Neurologic outcomes after pediatric large vessel occlusion (LVO) stroke are poor. In the absence of a pediatric randomized clinical trial, cohort and registry studies have demonstrated improved outcomes with thrombectomy compared with medical management alone. However, the benefit of thrombectomy in children with LVO and mild presenting symptoms remains uncertain. Our objective was to determine if thrombectomy is associated with superior functional outcomes compared with medical management alone in pediatric patients with acute LVO stroke and mild presenting symptoms. We undertook a case-control study pooling individual patient data from 4 published cohort studies on pediatric LVO stroke (Save ChildS, Save ChildS Pro, KidClot, Pediatric LVO Stroke Study), with patients treated at 75 centers across Europe, North America, and Australia between 2000 and 2023. Patients ≤18 years of age with acute LVO stroke on imaging and pediatric NIH Stroke Scale score ≤5 on admission were included. Patients treated with endovascular thrombectomy were compared with those treated with medical management alone. The primary clinical outcome was the functional status at 3 months after stroke, measured using the pediatric modified Rankin Scale and compared between groups using ordinal regression analysis. The primary safety outcome was the rate of symptomatic intracerebral hemorrhage. Pooled data identified 63 pediatric patients (female: n = 21, 33.3%; mean age 9.6 years, SD 5.1, range 0.5-18.0) who met the inclusion criteria. The cohorts were well balanced for IV thrombolysis status, age, sex, site and side of occlusion, ASPECTS, and stroke etiology. Thrombectomy treated patients (n = 25) had significantly better pediatric modified Rankin Scale scores at 3 months than medically managed patients (n = 38; odds ratio 5.5 [95% CI 1.22-24.81]; p = 0.027). In the medical management group, n = 13 (34.2%) of patients had early neurologic deterioration in the first 24 hours, compared with only one patient in the thrombectomy group (4%, p = 0.005). No symptomatic intracerebral hemorrhages occurred in either group. Thrombectomy in pediatric LVO stroke with mild presenting symptoms results in improved clinical outcomes compared with medical management alone and may prevent early neurologic deterioration. These findings can assist treating teams with acute clinical decision making in this complex clinical situation. This study provides Class III evidence that in pediatric patients with acute LVO stroke and mild presenting symptoms, thrombectomy results in better functional outcomes compared with medical management alone.

Predicting Salmonella Typhi incidence using prevalence metrics from sentinel studies of community-onset bloodstream infections: a secondary analysis of observational data.

Associations of Neutrophil-to-HDL Cholesterol Ratio and Systemic Inflammation Response Index With Aneurysm Wall Enhancement and Growth.

Association between full-scope practice, schedule balance, and burnout among nurses in health professional shortage areas: A cross-sectional study.

The study aims to understand the perceptions and provision of survivorship care among cancer survivors and identify barriers to optimal care. The findings will also provide insights to help Cancer Council NSW to develop policy recommendations to ensure survivors receive comprehensive support throughout their post-treatment journey. A cross-sectional survey was conducted among cancer survivors aged 18 and older who had completed active treatment (n = 209). Data on survivorship care experiences, barriers to access, and unmet needs were collected. Firth logistic and ordinal regression models were used to analyse associations between outcomes (ease of accessing care, information about supportive care, care effectiveness, and unmet needs) and demographic, socioeconomic, and clinical predictors. Most patients (64.2%) received information about supportive care services, and 72.2% felt their needs were met, but only 44.8% found access easy. Educational level was significantly associated with the effectiveness of care after treatment; while lacking a survivorship care plan was associated with lower perceived effectiveness of care after treatment (adjusted OR: 12.80, P < 0.001). Women reported significantly greater difficulty accessing supportive care services (adjusted OR: 0.08, P = 0.004) compared to men. Key barriers included high costs and long appointment wait times, particularly for psychological support, exercise physiology and specialist care. Addressing barriers to survivorship care in NSW requires targeted policy interventions, including financial support, enhanced access across gender groups, and standardised survivorship care plans. The findings assist Cancer Council NSW advocate for policy recommendations to enhance survivorship care services, ensuring equitable access for all cancer survivors.

Heterogeneity and clinician typologies in menopause management: Insights from a European survey and latent class analysis.

Sexual dimorphism in the association of circulating TAM receptors-ligands with MASLD-related fibrosis.

Identification of gastric mucosal carcinogenesis-related genes based on cross-sectional multi-stage samples: Expression and functional validation of LILRA4 and IGF2BP3.

Long-term pulmonary sequelae following hospitalization for COVID-19 remain incompletely characterized, and few studies have reported radiological outcomes beyond 2years. This study investigated the persistence of chest CT abnormalities up to 4.5years after hospitalization for COVID-19 and their association with current dyspnea and fatigue. This longitudinal cohort study included patients hospitalized for COVID-19 in 2020. Chest CT was performed 3months after hospital admission, with follow-up imaging after 12months and 4.5years in patients with persisting abnormalities. CT images were evaluated using a CT severity score (CSS) on a 0-12 scale, which was subsequently recoded to an abbreviated CSS (aCSS) on a 0-3 scale. Trends in CT abnormalities and their determinants were analyzed using multivariable mixed effects ordinal regression. In total, 187 patients underwent chest CT at 3 months. Among patients with persistent abnormalities, 99 completed follow-up CT at 12months and 54 at 4.5years. Dyspnea (33%) and fatigue (61%) remained common at 4.5 years; however, correlations between current symptoms and aCSS were weak. Greater severity of the initial disease and older age were strong predictors of CT abnormalities. Regression analysis showed a gradual reduction in ground glass opacities (GGO) severity over time, whereas parenchymal bands increased and were associated with initial severity as assessed by the WHO 8-point ordinal scale for clinical improvement. Mosaic attenuation decreased during follow-up, but remained associated with the severity of the initial COVID-19 episode. From 3 months to 4.5 years after hospitalization, GGO and mosaic attenuation decreased, whereas parenchymal bands increased, with minimal change beyond 12 months. CT abnormalities were associated with initial disease severity and age but showed little association with dyspnea or fatigue.

Dementia with Lewy bodies (DLB)is a multisystem neurodegenerative disorder often accompanied by autonomic and neuropsychiatric symptoms. Nutritional impairment is increasingly recognized yet under-characterized in DLB. DLB was chosen due to its early multisystem involvement, including brainstem-mediated autonomic and sleep disturbances, which may uniquely affect nutrition. This study evaluated nutritional status and its associations with cognitive, mood, autonomic, and sleep-related features. Seventy patients with probable DLB (2017 McKeith criteria) were retrospectively included. Cases of Parkinson's disease dementia or other Lewy body-related conditions were excluded. Nutritional status was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF). Cognitive function (Addenbrooke's Cognitive Examination, ACE-III), depressive symptoms (Geriatric Depression Scale, GDS), motor severity (Hoehn and Yahr staging), sleep disturbances (Rapid Eye Movement Sleep Behavior Disorder, RBD, insomnia), and autonomic symptoms (urinary incontinence, constipation, orthostatic hypotension) were extracted from clinical records. Multivariable logistic, ordinal regression, and hierarchical cluster analyses were performed. Normal nutrition was observed in 14.3% of patients, 60.0% were at risk, and 25.7% were malnourished. Malnutrition was significantly associated with lower ACE-III and higher GDS scores (p < 0.05). RBD and urinary incontinence differed across nutritional groups. Ordinal regression showed age and female sex independently associated with worse nutritional status. Cluster analysis identified a high-risk phenotype with greater cognitive, depressive, autonomic, and sleep-related burden linked to malnutrition. Malnutrition is highly prevalent in DLB and correlates with cognitive, psychiatric, autonomic, and sleep-related features. These associations support that nutritional impairment reflects the multisystem disease burden. Early identification of patients with combined deficits may help target those at risk and guide comprehensive management.

Academic medicine (AM) careers combine research, teaching, and patient care, yet their attractiveness has declined in recent years, particularly among women, who remain underrepresented in this field. Previous research highlights the central role of interest in research, but the cognitive and contextual processes underlying academic career intentions during residency remain insufficiently understood. Social Cognitive Career Theory (SCCT) provides a relevant framework for examining how individual cognitions and learning experiences jointly shape career intentions. This cross-sectional study included 1,570 French medical residents who completed an online questionnaire. Guided by the SCCT framework, we examined the relationships between learning experiences (academic satisfaction and perceived stress), self-efficacy, outcome expectations (operationalized through work centrality), professional interest in research, and intention to pursue a career in academic medicine. Hierarchical ordinal regression models were used to predict AM career intention, and structural equation modeling was conducted to investigate the formation of professional interest in research. Gender and prior research experiences (master's or PhD) were examined as moderating factors. Overall, residents reported low intention to pursue a career in academic medicine, with women expressing significantly lower intentions than men. Professional interest in research emerged as the strongest predictor of AM career intention, followed by research experiences and mentorship. Outcome expectations, measured through work centrality, also contributed significantly to career intentions. Structural equation modeling supported key assumptions of SCCT: perceived stress was negatively associated with self-efficacy, academic satisfaction was positively associated with outcome expectations, and work centrality played a central role in shaping professional interest in research. Gender differences in career intentions were largely explained by disparities in learning experiences and research opportunities rather than by differences in outcome expectations. Moderation analyses suggested gender-specific patterns at advanced levels of research involvement. These findings support the relevance of SCCT for understanding academic medicine career intentions and highlight the central role of professional interest in research and contextual learning experiences. Promoting positive learning environments, providing early and structured research exposure, and ensuring access to mentorship may represent key levers for fostering academic career engagement and addressing gender disparities in academic medicine.

Children with autism spectrum disorder (ASD) often experience co-occurring psychiatric conditions, such as anxiety and attention-deficit/hyperactivity disorder (ADHD), which significantly impair daily functioning. However, the underlying mechanisms linking these conditions to core ASD features remain poorly understood. This study examined relationships between anxiety, ADHD symptoms, and multi-domain neurocognitive abilities in a clinic-based sample of 701 Chinese children with ASD (mean age 8 years, 13.4% female), using the Hong Kong version of the Penn Computerized Neurocognitive Battery. Initial correlations revealed negative associations between cognitive performance and ADHD symptoms, but no direct links with anxiety. Ordinal regression demonstrated that poorer executive function (EF) independently predicted greater ADHD severity along a continuum from no ADHD to subclinical features to co-occurring ADHD, in a dose-dependent manner, even after controlling for core autism symptoms, other cognitive domains, and full-scale IQ. Moderation analyses showed that stronger EF specifically buffered the associations between sensory hyper-responsiveness/sensory-seeking and anxiety symptoms-an effect not seen with other cognitive domains or full-scale IQ. These findings indicate that EF plays a unique, compensatory role in modulating the two most common co-occurring psychopathologies in ASD. Systematic assessment of EF could support early risk stratification, while EF-targeted interventions may help mitigate the burden of ADHD and anxiety in children with ASD.

To evaluate the association between diabetic corneal neuropathy and diabetic foot risk by examining corneal nerve features, clinical characteristics, and tear mediators in patients with different diabetic foot risk categories. In this cross-sectional study, 710 participants underwent diabetic foot examination, invivo confocal microscopy scans, ocular surface assessments, and tear mediators measurements. Ordinal regression analysis was applied to determine the associations between foot risk categories and corneal nerve metrics. ROC curve analysis assessed the ability of corneal nerve parameters to identify high-risk diabetic foot. All diabetic foot risk categories exhibited significantly impaired corneal nerve fibre length, density, fractal dimension, and more swollen width compared with controls (all p < 0.001). These patients also demonstrated significantly shorter tear break-up time, more severe ocular symptoms, elevated tear MMP-9, and reduced tear Substance P levels (all p < 0.05). Patients with high-risk diabetic foot showed significantly more pronounced corneal nerve alterations than those in low and moderate-risk groups (all p < 0.05). The more severe diabetic foot risk category was significantly associated with reduced nerve fibre length, density, fractal dimension, and increased width (all p < 0.05). A predictive model incorporating corneal nerve fibre length, width, and serum creatinine achieved an AUC of 0.80 for identifying high-risk diabetic foot. A CNFL < 5.7 mm/mm2 was associated with 4.37-fold higher odds of having a high-risk diabetic foot. Corneal nerve impairment is evident even in low-risk diabetic foot patients and is associated with foot risk severity. Corneal nerve metrics may serve as early indicators for identifying high-risk diabetic foot.

The quality of medical services in public hospitals is significantly influenced by managerial styles, which shape organizational efficiency, patient satisfaction, and hospital accreditation outcomes. This study examines the impact of managerial leadership styles and organizational characteristics on accreditation performance in Romanian public hospitals. Using survey data from hospital managers, the study employs a structured analytical approach combining Chi-square tests and cross-tabulations, Kendall's Tau correlations, the Kruskal-Wallis H test, ordinal regression modeling, and exploratory K-means cluster analysis to examine how hospital size, managerial education, employee consultation, team motivation, and access to information are associated with accreditation outcomes. Results indicate that hospital administration type, field of study, and team motivation are significant predictors of accreditation success, while hospital size negatively correlates with accreditation scores, suggesting larger hospitals face greater challenges in meeting accreditation standards. Conversely, employee consultation and information transparency show no statistically significant impact on accreditation performance. These findings highlight the critical role of managerial education and team engagement in achieving higher accreditation outcomes. Strengthening leadership training and team-based quality initiatives could enhance accreditation performance in public hospitals. Policy makers should prioritize managerial development programs and strategic leadership approaches to improve healthcare quality and compliance.

ABSTRACT In language testing research, fluency is typically operationalized through single, isolated temporal features. However, in natural speech, fluency (or disfluency) is often characterized by the clustering of multiple temporal features, collectively revealing the speaker’s automaticity in speech production. In this study, we compare disfluency co-occurrence features with commonly used, single disfluency features in their prediction of language proficiency. We examined 31 (dis)fluency features of IELTS speaking responses by 278 L2 English speakers across three L1 backgrounds (Mandarin Chinese, Punjabi, and Arabic). These features were subjected to principal component analysis and ordinal regression analysis to predict IELTS band scores. The findings indicate that both single and co-occurrence disfluency features can effectively explain oral language proficiency, although disfluency co-occurrence features add nuances to the interpretation and implications for L2 speaking assessment research.

Cardiovascular disease risk increases for women during the menopause transition. While cardiorespiratory fitness (CRF) is linked to lower cardiovascular disease risk, its predictive relationship with cardiovascular health and quality of life during menopause is unclear. This study investigated the relationships between CRF, cardiovascular health markers, and quality of life in peri- and postmenopausal women. Fifty-eight participants underwent a graded exercise test to assess CRF, alongside measurements of vascular function, blood lipids, blood pressure, and anthropometrics. Questionnaires were used to evaluate physical activity (International Physical Activity Questionnaire [IPAQ]) and quality of life (Menopause-Specific Quality of Life [MENQOL] questionnaire and general health [EQ-5D]). Linear and ordinal regression analyses were conducted to assess associations. After adjusting for age and physical activity, regression models indicated that CRF was significantly associated with high-density lipoprotein cholesterol, waist-to-hip ratio, and triglycerides, explaining 11%-15% of their variance. Higher CRF was also linked to a lower burden of self-reported menopause-related symptoms in the MENQOL physical domain (odds ratio = 0.91 per unit increase in CRFs). However, no significant associations were found between CRF and vascular function measures. These findings suggest that CRF is independently associated with a more favorable cardiometabolic risk profile and may be related to fewer menopause-related symptoms in midlife women. In our sample, we did not find an association with vascular function, which may indicate that other factors might play a more prominent role in vascular health during the menopause transition.

ABSTRACTBackground and AimsAortic regurgitation (AR) is associated with characteristic changes in aortic root geometry. Data on detailed echocardiographic patterns of AR in Iranian cohorts remain limited. This study aimed to describe the echocardiographic and etiologic characteristics of patients with AR and to assess the associations between standard aortic root measurements—including the aortic annulus (AA), sinuses of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (ASC)—and AR severity.MethodsThis retrospective cross‐sectional study reviewed transthoracic echocardiography reports of patients diagnosed with AR (n = 445) between 2017 and 2023 at a tertiary center. All examinations were performed and interpreted by a single experienced cardiologist. Aortic root dimensions and left ventricular measurements were extracted. Associations with AR severity were examined using appropriate parametric or nonparametric tests based on distributional assessment. Ordinal regression analysis was used to evaluate the independent association of aortic root dimensions and indexed parameters with AR severity.ResultsGreater AA, SOV, STJ, and ASC diameters were associated with higher AR severity in unadjusted analyzes, with SOV demonstrating the strongest relationship. All variables, including ASC, STJ, SOV, AA, and STJ/BSA, were correlated with the severity of aortic regurgitation. In multivariable ordinal regression analysis, ascending aorta diameter and the STJ/AA ratio were independently associated with AR severity, whereas STJ diameter and the STJ/BSA ratio were not significant after adjustment. STJ diameter showed no correlation with age. Degenerative and rheumatic etiologies were the most common causes of AR.ConclusionAortic root dimensions were associated with AR severity, underscoring the role of aortic root geometry in disease expression. The STJ/AA ratio emerged as an independently associated geometric parameter in adjusted analyzes, while STJ/BSA did not retain significance. As this was a retrospective cross‐sectional analysis, findings reflect associations rather than causal relationships and require confirmation in prospective, standardized studies.

Fasting during Ramadan has been found safe for most chronic kidney disease (CKD) patients, but may pose risks for some. The Ramadan and Kidney Disease (RaK) working group has developed a risk stratification tool to categorize CKD patients who intend to fast into low-, moderate-, and high-risk groups. We propose a Ramadan fasting calculator that incorporates key risk factors to guide fasting decisions for CKD patients. A prospective cohort study was conducted at Ambulatory Healthcare Services from March 2024 to August 2024. The Electronic Medical Records (EMRs) of 220 patients were reviewed, supplemented by telephone interviews conducted before and after Ramadan. The primary outcomes assessed were the Ramadan fasting experience and the occurrence of adverse significant events (ASEs), which include hospital admissions. Among the 220 participants, 71.4% completed all 30 days of fasting during Ramadan, 7.3% began fasting but had to break it, and 21.4% did not fast. This sample's mean and median RaK scores were 9.78 and 9.0, respectively; 55.5% had a score of 9 or lower, 24.5% had scores between 10 and 13, and 18.6% had scores above 13. A total of 39 adverse significant events (ASEs) were recorded. Using ordinal regression (proportional odds model) the RaK score was the only significant predictor of fasting (none, interrupted, complete), with an estimate of -0.159 (95% CI: -0.264 to -0.053), p = 0.003. The area under the curve (AUC) for predicting attempts at fasting (using logistic regression) was 0.715 (95% CI: 0.635-0.794), with an optimal cutoff of 9.5. Using logistic regression, a higher RaK score was significantly associated with an increased incidence of ASE (β = 0.253, OR = 1.287( 1.036-1.599, p = 0.023). Decision-curve analysis showed a positive net clinical benefit across threshold probabilities of 7-44%, identifying about 1 additional ASE patient per 10 evaluated patients and avoiding 1 unnecessary intervention per 7 patients compared with universal intervention at a 10% threshold. The RaK score demonstrated potential predictive value for fasting status and adverse events among CKD patients; however, validation in different populations is recommended.

ObjectiveClinical practice guidelines support evidence-based care but are often underused due to complexity, time constraints, and navigation challenges. We investigated whether a conversational agent (chatbot) using an open-weight large language model (LLM) with retrieval-augmented generation (RAG) could provide guideline-consistent answers for bipolar disorder management based on the full 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and ISBD guidelines, comparing against a system using only the base LLM.MethodWe developed a multi-step RAG-based chatbot that retrieves relevant guideline sections and generates responses using Llama 3.3 70B. Twenty-one clinical vignettes spanning all guideline sections were created. Six expert psychiatrists generated queries and were presented with paired responses without labels from 2 systems: one using the base Llama 3.3 70B model, the other RAG-enhanced. Responses were rated for guideline consistency on a 3-point scale, and were analyzed using mixed-effects ordinal logistic regression.ResultsExperts evaluated 126 responses, of which 110 (87.3%) were rated as correct as or more correct than the baseline system. The RAG system produced 80 answers (63.5%) rated fully consistent with the guidelines versus 24 (19.0%) for baseline, and only 10 answers with major deviation (7.9%) versus 48 (38.1%) for baseline. Ordinal regression showed RAG responses were significantly more likely to be more correct (OR = 9.1, 95% CI [5.3-16.3], P < 0.001), which was consistent across all raters. Preference ratings favoured RAG answers in 78.7% of cases. Performance varied by vignette, with some errors in both retrieval and reasoning.ConclusionThe use of RAG with an open-weight model helped produce answers consistent with the CANMAT guidelines across vignettes that required adapting or combining guideline text, suggesting a proof-of-concept of a bipolar guideline chatbot. We identified areas to improve results and evaluation. Future work should explore additional retrieval strategies and LLMs, and test in more naturalistic settings.

ObjectiveOutcome after surgical hematoma evacuation for intracerebral hemorrhage (ICH) depends on hematoma location. As corticospinal tract (CST) integrity affects motor recovery after stroke, we hypothesized that CST integrity drives heterogeneity in surgical outcomes and investigated this in a secondary analysis of MISTIE-III participants.MethodsRisk of CST injury was categorized into four levels, based on the interaction between the CST, the hematoma, and perihematomal edema (PHE) on automatically segmented stability CT: no risk, PHE infiltration, hematoma infiltration, and complete interruption of the CST. Associations with outcome were tested using multivariable linear regression for motor National Institutes of Health Stroke Scale (NIHSS) at day 180 and ordinal regression for modified Rankin Scale (mRS) at day 365, introducing an interaction term between CST risk and treatment group.ResultsDay 180 motor NIHSS was significantly lower for ‘no risk’ (b:-3.77, [95% confidence interval [CI]: -5.8 to -1.70],p=0.0003) and ‘PHE infiltration’ (b:-2.3, [95%CI: - 3.5 to -1.1];p=0.0002) vs. ‘complete interruption’. Surgery was associated with lower Day 180 motor NIHSS in participants with hematoma infiltration (b:-2.07, [95%CI: -3.8 to -0.4],p=0.016). Compared to complete interruption, ‘no risk’ (adjusted odds ratio [aOR]:0.27, [95%CI: 0.10 to 0.74],p=0.01) and ‘PHE infiltration’ (aOR:0.41, [95%CI: 0.23 to 0.74];p=0.003) were associated with lower odds of unfavorable day 365 mRS. Surgery was associated with lower mRS in participants with no risk (aOR:0.23, [95%CI: 0.05 to 0.97,p=0.045).InterpretationIncreasing CST risk is associated with worse motor recovery (day 180) and disability (day 365). CST risk modifies the effect of the MISTIE-III procedure on motor recovery and disability.Trial registrationNCT01827046 (https://clinicaltrials.gov/study/NCT01827046)