences were observed for body weight, BMI, fat-free mass, or biomarkers. Sensitivity and per-protocol analyses yielded consistent results. Although the intervention did not significantly affect the primary endpoint of total fat mass, between-group differences were observed for VAT and waist circumference. These findings suggest that structured, individualized dietetic care initiated during SCI rehabilitation and continued post-discharge may attenuate accumulation of abdominal adiposity. Longer-term follow-up is needed to determine whether early attenuation of abdominal adiposity translates into reduced cardiometabolic risk and improved functional outcomes. NCT04109586.

Study Design: A multicenter, prospective and retrospective, real-world evidence study conducted at eight US sites (PAULA, NCT05640908). Objective: To assess the one-year interim results of the clinical performance and safety of 3D-printed porous pelvic fixation implants (PPFI) in adult patients undergoing multilevel (≥4 levels) spinal fusion with pelvic fixation. Summary of Background Data: Adult spine deformity (ASD) is a prevalent cause of low back pain and disability among older adults. Complex multilevel spinal fusion with pelvic fixation is commonly performed to restore alignment and reduce hardware failure. Despite advancements in fixation techniques, pelvic construct failure remains frequent, contributing to high rates of mechanical complications and revision surgeries. Materials and Methods: Adults scheduled for spinal fusion with pelvic fixation using a PPFI were enrolled prospectively or retrospectively. Eligible patients were adults undergoing lumbar fusion of ≥4 levels with pelvic fixation using PPFIs. Collected assessments consisted of patient-reported outcomes (PROs), x-rays, and advanced imaging (CT scan, MRI), as per standard of care, and adverse events at 6, 12, and 24 months postprocedure. Statistical analyses included the Fisher exact test and general linear modeling. Results: A total of 122 patients were treated (36 primary and 86 revision fusions). Thirty-six (28.8%) of cases were primary surgery, and 89 (71.2%) were revision surgeries. The mean (SD) age at study entry was 64.1 (10.4) years, BMI 30.8 (6.0), and 56.8% female. Four device-related adverse events (3.2%) were reported, comprising one primary PPFI failure, two distal rod fractures, and one case of PPFI malposition. At 12 months, mean low back pain decreased from 7.2 to 4.5 points, and mean Oswestry Disability Index improved from 55.2 to 39.6 points, representing clinically meaningful improvements. Conclusion: PPFI demonstrated a low rate of primary implant-related failure and favorable short-term clinical outcomes in patients undergoing complex multilevel fusion for ASD. Longer-term follow-up and radiographic data are needed to determine whether these advantages persist over time. Level of Evidence: Level III.

Antinuclear antibody and delayed immunotherapy predict disease evolution in isolated optic neuritis-onset NMOSD: A long-term cohort study.

Achieving long-term behavioural change in chronic disease management, particularly in chronic obstructive pulmonary disease (COPD), remains a significant challenge. Although maintenance programmes have been developed to extend the benefits of pulmonary rehabilitation, patient adherence is often comperomised by persistent symptoms, low motivation, and fragmented care. Research highlights the importance of therapeutic alliance, social support, and personalised follow-up to encourage long-term healthy behaviour. Care managers (CMs) may help facilitate these key elements by providing individualised support and coordination. The aim of this study is to identify key elements that support the sustainable implementation of the CM role in chronic care pathways, by exploring the shared experiences of COPD patients and CM involved in an 18-month remote follow-up post-rehabilitation programme. A qualitative descriptive study was conducted using semi-structured interviews with COPD patients and care managers who participated in the INSPIR'ACTION national experiment. This programme included an initial pulmonary rehabilitation phase followed by an 18-month remote follow-up. Interviews focused on the follow-up phase and were analysed using inductive thematic analysis. Data saturation was reached with a final sample of 9 patients and 7 CMs. Patients described CMs as supportive professionals who helped sustain motivation, adherence to healthy behaviours, and continuity of care. The relationship was perceived as trustful and personalised, even in a remote format. CMs expressed pride in their role but also reported organisational challenges, including lack of recognition and insufficient time allocation. Both groups emphasised the importance of relational continuity and individualised support. Patients and care managers described the CM as a key supportive figure offering personalised follow-up perceived as helping promote therapeutic engagement and behavioural change. Relational continuity throughout the remote follow-up was seen as fostering a trusting relationship that shaped participants' experience of the programme. By highlighting organisational elements that could influence implementation, our study may help inform future strategies to enhance the sustainable integration of care management in COPD care pathway. COPD patients and CMs involved in the INSPIR'ACTION programme shared their experiences through interviews, helping to identify key factors for improving care manager support and long-term follow-up. Their input directly informed the study's findings and recommendations.

Right ventricular pacing increases the risk of dyssynchrony, which raises the need for more physiological pacing strategies. Left bundle branch area pacing (LBBAP) has emerged, with most early studies utilizing lumen-less pacing leads. The feasibility and safety of LBBAP using conventional stylet-driven pacing lead (SDL) have been reported. We present prospective multicenter data, particularly in Asian clinical settings. The ACHIEVE-SYNC pilot study was a multicenter prospective observational cohort study conducted across several tertiary hospitals in South Korea. Patients with standard indications for pacemaker implantation underwent LBBAP using a 5.6Fr SDL with an extendable screw. Procedural success rate and LBBAP-related complications were evaluated. Pacing parameters, electrocardiographic features, and echocardiographic outcomes were assessed up to 12 months after implantation. LBBAP using SDL was successful in 100 of 101 (99.0%) patients. LBBAP lead-related adverse event occurred in 1 case (0.99%), which was lead dislodgement. The median pacing threshold at 12-month follow-up was 0.8 [0.7-1.0] V at 0.5 ms. At 12-month follow-up, the mean QRS duration changed from 119.2 ± 28.6 ms to 131.2 ± 23.8 ms. The mean left ventricular ejection fraction was 61.3% ± 8.5% before the procedure and 61.3% ± 7.5% at 12-month follow-up. In this prospective multicenter registry, LBBAP using SDL demonstrated a near-complete procedural success rate and a high incidence of confirmed Left bundle branch capture. Lead performance remained stable during long-term follow-up, and adverse events were rare, supporting the safety and technical feasibility of this approach in routine clinical practice.

Long-term outcomes of middle ear regenerative therapy using cell sheet transplantation combined with tympanoplasty.

To evaluate the radiological bone loss and survival outcomes of teeth adjacent to dental implants (TAIs) in comparison to non-adjacent teeth (TNIs) of similar type and baseline condition, using a matched retrospective cohort design. This retrospective study included 233 patients treated with 348 implants between 2013 and 2020 at the University of Freiburg. A total of 480 TAIs and 348 matched TNIs were observed over a mean follow-up of 54 months. Radiographic bone levels, survival rates, and restorative interventions were compared. Control teeth (TNIs) were matched by tooth type and jaw location. Statistical analyses included t-tests, Chi-squared tests, Kaplan-Meier survival analysis, and multivariate Cox-regression. TAIs demonstrated significantly greater bone loss than TNIs (mean: 4.3 % (SD 6.8 %, median: 1.6 %, IQR: 0 - 6.1 %) vs. mean 3.1 % (SD 5.23 %, median: 0.9 %, IQR: 0 - 4.4 %), p = 0.005). New crown restorations were significantly more frequent in TAIs (14.4 %) than TNIs (7.3 %, p = 0.04), though differences in root canal therapy rates were not significant. Survival analysis showed higher 5-year survival rates for TNIs compared with TAIs (93.6 % vs. 88.6 %, p = 0.015). After adjustment for relevant covariates, implant adjacency showed only a limited association with tooth survival, and a stronger association with restorative factors. The most common causes of TAI loss were root fracture and caries. Teeth adjacent to dental implants showed higher rates of bone loss and restorative interventions compared with TNI. This is the first investigation on TAI-survival with respect to preexisting restorative and site-specific conditions of both the TAI and the control teeth, indicating that restorative and endodontic conditions play a greater role than implant adjacency itself. The findings indicate that implant adjacency has a limited effect on the survival of neighboring teeth when tooth-related factors are adequately controlled. Pre-existing restorative conditions, particularly crown restorations and root canal treatment, seem to play a more important role and should be considered in treatment planning and long-term follow-up.

Mid- to Long-Term Outcomes of Intracranial Aneurysms Treated with the Silk Flow Diverter: A Single-Center Experience.

To map current evidence on artificial intelligence (AI)-enhanced robotic systems for dental implant placement, focusing on system autonomy, accuracy, and clinical applicability. This mixed-method scoping review followed PRISMA-ScR guidelines and included studies published up to August 2025. Five electronic databases were systematically searched (PubMed, Scopus, Web of Science, Embase, Cochrane Library), supplemented by grey literature search, to identify English-language studies assessing robotic-assisted dental implant placement in terms of accuracy, time efficiency, or clinical feasibility. Two reviewers independently performed study selection, data extraction, and quality appraisal. Quantitative data were pooled descriptively using random-effects models with subgroup analyses, while remaining findings were synthesized narratively. A parallel search identified commercially available robotic and dynamic navigation systems, including their regulatory status, validation level, and human-robot interaction features. The systematic search identified 27 studies evaluating robotic-assisted dental implant placement met the inclusion criteria. Methodological quality was generally high, with 92.6% of studies scoring ≥ 8/10 on the Mixed Methods Appraisal Tool (MMAT). Robotic systems demonstrated high placement accuracy, with a mean coronal deviation of 0.45 mm, apical deviation of 0.50 mm, and angular deviation of 0.80° However, statistical heterogeneity was high across outcomes (I² > 97%). Subgroup analyses indicated that fully autonomous robotic systems achieved the lowest deviation values. Implant placement in the mandible showed greater accuracy compared with maxillary and zygomatic sites. When compared with dynamic navigation systems, robotic-assisted approaches demonstrated comparable linear deviations but superior angular precision. Limited evidence suggested potential improvements in procedural efficiency, particularly in multi-implant cases. Robotic systems show strong technical performance, but current evidence is dominated by in vitro and single-center studies with limited long-term clinical data. Future multicenter trials with standardized outcomes and long-term follow-up are needed to confirm clinical benefits. Robotic systems offer high accuracy and reproducibility in dental implant placement, potentially improving efficiency and reducing variability in complex cases. However, clinical adoption should be guided by further multicenter trials with long-term outcomes.

Posttraumatic stress disorder (PTSD) is a chronic and disabling condition and identifying beneficial therapies is timely and important. We aimed to estimate the efficacy of 3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) compared with control on clinical and functional outcomes in PTSD. A PRISMA-compliant search (PROSPEROCRD42022353261) up to August 14, 2025, covered nine databases and manual searches to identify randomised controlled trials (RCTs). Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB2), and the certainty of the evidence for each outcome was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Of 1035 records identified, 14 studies met inclusion criteria for qualitative synthesis; eight trials provided sufficient data for quantitative synthesis (k = 24). Random-effects meta-analyses indicated that MDMA-AT was associated with reductions in PTSD symptom severity (n = 298, k = 9, SMD = -1.19, 95 % CI [-1.95, -0.42]; I² = 68.8 %, τ2 = 1.02), dissociative symptoms (n = 148, k = 5, SMD = -0.37, 95 % CI [-0.70, -0.04]; I² = 0.0 %, τ2 = 0), and may improve functioning (n = 227, k = 4, SMD = -0.83, 95 % CI [-1.47, -0.19]; I² = 61.2 %, τ2 = 0.27). No clear evidence of benefit was observed for depressive symptoms. Most studies showed a high risk of bias in the measurement of the outcome, and some concerns due to deviations from the intended intervention; the overall certainty of the evidence was very low. The number of trials remains limited, with considerable heterogeneity in certain outcomes, small sample sizes, and the absence of active controls in most studies, which likely compromised blinding integrity. Current findings suggest that MDMA-AT may warrant further investigation as a potential treatment for PTSD; however, larger, higher-quality RCTs with active controls and long-term follow-up are needed to determine its efficacy.

Evaluation of presurgical infant orthopedics by the rhinoplasty appliance system with intraoral alveolar molding appliance in infants with bilateral cleft lip and palate: A preliminary study.

Older adults have a higher prevalence of pain and are more likely to receive long-term opioid therapy (LTOT) compared to other age groups. They are also at elevated risk of opioid-related adverse events due to physiological changes and polypharmacy. This systematic review aimed to identify predictors and clinical outcomes associated with LTOT in older adults. We searched PubMed, Embase, and Cochrane Library to identify randomized clinical trials (RCT) and observational studies published from inception until July 31, 2025. We included studies that examined opioid use for ≥ 90 days and included participants aged ≥ 60 years. Data were synthesized using harvest plots and narrative synthesis. The Newcastle-Ottawa Scale was used for risk of bias assessment. Forty-one observational studies were included; no RCTs met the inclusion criteria. Patient-related factors associated with LTOT across most studies were low income/wealth (n = 6/6 studies), depressive disorders (n = 6/9 studies), and dual insurance eligibility/enrollment (n = 4/6 studies). Prescription/dispensation-related factors associated with LTOT across most studies were opioid use before surgery/trauma (n = 6/6 studies), prior/concurrent use of benzodiazepines (n = 6/6 studies), anxiolytics/sedatives/hypnotics (n = 3/4 studies), anticonvulsants (n = 3/4 studies), opioid use after surgery/trauma (n = 3/3 studies), long-acting opioids (n = 3/3 studies), and longer duration of initial opioid (n = 2/2 studies). Regarding outcomes of LTOT, most studies reported positive associations between LTOT and hospital readmission/emergency department visit (n = 3/4 studies), revision surgery (n = 2/2 studies), health care costs (n = 2/2 studies), opioid overdose (n = 1/1 study), and falls (n = 1/1 study). Evidence on the association of LTOT with mortality and fractures was inconclusive. This systematic review identified several predictors and adverse outcomes associated with LTOT in older adults. However, no evidence exists regarding the effectiveness of LTOT for pain management in this population. Prospective studies with long-term follow-up are needed to address this gap and inform benefit-harm assessment of LTOT in clinical practice.

Diagnostic accuracy of contrast-enhanced mammography (CEM) for the evaluation of mammographic asymmetries: A systematic review and meta-analysis.

Effect of dialectical behavior therapy on affective symptoms in borderline personality disorder: A systematic review and meta-analysis.