Objective: To investigate the clinical characteristics of symptoms and signs of ocular surface lesions in dry eye patients with type 2 diabetes mellitus (T2DM) of different disease durations. Methods: A cross-sectional study was conducted. Consecutive T2DM patients complicated with dry eye who visited the Special Clinic for Diabetic Ocular Surface Diseases at Qingdao Eye Hospital, Shandong First Medical University from January 2020 to December 2024 were enrolled as the T2DM group. Dry eye patients without T2DM from the Dry Eye Clinic and age-and gender-matched healthy volunteers were recruited as the non-T2DM group and control group, respectively. The T2DM group was further divided into four stages according to disease duration: Stage Ⅰ (duration≤5 years), Stage Ⅱ (5 years<duration≤10 years), Stage Ⅲ (10 years<duration≤20 years), and Stage Ⅳ (duration>20 years). Ocular symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Ocular surface function was assessed by corneal sensitivity (CS), corneal fluorescein staining (CFS) score, Schirmer Ⅰ test (SⅠT), tear meniscus height (TMH), non-invasive first tear film break-up time (NIKf-BUT), non-invasive average tear film break-up time (NIKav-BUT), lipid layer thickness (LLT), and meibomian gland loss (MGL) grading score. Anterior segment optical coherence tomography was used to measure central corneal epithelial thickness (CCET) and central corneal thickness (CCT). In vivo confocal microscopy was performed to detect corneal nerve fiber parameters. Spearman's rank correlation analysis was used to evaluate the correlations between variables. Results: A total of 278 T2DM patients (556 eyes) were enrolled in the T2DM group, with a mean age of (60.25±8.71) years, a male-to-female ratio of 117∶161, and a mean disease duration of (11.09±8.02) years; among them, 84 cases were Stage Ⅰ, 81 cases Stage Ⅱ, 90 cases Stage Ⅲ, and 23 cases Stage Ⅳ. The non-T2DM group included 60 patients (120 eyes), with a mean age of (58.52±7.93) years and a male-to-female ratio of 23∶37. The control group comprised 53 healthy volunteers (106 eyes), with a mean age of (58.79±5.73) years and a male-to-female ratio of 21∶32. There were no statistically significant differences in age and gender distribution among the three groups (all P>0.05). Compared with the control group, the T2DM group showed significantly higher OSDI score (31.58%±20.56%), MGL grading score (3.59±0.95) and CFS score (1.84±3.01) (all P<0.05); while significantly lower SⅠT [(5.79±3.10) mm], NIKf-BUT [(5.81±3.14)s], NIKav-BUT [(9.31±4.85)s], LLT [(60.48±16.6) nm], CCET [(51.95±5.56) μm], CS [(56.9±8.30) mm], corneal endothelial cell density [(2 596±465.38)/mm²], and all corneal nerve parameters (including paracentral corneal nerve fiber density and length, etc.) (all P<0.05). Compared with the non-T2DM group, the T2DM group had significantly lower LLT, CCET, CS, OSDI score and all corneal nerve parameters, along with significantly higher MGL grading score and CFS score (all P<0.05); no statistically significant differences were found in SⅠT, NIKf-BUT and NIKav-BUT between the two groups (all P>0.05). In T2DM patients with disease duration≤5 years, compared with the control group, the OSDI score (23.98%±18.21%) and MGL grading score (3.35±0.91) were significantly increased, while SⅠT [(5.65±2.93) mm], LLT, NIKf-BUT and all corneal nerve parameters were significantly decreased (all P<0.05); meanwhile, compared with the non-T2DM group, this subgroup had significantly lower OSDI score and significantly higher MGL grading score (all P<0.05). When the disease duration exceeded 10 years, the OSDI score further increased to be comparable with that of the non-T2DM group, and NIKf-BUT [(5.44±2.92)s], CFS score (2.75±3.25), CCET [(51.36±4.17) μm], CS [(55.21±8.02) mm] showed statistically significant differences compared with both the control group and non-T2DM group (all P<0.05). Spearman's correlation analysis indicated that disease duration was significantly positively correlated with OSDI score, MGL grading score and CFS score, and significantly negatively correlated with NIKf-BUT, CCET, CS and all corneal nerve parameters (all P<0.05). Conclusions: Ocular surface lesion characteristics vary among dry eye patients with T2DM of different disease durations: decreased tear secretion, meibomian gland dysfunction and corneal nerve structural changes occur when the disease duration is ≤5 years, and corneal hypoesthesia and epithelial thinning develop when the duration exceeds 10 years, with lesions gradually worsening as the disease progresses. Compared with non-diabetic dry eye, significant differences exist in meibomian gland function, corneal nerves and epithelial barrier between the two groups.

Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism after Parkinson disease (PD). It is crucial to diagnose DIP in patients presenting with parkinsonian symptoms because discontinuation of the offending drug can improve parkinsonism. However, the detailed pathophysiology of parkinsonism related to striatal dopamine receptor blockade and disease-specific cerebral changes remains unclear. In this cross-sectional study, we recruited patients with DIP who underwent the Unified Parkinson's Disease Rating Scale (UPDRS) assessment, brain MRI, and dual-phase 18F-FP-CIT PET. The offending drugs were gastrointestinal prokinetics (DIPGI) and antipsychotics (DIPAP). In addition, we enrolled early and drug-naïve patients with PD and healthy controls (HCs). We compared early-phase 18F-FP-CIT uptakes between DIP, PD, and HC groups and investigated its association with the UPDRS part III total score. We calculated the DIP-related perfusion patterns using W-scores, compared their expression among groups, and analyzed their diagnostic performance. Age at PET scan, sex, and vascular risk factors were included as covariates. Compared with patients with PD (n = 160, mean age 68.9 ± 7.9 years; 74 men), the DIP group (n = 72, mean age 67.9 ± 12.9 years; 25 men) exhibited more profound hyperperfusion in the motor-related brain circuit and prominent hypoperfusion in widespread brain regions except for the occipital cortex than HCs (n = 62, mean age 66.9 ± 9.0 years; 25 men). In particular, the DIPGI group (n = 23) showed relative hypoperfusion in the lateral prefrontal, insular, inferior parietal, and cingulate cortices. In the DIP group, UPDRS part III total score was not correlated with striatal dopamine deficits but was associated with the degree of relative perfusion in the prefrontal, insular, and cingulate cortices. By contrast, the UPDRS part III total score in the PD group was not correlated with cerebral perfusion but was associated with striatal dopamine depletion, especially in the posterior putamen. The DIP-related cerebral perfusion pattern effectively discriminated patients with DIP from HCs and patients with PD. Blockage of dopamine receptors by drugs is associated with characteristic cerebral perfusion patterns that are distinct from those in patients with PD and correlate with symptom severity.

Epilepsy incidence peaks in childhood and again after age 55. Up to half of individuals with late-onset epilepsy lack an identifiable cause, but previous imaging studies suggest subtle mesiotemporal atrophy. In this study, we aimed to quantify whole-brain cortical and deep gray matter alterations in late-onset unexplained epilepsy (LOUE) and to examine their associations with cognitive and clinical measures. We prospectively recruited patients with LOUE through Brigham and Women's Hospital and its affiliated sites and compared them with sociodemographically matched healthy older adults from the Harvard Aging Brain Study. Inclusion criteria for LOUE were at least 1 unexplained seizure after age 55, onset within the past 5 years, and no identifiable cortical lesion on MRI. All participants underwent 3T structural MRI and neuropsychological testing. Cortical thickness and deep gray matter volumes were extracted, and linear models were used to compare patients with LOUE and controls. Correlations were computed between structural alterations and demographic, cognitive, and clinical measures. We included 59 patients with LOUE (mean age 71.2 ± 7.0 years, 49% female) and 53 controls (mean age 70.7 ± 5.2 years, 53% female). Patients with LOUE showed reduced cortical thickness in sensory and mesiotemporal cortices (d = -0.75, 95% CI [-1.14 to -0.37], FDR-corrected p values [pFDR] < 0.05) and reduced deep gray matter volumes in the pallidum and putamen (d = -0.55, 95% CI [-0.93 to -0.17], pFDR < 0.05). These structural reductions correlated with lower performance on a category fluency task (r = 0.31, pFDR = 0.016) and the extended Preclinical Alzheimer's Cognitive Composite (r = 0.37, pFDR = 0.0041). Conversely, patients showed increased thickness in the left inferior frontal gyrus (d = 0.82, 95% CI [0.43-1.20], pFDR < 0.05) and increased thalamic volume (d = 1.13, 95% CI [0.73-1.53], pFDR < 0.05), which were more pronounced in those with focal seizures sparing consciousness (d = -0.62, puncorr = 0.021). Structural brain changes in LOUE are more extensive than previously recognized and are associated with cognitive vulnerability. Although the cross-sectional design and use of independent cohorts limit conclusions about disease progression, the findings suggest that LOUE may fall along a continuum between epilepsy and neurodegenerative disease.

Hearing loss is a risk factor of cognitive decline and dementia. We sought to investigate the effect of hearing aid (HA) use on cognition and dementia risk in older adults with hearing impairment. We emulated a target trial using data from Australian participants of the ASPirin in Reducing Events in the Elderly study. In the target trial, eligible participants were dementia-free, had moderate hearing impairment, and had no previous HA use. The treatment strategies were "use HAs" and "do not use HAs." Outcomes included overall cognition, dementia (DSM-IV criteria), and cognitive impairment (cognitive decline or dementia). The emulation used new HA prescription and frequency-of-use data measured by questionnaire, as well as cognition data from semiannual assessments over 7 years. Self-reported hearing problems were used as a proxy for moderate hearing impairment. Using the parametric g-formula, we estimated observational analogs of the intention-to-treat effect, using HA prescription to emulate allocation. Analyses for cognition outcomes were restricted to survivors. Multiple imputation was used for missing covariate and cognitive outcome data. We also emulated a second target trial with treatment strategies of (1) never, (2) rarely/sometimes, and (3) often/always use HAs. Across imputed data sets, a median of 2,777 eligible individuals were included, with a median of 664 receiving a new HA prescription. The mean age was 75 years, and 48% were female. The estimated 7-year mean overall cognition scores among survivors were similar under HA prescription and no HA prescription (mean difference 0.03 SDs; 95% CI -0.14 to 0.21). The estimated 7-year risk of dementia was 5.0% under HA prescription and 7.5% under no HA prescription (risk ratio [RR] 0.67; 95% CI 0.37-0.97), and that of cognitive impairment was 36.1% under HA prescription and 42.4% under no HA prescription (RR 0.85; 95% CI 0.70-1.00). The risks of dementia and cognitive impairment were inversely associated with the frequency of HA use. We found that HA use in older people with hearing impairment may reduce dementia risk, although differences in age-related cognitive change were insubstantial. We cannot rule out residual confounding as an explanation for our findings. Long-term randomized trials of HAs for dementia risk are justified. This study provides Class III evidence that the use of hearing aids did not change overall cognitive scores in people 70 years and older with moderate hearing impairment as compared to those who used hearing aids.

Dementia risk prediction models developed for the general population perform poorly in stroke cohorts. Existing stroke-specific models are few and limited by short prediction horizons or reliance on neuroimaging. The aim of this study was to develop a clinically practical model for predicting 5-year dementia risk after stroke using commonly available variables and individual participant data from the Stroke and Cognition Consortium (STROKOG). Data were pooled from 12 studies across 10 countries. Dementia was diagnosed mainly by expert panel consensus and algorithmic classification. Fine-Gray subdistribution hazard models estimated dementia probability, accounting for death as a competing event. Candidate predictors included routinely collected baseline clinical and stroke-related variables, selected through backward stepwise elimination. Model performance was evaluated using discrimination (C-index) and calibration for prediction up to 5 years after stroke. Internal-external cross-validation (IECV) assessed generalizability across studies, regions, and study periods. A total of 2,663 participants (mean age 67.0 years [SD 11.1]; 40% female) were followed for a median of 2.0 years (IQR 1.0-5.0), during which 655 developed dementia (8.7 per 100 person-years). The final model included age, sex, education, history of previous stroke, diabetes, stroke severity, 2 interactions (age × sex; age × stroke severity), and study-level variables including national current health expenditure. An Excel-based risk calculator is available in the Supplement (eAppendix 1). The model demonstrated strong discrimination (C-index: 0.81; 95% CI 0.75-0.87) and excellent calibration in the full data set used for development. In IECV, discrimination was acceptable across individual studies (pooled C-index: 0.70 [0.67-0.73]) and higher in recent (post-2010; 0.79 [0.76-0.82]) and European (0.74 [0.71-0.78]) cohorts. Risks were slightly overestimated in Asian cohorts. Case numbers were too small for reliable assessment in other regions. We developed and internally-externally validated a 5-year dementia risk model for stroke survivors using routinely available clinical variables. The model showed strong performance in the full development data set and generalized well to recent and European cohorts, although external validation in diverse populations is needed. This tool can help identify high-risk individuals for targeted cognitive monitoring and follow-up. By informing clinical decision making and resource planning, it offers a practical means to improve long-term outcomes.

Current international guidelines recommend blood pressure (BP) thresholds for patients eligible for endovascular thrombectomy (EVT). Previous studies have suggested that both low and high admission BPs are associated with poor functional outcome after EVT. However, the association between admission BP and outcomes after EVT remains poorly understood.The aim of this study was to investigate the relationship between admission systolic BP (SBP) and outcomes in patients treated with EVT and to assess whether this association is modified by IV thrombolysis (IVT) treatment and recanalization status. In this observational, international, multicenter cohort study, we used data from the EVA-TRISP registry. Consecutive patients treated with EVT with available admission SBP were included. The primary outcome was 90-day functional outcome. Secondary outcomes included 90-day mortality, 24-hour NIH Stroke Scale (NIHSS), successful recanalization, and symptomatic intracranial hemorrhage (sICH). We used multivariable regression to study the relation between admission SBP and outcomes and to assess effect modification by IVT treatment and recanalization status. We included 10.963 EVT patients. At baseline, the mean age was 72.8 years (SD 13.5), 50.2% were female and the median NIHSS at presentation was 15 (interquartile range 9-19). The association between admission SBP and functional outcome, mortality, and 24-hour NIHSS score was U-shaped, and the nadir was around 150 mm Hg. Below 150 mm Hg, every 10 mm Hg decrease in SBP was associated with higher odds of poor functional outcome (adjusted odds ratio (aOR) 1.07 [95% CI 1.02-1.11]) and mortality (aOR 1.17 [1.12-1.23]). Above 150 mm Hg, every 10 mm Hg increase in SBP was associated with higher odds of poor functional outcome (aOR 1.05 [1.01-1.08]), mortality (aOR 1.04 [1.01-1.09]), and higher 24-hour NIHSS score (β-coefficient 0.28 [0.17-0.40]). We found a positive linear relationship between admission SBP and sICH (1.04 [1.01-1.08]). IVT treatment modified the association between admission SBP and outcomes after EVT. In 5544 EVT-only treated patients, there was no longer a clear association between higher admission SBP values and worse outcome. Lower and higher admission SBP was associated with worse outcomes in the complete cohort. In EVT-only patients, this association was less evident, suggesting that high admission BP alone should not always delay or preclude treatment with EVT in otherwise eligible patients.

Twinkle, encoded by the TWNK gene, is a mitochondrial DNA helicase that unwinds the double helix of DNA during replication, playing a pivotal role in mitochondrial function. Twinkle-related disorders encompass a variety of genetic disorders characterized by mitochondrial dysfunction. Although several phenotypes have been described, the full clinical and molecular spectrum remains poorly defined. The aim of this study was to characterize the phenotypic and genotypic variability among multinational patients diagnosed with Twinkle-related disorders. A retrospective cohort study was conducted in patients with Twinkle-related disorders at several specialized centers in Italy, France, Germany, Spain, Denmark, Hungary, and the United States, establishing the Twinkle-Related Disorders International Consortium for Trial Readiness (TReDIC). Data were collected from medical records, including clinical features, age at onset, disease progression, and results from genetic testing. Phenotypic categories included infantile-onset cerebellar ataxia, parkinsonism, primary mitochondrial myopathy (PMM), multisystem involvement, asymptomatic carriers, undetermined phenotypes, and other phenotypes. All patients' diagnoses were confirmed by genetic analysis, and their genetic variants were noted. Outcomes included prevalence of phenotypes, symptom chronology, and mutational patterns. The study included a total of 189 patients (116 female), with a mean age at symptom onset of 40.3 years. At the time of analysis, 70.4% were alive. PMM was the predominant syndrome (85.2%), and most common features were progressive external ophthalmoplegia (84.7%) and skeletal myopathy (55.6%), followed by hearing loss (17.5%) and psychiatric symptoms (15.3%). Most patients (76.8%) presented with neuromuscular symptoms, with fewer showing CNS (19.6%) or multiorgan (3.6%) features at onset; by more than 8 years from onset, these proportions shifted to 54.4%, 23.3%, and 23.3%, respectively. A total of 73 TWNK variants (16 novel) were found, mostly missense, clustered in functionally critical regions. This large multinational cohort analysis advances our understanding of Twinkle-related disorders by identifying mutational hotspots with clinical relevance and illustrating the broad phenotypic spectrum and progression patterns. In the context of such rare diseases, the formation of international collaborations, such as TReDIC, can enhance our understanding and support the design of upcoming clinical trials.

Ischaemic heart disease remains the leading global cause of death, and is strongly linked to hypertension. However, recent data on hypertension and cardiovascular risk in Sri Lanka are limited. This study aimed to determine the prevalence of hypertension, its associations with demographic characteristics, and the cardiovascular risk profile of the population in the Western Province of Sri Lanka. A descriptive cross-sectional epidemiological study was conducted in 2018-2020 in Western province. A total of 1800 non-institutionalized adults aged over 20years were recruited using a multi-stage stratified random cluster sampling method. Data collection was made through interviewer administered questionnaire, physical measurements, and laboratory investigations of biochemical analysis. Hypertension was diagnosed based on the 2017 guidelines of the American College of Cardiologists/American Heart Association. Cardiovascular risk was assessed using the WHO Cardiovascular Disease Risk Laboratory-Based Chart for the South-East Asia region and the Framingham Risk Score (FRS). Prevalence estimates are presented with 95% confidence interval. Data from 1,333 participants (response rate 78.2%) were analyzed; 62.3% were females, 36.4% lived in urban areas, and the mean age was 49.8years (± 9.1) (males- 49.7 ± 8.93, females-49.8 ± 8.99). Age- and sex-standardized prevalence of hypertension among all adults was 47.2% (95% CI:44.5-49.9). Crude prevalence was 56.3% (95% CI: 52.1-60.5), undiagnosed prevalence was 32.9% (95% CI:28.4-37.4) and already diagnosed was 23.4% (95% CI:20.2-26.6). Hypertension prevalence was highest among adults aged 60-69years (75.5%, 95%CI:68.8-82.2), those with primary education (62.6%, 95% CI:52.7-72.5), in Gampaha district (57.3%, 95% CI:53.0-61.6), rural setting (57.2%, 95% CI:53.6-60.8) and with lowest monthly income of USD < 200 (59.8%, 95% CI:52.7-66.9). Among adults aged 40years and older, the prevalence of high cardiovascular risk (> 20%) was 19.3% (95% CI:16.1-22.5) based on the FRS and 5.4% (95% CI:3.5-7.3) according to the WHO Risk Score. Over half of adults in Western Province, Sri Lanka have hypertension, with one-third undiagnosed. Nearly one-fifth of midlife adults face high cardiovascular risk. Socioeconomic disparities highlight the need for targeted workplace screenings and tailored health education for lower-income communities.

Background: Renal hyperparathyroidism is a frequent complication among patients with kidney failure. Data on outcomes following parathyroidectomy in patients undergoing kidney replacement therapy (KRT) remain limited in South Africa (SA). This study aimed to assess postoperative surgical and biochemical complication rates and disease recurrence. Methods: We conducted a retrospective cohort study of adult KRT patients who underwent parathyroidectomy for renal hyperparathyroidism at Tygerberg Hospital over 7 years. Kaplan-Meier and univariate logistic regression analyses were used to determine predictors of recurrence. Results: Forty-six patients underwent parathyroidectomy. Two-thirds were female with a mean age of 40.7 ± 8.50 years. Preoperative serum calcium and parathyroid hormone (PTH) concentrations were 2.41 ± 0.27 mmol/L and 176.7 (interquartile range [IQR] 124.4–245.1) pmol/L, respectively. Most patients (80%) underwent subtotal parathyroidectomy. The most common postoperative complication was hungry bone syndrome (HBS), which occurred in 98% of patients, and the postoperative total calcium concentration was 1.63 ± 0.28 mmol/L, observed on day 4 or later. Overall, recurrence of renal hyperparathyroidism occurred in 15% of patients. There were no predictors of recurrence on univariate logistic regression. Conclusion: A lower recurrence rate was observed in total parathyroidectomy and a lower hypoparathyroidism rate in subtotal parathyroidectomy (SPTX). Hungry bone syndrome was found to be the most frequent postoperative complication, reflecting more advanced disease at the time of surgery. Contribution: In the future, the focus at Tygerberg Hospital should be on earlier surgical referral considering our limited medical options, and the decision-making regarding the surgical procedure should be discussed in a multidisciplinary team, with a focus on individualised priorities.

Abstract Context Arginine (Arg) is an important amino acid in T2D as a potent insulin secretagogue and precursor for nitric oxide (NO). Citrulline (Cit), the substrate for de novo Arg synthesis, is mostly produced from glutamine (Gln). Objective We aimed to investigate their metabolism in T2D using novel stable isotope tracer approach. Methods We studied 42 individuals (21 with T2D, 21 controls). After overnight fasting, blood samples were collected following pulse administration of stable amino acid tracers. Plasma concentrations and isotopic enrichments were measured by LC-MS/MS, and compartmental analyses were performed to calculate their whole-body production (WBP) rates and kinetics. Results The cohort was 59.5% female, with a mean age of 64.4 (7.5) years and a BMI of 33.0 (4.3) kg/m2 (all p&amp;gt;0.05). After adjusting for sex and age, the T2D group had lower plasma concentrations of Arg (p=0.007), Cit (p=0.002), and Gln (p=0.002) than the control group. In T2D, WBP was lower for Cit (p=0.004) but higher for Gln (p=0.037) and glutamate (p=0.017) after controlling for age, sex and lean soft tissue mass. The T2D group also had lower Cit intracellular production, but higher Gln clearance and intracellular pool size, and a trend towards higher Arg clearance. Conclusion Significant dysregulation exists in Arg-Cit-Gln metabolism in T2D. Our findings suggest a working model in which increased Gln turnover stimulates gluconeogenesis, increases Gln consumption, and reduces Cit availability for Arg and NO synthesis, thereby contributing to metabolic dysregulation in T2D. Interventions targeting Gln-driven gluconeogenesis while increasing Cit availability may benefit T2D management.

Stroke represents a major complication in Takayasu arteritis (TA). We aimed to determine clinical characteristics and neurological outcomes in TA patients with stroke compared to those without. We retrospectively analyzed 35 patients (27F/8M) with documented stroke to 50 consecutive patients (47F/3M) without stroke followed by the Istanbul University-Cerrahpasa Medical Faculty. Demographic data, clinical manifestations, arterial involvement patterns, treatments, and neurological outcomes were evaluated. Disability was assessed using the Expanded Disability Status Scale (EDSS), Barthel Index, and Modified Rankin Scale. Mean age at diagnosis among patients with stroke and non-stroke was similar (38.5 ± 10.7 vs. 35.6 ± 11.6 years). The mean age at stroke was 43.1 ± 10.3 years. Patients with stroke were more likely to be male (22.9% vs. 6.0%, p = 0.023). Strokes were predominantly ischemic (91.4%), affecting anterior circulation (82.8%) with left hemisphere predominance (72.4%). Internal carotid artery (ICA) involvement was significantly associated with stroke (right ICA: 51.4% vs 18.0%, p = 0.001; left ICA: 37.1% vs 18.0%, p = 0.047), while abdominal aorta involvement seemed to be protective (20.0% vs 42.0%, p = 0.028). Male gender (OR = 5.70, p = 0.038) and any ICA involvement (OR = 5.98, p = 0.004) were identified as independent predictors of stroke. Importantly, 40% experienced stroke as the initial TA manifestation. Among those developing stroke after TA diagnosis, 85.7% were already receiving immunosuppression and 47.6% antiplatelet therapy. Stroke patients demonstrated significant disability (mean EDSS: 3.63 ± 3.36 vs 0.02 ± 0.14, p < 0.001) and 11.4% mortality, median 5years after stroke. Male patients and those with ICA involvement face the highest risk for stroke in TA. Long-term consequences are devastating with increased mortality, severe disability and high recurrence rates. The failure of immunosuppressive therapy to prevent stroke in the majority of treated patients, combined with substantial perioperative mortality, stress the inadequacy of current management strategies.

With the increasing use of magnetic resonance imaging (MRI) in children, radiologists frequently encounter incidental findings that may mimic pathology. One such underrecognized finding is T2-weighted hyperintensity in the superior extraconal orbital fat, which is occasionally mistaken for an infiltrative or neoplastic process. Our objective was to characterize the imaging appearance, prevalence, and clinical associations of superior extraconal orbital fat T2 hyperintensity in pediatric MRI. We conducted a retrospective study of 143 pediatric patients (mean age 7.2±5.1years) who underwent brain MRI with an orbit-specific protocol between 2015 and 2022. Patients were grouped based on the presence or absence of bilateral papilledema and whether imaging was performed under general anesthesia. Clinical data were extracted from the electronic medical records. Three neuroradiologists reviewed images for the presence of a hyperintense signal along the superior extraconal orbital fat. Interobserver agreement was calculated using Fleiss' kappa. Univariate and multivariable logistic regression analyses were performed to assess associations with age, anesthesia, gender, and magnet strength. Symmetric T2-hyperintense bands along the superior extraconal orbital fat were observed in 45.5% of patients. The finding was more common in younger children (4.4±3.9years vs. 9.6±4.8years; P<0.001). Multivariate analysis showed a significant negative correlation with age (P<0.001) and a positive correlation with papilledema (P=0.012), but no independent association with gender, anesthesia, or magnet strength. The hyperintensity was non-enhancing or only subtly enhancing. Clinical follow-up demonstrated no subsequent orbital or infiltrative pathology in the majority of patients, and most patients without documented follow-up underwent ambulatory MRI for evaluation of strabismus, which showed no evidence of infiltrative or other orbital disease. Superior extraconal orbital fat T2 hyperintensity is a relatively common, likely non-pathologic MRI finding in pediatric patients, particularly in younger children, and the apparent association with anesthesia likely reflects age-related confounding. Awareness of this benign appearance may help avoid diagnostic confusion and prevent unnecessary workup or intervention.

Academic performance is often highly prioritized among college students, sometimes at the expense of their health. Despite growing interest in this relationship, limited research with college students has explored how diet quality (DQ) varies by gender, first-generation status, and grade-point average (GPA). The purpose of this paper was to: (1) examine the relationship between DQ and academic performance in college students and (2) identify potential differences based on gender, first-generation status, and varying GPAs. In this cross-sectional study, undergraduate students (n = 301), mean age 21.2 (SD ± 2.49), completed the validated Short Healthy Eating Index (sHEI) based on the USDA's Healthy Eating Index (HEI) per 2015-2020 Dietary Guidelines for Americans, to examine DQ. Academic performance was assessed using self-reported GPA. Students were predominantly non-Hispanic White (63%), Female (61%), and 75% had at least one parent graduate college. Descriptive statistics, correlation, and one-way ANOVAs were used to analyze the data using SPSS V.29. GPA was categorized into 3 groups: high, mid, and low GPA groups. Results were significant when p < 0.05. DQ scores ranged from 21% to 68%, with a mean of 44% (SD: ±2.494). There were no significant associations between GPA and total DQ. However, significant associations were found between gender and specific dietary components. Further, total protein scores were greater among students with a high GPA compared to low and mid-GPA groups (F = 5.214, p = 0.006). Plant-based protein was greater among students who had at least one parent graduate college compared to first-generation students (F = 3.435, p = 0.034). Students living independently had lower total protein scores compared to those living with family (F = 4.841, p = 0.029). Additionally, students without a current job had higher dairy scores than those employed (F = 4.280, p = 0.039). Overall, college students reported poor DQ; however, personal (e.g., gender) and environmental factors (e.g., living arrangements) were associated with one's DQ. Further investigation is needed to facilitate the development of effective interventions that encourage healthier dietary habits among college students to improve their overall health and wellness.

To evaluate the impact of calcium suppression (CaSupp) imaging of spectral computed tomography (SpCT) on fracture detection in clinical routine in the acute trauma setting of the hand and wrist. Retrospective inclusion of 125 patients who underwent both X-ray and SpCT examinations of the hand and wrist in an acute trauma setting. Two independent readers evaluated fracture presence on X-ray, conventional CT, and conventional CT plus CaSupp images (time interval 4weeks, each). Bone bruise (BBr) presence was evaluated on CaSupp images. Sensitivity and specificity were calculated according to the consensus reading as the reference standard. Of the 125 patients (mean age, 55years ± 19.5 [SD]; 67 female), 120 presented with at least one fracture, for a total of 212 fractured bones. Sensitivity was increased significantly for both readers in CT + CaSupp (94.3 and 97.2%) compared to conventional CT (88.2 and 90.1%, p < .01) and X-ray (72.6 and 75.9%, p < .01). Specificity was 99.9 and 100% for CT + CaSupp, 99.8 and 99.9% for conventional CT, and 99.4 and 99.9% for X-ray. Reader 1 detected 13 additional fractures in CT + CaSupp compared to conventional CT alone, while Reader 2 detected 15 additional fractures. BBr was seen in 58% of all fractures, in 76% of multifragmentary fractures, and in 13% of avulsion fractures. Inter-reader κ was almost perfect for X-ray (κ = .85), CT and CT + CaSupp (κ = .95), and substantial for BBr (κ = .61). CaSupp images in combination with conventional CT images significantly improved sensitivity for acute trauma fracture detection in the hand and wrist compared to conventional CT images alone and X-ray.

Germline mutations of BRCA1 and BRCA2 may impair DNA repair in the ovarian cortex, leading to increased oocyte apoptosis, thus, affecting ovarian reserve. Aim of this study was to assess follicular density in ovarian biopsies from women with breast cancer carrying BRCA1 and BRCA2 mutations who underwent ovarian tissue cryopreservation (OTC) at our center. This was a single center, observational, cross-sectional study carried out in a tertiary level referral center for fertility preservation treatment. Exclusion criteria were: patients aged < 18years or > 38years, patients who had already undergone chemotherapy/pelvic radiotherapy at the time of OTC, patients without data on follicular density and those with unknown BRCA mutational status. Follicular density was defined as the number of primordial, intermediate primordial, small primary, large primary, secondary, preantral, and antral follicles per 1 mm2 of cortical section area. Out of 216 patients, 21 women reported germline mutation: 9 (4.2%) were carriers of the BRCA1 mutation and 13 (6%) of the BRCA2 mutation. The mean age at OTC was 31.5 ± 3.6years, and the median age was 32.4years (range, 21-38). No significant difference in follicular density was observed among women without BRCA mutations, those with BRCA1 mutations, and those with BRCA2 mutations. The median follicular density was 4.0/mm2 (range 0-74.5) in BRCA-negative women, 3.5/mm2 (range 0-20) in women with BRCA1 mutations, and 4.0/mm2 (range 0-32) in women with BRCA2 mutations (p = 0.272 and p = 0.703, respectively). After adjusting for age, no statistically significant differences in follicular density were observed according to BRCA1 and BRCA2 mutation status: the median follicular density was 4.6/mm2 in BRCA-negative women, 3.1/mm2 in women with BRCA1 mutations, and 3.6/mm2 in women with BRCA2 mutations (p = 0.428 and p = 0.385, respectively). No significant difference in follicular density was observed between women with BRCA1/BRCA2 mutations and those without. Our findings suggest that the presence of a BRCA mutation does not have a significant negative clinical impact on the follicular population of the ovarian cortex. Larger studies are needed to further validate these findings.

To investigate the longitudinal relationship between informal social participation and life satisfaction among older adults relocated for poverty alleviation in China, as well as the mediating role of perceived stress and sleep duration. Overall, 1345 participants [mean age 71.52 (SD:7.19) years; 48.4% female] were included in the longitudinal study. The participants were surveyed using perceived stress scale-14 (PSS-14) and satisfaction with life scale (SWLS). AMOS Statistics 26 was used to test for common method bias (CMB). SPSS Statistics 26 was used to conduct descriptive statistics, and correlation analysis. Besides, four longitudinal cross-lagged models and bootstrap methods were employed to investigate whether there is a mutual influence among informal social participation, perceived stress/sleep duration, and life satisfaction by AMOS Statistics 26. This study did not have a severe problem of CMB. The results indicated informal social participation predicted perceived stress and sleep duration 6months later; perceived stress predicted life satisfaction 6months later; and informal social participation at T1 predicted life satisfaction at T3 through perceived stress at T2. However, informal social participation at T1 did not predict life satisfaction at T3 through sleep duration at T2. These results indicate that for relocated older adults, informal social participation enhances life satisfaction not by improving sleep duration, but primarily through reducing perceived stress. The key pathway is that social participation lowers stress levels, which in turn leads to greater long-term life satisfaction. Hence, our findings could serve to prompt the administrators of community to be aware of the significance of stress alleviation and regard it as a key intervention target in programs designed to enhance the well-being of relocated older adults.

Vitamin D deficiency remains a major global public health concern. This study aimed to assess vitamin D levels measured in individuals aged 18 years and older between 2016 and 2025 in a tertiary care hospital and to examine the association of these levels with seasonal, annual, and demographic variables. This retrospective observational study included patients who presented to Duzce University Hospital for any reason between 2016 and 2025 and had serum 25(OH)D levels measured. In total, data from 85,892 individuals were analyzed. Vitamin D status was categorized as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or deficient (< 20 ng/mL). Among the participants, 70.2% (n = 60,309) were women and 29.8% (n = 25,583) were men. The mean age was 47.16 ± 17.62 years. The overall mean serum 25(OH)D level was 17.90 ± 12.08 ng/mL. Vitamin D deficiency (< 20 ng/mL) was identified in 68.6% of women and 61.3% of men. Overall, 66.4% (n = 57,051) of participants had Vitamin D deficiency (< 20 ng/mL), 21.7% (n = 18,635) had Vitamin D insufficiency (20-30 ng/mL), and 11.9% (n = 10,206) had sufficient Vitamin D levels (> 30 ng/mL). The mean 25(OH)D level was 19.16 ± 10.74 ng/mL in men and 17.37 ± 12.56 ng/mL in women, with significantly higher levels observed in men (p < 0.001). Participants aged 65 years and older had significantly higher vitamin D levels compared with those under 65 years (p < 0.001). Seasonally, the highest mean vitamin D levels were recorded in summer, whereas the lowest levels were found in winter. Vitamin D deficiency continues to pose a substantial public health challenge in Turkey. Addressing this issue should be considered a priority, and further comprehensive studies are urgently needed to support the development of effective strategies aimed at reducing deficiency rates.

Meniscal tears occur at the time of anterior cruciate ligament (ACL) injury in 55% to 65% of patients. These tears exhibit different healing patterns and behavior compared with meniscal tears in a stable knee. The optimal management of different medial, lateral and bicompartmental tears during primary ACL reconstruction (ACLR) has yet to be defined. To evaluate the reoperation rates associated with different meniscal treatment strategies and analyze the effect of medial, lateral, and bicompartmental meniscal tears on ACLR outcomes. Cohort study; Level of evidence, 2. This investigation included 1137 patients undergoing primary ACLR with a concomitant meniscal injury. Patients with chondral defects and multiligament knee injuries were excluded. Meniscal treatments were divided into 3 categories: left in situ (LIS), partial meniscectomy (PM), and repair. Reoperation was defined as the primary endpoint, and multivariable analysis was conducted to identify patient and tear characteristics associated with reoperation. The influence of different treatment strategies on return to play (RTP), ACL reinjury rate, and patient-reported outcome measures (PROMs) was reported at 2 years. The PROMs recorded were the International Knee Documentation Committee (IKDC) score, the Marx Activity Rating Scale, and the Anterior Cruciate Ligament-Return to Sport after Injury score. The mean age was 24.0 ± 6.9 years, and 76% of patients were male. Most injuries were noncontact (64.9%), commonly resulting from pivoting/sidestepping (50.1%). No significant differences in injury mechanism, playing surface, or footwear type were found between medial, lateral, or bicompartmental tears. Reoperation rates for patients were low for lateral (1.3%), medial (2.6%), and bicompartmental tears (3.2%) LIS at the time of ACLR. The rate of reoperation/subsequent meniscectomy for medial meniscal repairs (14.8%) was significantly higher than for other medial treatments (hazard ratio 12.8; P < .001). Patients who underwent meniscal repair with a concomitant tear in the opposite compartment (repair + PM/LIS) had the highest reoperation rates (16.7%) and lowest RTP rates (60%). IKDC scores were significantly lower for patients who underwent lateral meniscal repair (81.1 ± 15.3) compared with other types of lateral meniscal management (P < .027). ACL reinjury rate was not influenced by meniscal treatment. A higher preoperative Marx score increased the risk of reoperation in all groups. Stable meniscal tears LIS during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears. Medial meniscal repairs had the highest risk of reoperation, particularly when another tear was present in the lateral compartment. Lateral meniscal repairs were associated with lower IKDC scores compared with other lateral meniscal treatment strategies.

The most important factors for a successful colon capsule endoscopy (CCE) study are the quality of bowel preparation and the capsule excretion during battery life. Incomplete conventional colonoscopy is one of the main indications for CCE. The aim of this study was to analyze clinical and demographic factors for incomplete CCE after an incomplete conventional colonoscopy. A retrospective single-center study was conducted including patients who underwent CCE after an incomplete colonoscopy (IC). Complete CCE was defined as capsule excretion or visualization of hemorrhoidal pedicles within battery time. Demographic (gender and age) and clinical data (obesity, smoking history, diabetes mellitus, hypothyroidism, constipation, depression, psychotropic medication use and history of abdominal or pelvic surgery) were collected. A total of 197 patients were included (mean age 67±10years; 71.6% female). Complete CCE was achieved in 133 (67.5%) of cases. Adequate bowel preparation was observed in 145 (73.6%) of cases. The most common causes of incomplete conventional colonoscopy were colonic fixed angulation (56.3%) and irreducible loop (42.1%), with no significant difference in capsule completion between these groups (p=0.770). Obesity (OR 5.328; 95% CI 1.735-16.369; p = 0.003) and constipation (OR 2.999; 95% CI 1.264-7.114; p = 0.013) were independently associated with incomplete CCE. Obesity and constipation are risk factors for incomplete CCE. Adjustments or intensification of bowel preparation protocols may improve completion rates in these patients.

To evaluate the feasibility and safety of ileal ureteral replacement (IUR) for long-segment ureteral strictures secondary to urogenital tuberculosis (UGTB). 11 patients with complex tuberculous ureteral strictures underwent IUR across three tertiary centers between March 2015 and January 2024. Surgical approaches included open (n = 2), laparoscopic (n = 4), and robotic-assisted (n = 5). Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected. 11 patients (8 males, 3 females) with a mean age of 38.3 ± 13.1years were included. Two patients had bilateral involvement, and nine patients had unilateral involvement. Four patients underwent concomitant ileocystoplasty. The mean stricture length was 19.0 ± 6.3cm, and the median length of ileum harvested was 25cm. The mean operative time was 283.9 ± 28.1min. The median estimated blood loss was 150mL. The median postoperative hospital stay was 15days, with the robotic approach significantly reducing hospitalization time (p = 0.015). During the median follow-up of 36months, all patients achieved ureteral patency. The mean preoperative and latest estimated glomerular filtration rate were 82.0 ± 24.1 and 74.7 ± 22.9mL/min/1.73 m2 (p = 0.062), respectively. Complications were reported in 8 patients, primarily metabolic acidosis (6/11) and urinary tract infections (4/11). Metabolic acidosis was associated with renal function decline (p = 0.015). Two patients experienced major complications, consisting of ileus and incision infection respectively. IUR is a safe and effective last resort for patients with complex ureteral strictures secondary to UGTB. High complication rates and long-term metabolic risks limit its application, necessitating strict patient selection and rigorous lifelong management.