Persistent Dysfunction Research Articles

The dynamic of concentration of von Willebrand factor concentration in peracute and acute periods of cardioembolic stroke during heparin therapy

To study the prognostic value of von Willebrand factor (vWF) in peracute and acute periods of cardioembolic stroke (CES) in patients receiving unfractionated (UFH) and low molecular weight heparin (LMWH). Thirty patients with CES receiving UFH/LMWH and acetylsalicylic acid were examined. The comparison group included 15 patients with non-cardioembolic stroke without heparin therapy. On Days 2-3 and 7-10 from the disease onset, patients were evaluated using the NIHSS and HAS-BLED scales; also, brain CT, Doppler ultrasound, echocardiography, complete blood count and blood chemistry, vWF measurement, and induced platelet aggregation test with ristocetin, arachidonic acid, and collagen were performed. During LMWH therapy in the peracute period, increased platelet aggregation with ristocetin (p=0.038) and vWF levels (p=0.017) were found versus the comparison group. A correlation between vWF level and platelet aggregation with collagen was identified (p=0.010, r=0.461). No inhibition of platelet function with ristocetin was observed during the entire period of therapy with both LMWH and UFH. During LMWH treatment, increased platelet activity with ristocetin was observed in the acute period, compared with patients receiving UFH (p=0.007). There were no significant differences in the change in the vWF levels in patients with and without hematuria. There was a correlation between the HAS-BLED score and hematuria in the semiquantitative analysis of erythrocytes in urine (p=0.041, r=0.375), as well as a correlation between the vWF levels and the ASPECT score (p=0.001, r=-0.576). The concomitant use of heparin with antiplatelet agents, particularly with aspirin in CES, enhances its anticoagulant activity and inhibits platelets in the test with arachidonic acid. Continued high ristocetin- and collagen-induced platelet aggregation supports the use of vasoprotective agents activating metabolic processes in the walls of blood vessels to correct persistent endothelial dysfunction.

Effectiveness of a sport-specific exercise programme for overhead athletes with unilateral subacromial shoulder pain: a study protocol of a randomised controlled trial

Subacromial shoulder pain is one of the most common musculoskeletal conditions affecting overhead athletes, particularly those engaged in high-intensity training modalities such as CrossFit. The prevalence of shoulder injuries in...

Interrelatedness of Neurocognitive Domain Functioning Between Unprompted and Prompted Identification Testing With Psychophysical Olfactory Evaluation in a Post‐COVID‐19 Cohort

ABSTRACTObjectiveAssessment of olfactory function with psychophysical testing requires cognitive demand to correctly pair test odors with remembered scents. Individuals suffering from long‐Corona Virus Disease 2019 (long‐COVID‐19) may develop a decline in neurocognitive performance, which may be concurrent with persistent olfactory dysfunction (OD). Given the rigorous cognitive demand of the unprompted identification (UI) olfactory assessment, the goal of this study is to understand whether it could serve as a proxy for specific neurocognitive domains during clinical assessment of olfaction.MethodsParticipants from our long‐COVID cohorts with persistent OD underwent a panel of neurocognitive screening followed by olfactory assessment of threshold followed by unprompted (UI) and prompted identification (PI) tests using Sniffin' Sticks. Hierarchical linear mixed‐effect models were used to understand the relative impact of each neurocognitive variable after controlling for demographics and olfactory threshold scores.ResultsNeurocognitive variables demonstrated common correlation trends. Models containing Montreal Cognitive Assessment (MoCA) and digit‐span backward scores had statistically significant fits for both UI (MoCA: χ2 = 10.20, p = 0.001/digit‐span backward: χ2 = 4.27, p = 0.04) and PI (MoCA: χ2 = 4.51, p = 0.03/digit‐span backward: χ2 = 5.04, p = 0.02) linear mixed‐effect models, but UI was further explained by logical memory (χ2 = 7.84, p = 0.005), verbal fluency (χ2 = 8.79, p = 0.003), and digit‐span forward (χ2 = 12.30, p = 0.0004). These relationships were statistically significant after controlling for demographic and olfactory threshold covariates.ConclusionsUI and PI have interrelated neurocognitive dependence on global cognition (MoCA) and executive function (digit‐span backward) among long‐COVID participants. As UI draws upon neurocognitive domains of episodic (logical memory), semantic (verbal fluency), and working memory (digit‐span forward), the inclusion of a UI task may provide supplementary screening for cognitive impairments in those undergoing clinical olfactory assessment, particularly among those with lingering effects of COVID‐19.

Persistent innate immune dysfunction and ZIKV replication in the gastrointestinal tract during SIV infection in pigtail macaques.

Mosquito-borne flaviviruses, including dengue (DENV) and Zika (ZIKV) viruses, have caused widespread epidemics in areas with high HIV prevalence, partly due to the expanded geographic range of arthropod vectors. Despite the occurrence of large flavivirus outbreaks in areas with high HIV prevalence, little is known about the effects of flavivirus infection in people living with HIV (PLWH). Here, we use a pigtail macaque model of HIV/AIDS to investigate the impact of simian immunodeficiency virus (SIV)-induced immunosuppression on ZIKV replication and pathogenesis. During acute SIV infection, peripheral ZIKV cellular targets expanded and innate immune activation increased. In vitro, peripheral blood mononuclear cells (PBMC) from SIV infected pigtail macaques were less permissive to ZIKV infection. In vivo, ZIKV viremia was delayed and ZIKV was more persistent in the gastrointestinal tissues of SIV-ZIKV co-infected animals. This persistence was associated with changes in innate cellular (monocytes, neutrophils) recruitment to the blood and tissues, reduced anti-ZIKV immunity, and sustained expression of peripheral inflammatory and innate immune genes. Collectively, these findings uniquely suggest that untreated SIV infection may promote inflammatory cellular innate responses and create a state of persistent immune activation that contributes to prolonged ZIKV viremia and persistence in the gastrointestinal tract. Furthermore, these results suggest that PLWH and other immunocompromised individuals could be at higher risk for prolonged ZIKV infection, potentially extending the window of ZIKV transmission. These insights highlight the importance of including PLWH in strategies for deploying vaccines and treatments against ZIKV.

Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.

Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes. We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (TPOD). Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of TPOD (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and TPOD remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation. Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery. ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.

Stress hyperglycemia ratio: a novel predictor of left ventricular dysfunction in peripartum cardiomyopathy

Objective This study aims to assess the predictive value of the stress hyperglycemia ratio (SHR) for left ventricular (LV) systolic dysfunction in patients with peripartum cardiomyopathy (PPCM). Methods We conducted a retrospective analysis of 78 consecutive PPCM patients from January 2007 to March 2023. Their clinical, laboratory, and auxiliary examination data were collected. The estimated average glucose (eAG) was calculated using the formula: eAG = [1.59 × hemoglobin A1c (%) −%2.59]. The SHR was determined by the formula: SHR = (blood glucose at admission)/eAG. The primary outcome measured was the recovery of LV systolic function. A receiver operating characteristic (ROC) curve was used to evaluate the SHR. Logistic regression analysis was performed to identify risk factors for LV systolic dysfunction in PPCM patients. Results The mean random blood glucose level in the PPCM patients was 6.38 mmol/L, with an SHR of 1.16. Among these patients, 37 (47.4%) exhibited persistent LV systolic dysfunction during follow-up. The SHR was significantly higher in the non-recovery group than in the recovery group (1.45 vs. 0.91, p < .001). An SHR cutoff of 1.079 predicted persistent LV systolic dysfunction with a sensitivity of 81.1% and a specificity of 90.2%, yielding a Youden index of 0.713. Logistic regression identified an SHR ≥ 1.079, a left ventricular end-diastolic diameter (LVEDD) > 55 mm, and digoxin usage as risk factors for LV systolic dysfunction. Conclusions PPCM patients with an SHR of 1.079 or higher should receive increased scrutiny for persistent LV systolic dysfunction.

Persistent Pelvic Floor Dysfunction in Female Athletes: A Commentary on Postconservative Management.

Pelvic floor dysfunction is still an undervalued, underreported, and undertreated condition among female athletes. Despite high prevalence rates and growing interest within the scientific community, significant gaps persist in the application of evidence-based practices in sports medicine. This commentary, inspired by real questions encountered in the authors' work, is presented in a Q&A format to simulate a realistic conversation. The authors aim to provide answers to sports medicine physicians and the wider interdisciplinary team by offering a comprehensive overview of key considerations for managing athletes with persistent pelvic floor dysfunction symptoms. Through evidence-based suggestions, strategies, and a critical approach, the commentary aims to improve the understanding of the current best practice strategies for managing these athletes, both during and after conservative treatment options.

Conversion of Failed Anatomic Total Shoulder Replacement With Severe Glenoid Bone Defect to Humeral Hemiarthroplasty

Conversion of Failed Anatomic Total Shoulder Replacement With Severe Glenoid Bone Defect to Humeral Hemiarthroplasty

Persistent cognitive dysfunction after chimeric antigen receptor T-cell therapy in adolescents and young adults

Persistent cognitive dysfunction after chimeric antigen receptor T-cell therapy in adolescents and young adults

Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction

Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction

Challenges and Research Opportunities for Integrating Quantitative Electroencephalography Into Sports Concussion Rehabilitation.

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG's low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician-scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.

Therapeutic Potential of Chitosan Nasal Gel in Addressing Olfactory Dysfunction: A Clinical Trial and Mechanistic Study.

Olfactory dysfunction significantly impacts daily life, affecting safety, appetite, and sensory enjoyment. Olfactory receptor neurons (ORNs) are essential for odor detection, but environmental exposure can lead to dysfunction. Regeneration of these neurons is crucial for maintaining olfactory function, and elevated calcium levels in nasal mucus are linked to this dysfunction. The study evaluated chitosan nasal gel for persistent olfactory dysfunction lasting over 6 months, focusing on ORNs regeneration and reduced calcium levels in nasal mucus. A randomized, double-blind trial included 215 participants with persistent olfactory dysfunction lasting over 6 months. Participants were divided into two groups: 116 received nasal chitosan gel, and 99 received a control sodium chloride gel. Over 3 months, 11 participants in the chitosan group and 9 in the control group were lost to follow-up. Olfactory function was assessed with the Sniffin' Sticks test, and calcium levels were measured before and after treatment. Patients treated with chitosan nasal gel showed an increased composite threshold, discrimination, identification (TDI) score, indicating improved olfactory function. Discrimination and identification scores improved, while threshold scores showed no significant change. Notably, while the total TDI score improved by 4.55 points, it did not reach the threshold for clinical significance (5.5 points). Furthermore, chitosan nasal gel significantly reduced calcium levels in nasal secretions compared to the control group. No improvement was observed in the placebo group, likely due to the strict inclusion criteria targeting individuals with treatment-resistant olfactory dysfunction persisting over 6 months. This small-scale pilot study highlights the potential of chitosan nasal gel to improve specific domains of olfactory dysfunction and reduce nasal calcium levels. However, further studies with larger sample sizes, diverse populations, and longer follow-up periods are required to confirm these preliminary findings.

Catheter Ablation Improves Ventilatory Efficiency in Atrial Fibrillation-Mediated Cardiomyopathy.

Exercise Oscillatory Ventilation (EOV) and a steep ventilatory efficiency (VE/VCO2) slope are features of ventilatory inefficiency on cardiopulmonary exercise testing (CPET), both associated with poor prognosis in patients with heart failure (HF). The prevalence in patients with co-existent atrial fibrillation (AF) and the impact of catheter ablation (CA) is unknown. To characterize ventilatory inefficiency in patients with persistent AF and Left Ventricular Systolic Dysfunction (LVSD) and assess the impact of CA. Patients with persistent AF and Left Ventricular Ejection Fraction (LVEF) < 50% undergoing first-time CA were prospectively enrolled. Echocardiography and CPET were performed at baseline and 6 months post-CA. EOV was defined using the Kremser-Corrà criteria, and VE/VCO2 slope gradient > 30 was considered abnormal. A total of 53 participants were enrolled (mean LVEF of 34 ± 9%). A total of 10 (19.2%) exhibited EOV at baseline. These patients had larger indexed left atrial (41.6 ± 13.1 mL/m2 vs. 33.3 ± 9.3 mL/m2, p = 0.03) and ventricular volumes [65.7 mL/m2 (57.1, 89.0) vs. 46.7 mL/m2 (39.8, 61.4), p = 0.03]. The partial pressure of end-tidal carbon dioxide (PETCO2) at peak exercise increased (33.7 ± 6.1 mmHg to 41.2 ± 5.8 mmHg, p < 0.001) and correlated with improvement in HF symptoms (p = -0.003) and objective HF markers. A total of 25 (48.1%) had an abnormal VE/VCO2 gradient. The EOV pattern resolved in eight (80%) participants due to a reduction in EOV burden (71.1 ± 11.9% vs. 48.8 ± 14.8%, p = 0.006) and the component amplitude of minute ventilation cycles (2.6 L/min (2.5,3.2) vs 2.2 L/min (1.8,2.6), p = 0.028). Fewer patients had an abnormal VE/VCO2 gradient after CA [25 (48.1%) vs. 16 (34.0%), p = 0.004]. Ventilatory inefficiency is common in patients with AF and LVSD. CA improves both EOV and VE/VCO2 in AF-induced cardiomyopathy. Improvement in PETCO2 is also seen and correlates with HF symptom burden.

Update on Vaccination Recommendations for Adults with HIV.

Vaccination recommendations for people with HIV (PWH) differ from the general population given potential for diminished immune responses as well as increased risk for infection or more severe disease. This review highlights updated vaccine recommendations, summarizes available data informing use of vaccines, and identifies areas in need of additional study for adults with HIV. Vaccine recommendations differ for PWH in terms of timing, dosing, and need to check for serological response. New vaccines are available and recommended for PWH for prevention of invasive pneumococcal disease, respiratory syncytial virus (RSV), COVID-19, mpox, and hepatitis B virus (HBV). People with HIV experience persistent immune dysfunction, characterized by chronic immune activation and increased susceptibility to certain infections. To optimize potential of vaccines to reduce infection and infection-associated malignancies in PWH, strategies to improve vaccine responses and reduce vaccine hesitancy are necessary. While newer adjuvants show promise in enhancing immunogenicity, key questions remain regarding the durability of vaccine-induced protection and the ideal timing and necessity of booster doses for many vaccines.

The effects of positive psychology theory in the rehabilitation nursing of Chinese patients with schizophrenia: a systematic review and meta-analysis of randomized controlled trials.

Schizophrenia is a complex and severe chronic mental disorder characterized by persistent cognitive dysfunction. Particularly in Chinese families, the disability of patients with schizophrenia and the burden on their caregivers are especially heavy, reflecting the profound impact of the disease on both the patients and their families. Positive psychology is a science that focuses on human happiness, strengths, and potential. It originated at the end of the 20th century, advocated by psychologists such as Martin Seligman, aiming to go beyond the traditional psychology's focus on diseases and deficiencies and instead explore how to help people achieve the best mental state and quality of life. This study aims to conduct a meta-analysis to evaluate the impact of positive psychology interventions on Chinese patients with schizophrenia. This study aims to explore the impact of positive psychology on the wellbeing, positive symptoms, negative symptoms, depressive symptoms, social functioning, social adaptability, and cognitive functions of patients with schizophrenia. Literature was retrieved from 11 databases (CNKI, Wan fang Database, VIP Database, CBM Database, PubMed, EMBASE, Cochrane Library, Web of Science, APA PsycINFO, CINAHL, and MEDLINE), with the search period ranging from the inception date to 1 August 2024. Two researchers independently conducted literature reviews, data extraction, and bias risk assessments. The quality of the included studies was assessed using the Cochrane Risk of Bias tool, and meta-analyses were conducted using RevMan 5.3 and Stata 14.0. The continuous outcomes were analyzed by calculating the mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) according to whether combining outcomes measured on different scales or not, depending on whether the results measured by different scales were combined. A total of 54 randomized controlled trials met the criteria for this study. The results showed that positive psychology can significantly improve the wellbeing of Chinese patients with schizophrenia (MD = 0.61, 95% CI = 0.56 to 0.66, p < 0.001, I 2 = 0%), and long-term and mid-term treatments were significantly better than short-term treatments (p < 0.001). Positive psychology can significantly improve the psychological health status of Chinese patients with schizophrenia (MD = 43.50, 95% CI = 40.11 to 46.89, p < 0.001, I 2 = 0%), and long-term and mid-term treatments were significantly better than short-term treatments (p = 0.004). Positive psychology can significantly improve the positive symptoms of Chinese patients with schizophrenia (SMD = -2.68, 95% CI = -3.53 to -1.84, p <0.001, I 2 = 95%), and long-term and mid-term treatments were significantly better than short-term treatments (p < 0.001). Positive psychology can significantly improve the negative symptoms of Chinese patients with schizophrenia (SMD = -2.63, 95% CI = -3.40 to -1.87, p < 0.001, I 2 = 94%), and long-term and mid-term treatments were significantly better than short-term treatments (p < 0.001). Positive psychology can significantly improve the social functioning of Chinese patients with schizophrenia (MD = -2.68, 95% CI = -3.26 to -2.10, p < 0.001, I 2 = 94%), and long-term and mid-term treatments were significantly better than short-term treatments (p < 0.001). Positive psychology can significantly improve the self-esteem of Chinese patients with schizophrenia (MD = 7.98, 95% CI = -7.53 to 8.42, p < 0.001, I² = 0%). Positive psychology can significantly improve the social adaptability of Chinese patients with schizophrenia (MD = -8.72, 95% CI = -9.16 to -8.27, p < 0.001, I² = 0%). Positive psychology can significantly improve the cognitive function of Chinese patients with schizophrenia (MD = 2.38, 95% CI = 1.97 to 2.78, p < 0.001, I 2 = 38%). Positive psychology has significant effects on enhancing the wellbeing of Chinese patients with schizophrenia. It not only improves the positive and negative symptoms of the disorder but also strengthens social adaptability and cognitive functions. Moreover, positive psychology provides clear benefits in alleviating depressive symptoms among individuals with schizophrenia. Notably, the long-term adherence to positive psychological interventions yields much better treatment outcomes than short-term interventions. Therefore, we recommend the widespread application of positive psychology in clinical treatment. https://www.crd.york.ac.uk/prospero/, identifier CRD42024585178.

Insights into the peripheral nature of persistent sexual dysfunction associated with post-finasteride, post-SSRI and post-accutane syndromes: lessons learned from a case study.

Retinoids for acne, finasteride/saw palmetto for hair loss/BPH, and selective Serotonin Reuptake inhibitors (SSRIs) for depression, have all been implicated in severe, persistent sexual dysfunction that occurs after stopping these medications. The underlying mechanism of this post-drug syndrome is unknown, nor is an effective treatment available. The purpose of this investigation is to use a retrospective chart review to characterize a cohort of patients who suffer from post-drug syndrome and to determine if improvement in symptoms is feasible when focusing treatment on the peripheral nerves of the genitalia. Three male patients seen in our urology clinic were sequentially treated with high frequency electrical stimulation and low intensity extracorporeal shock wave therapy for a total of 16weeks. Symptom improvement was assessed using the International Index of Erection Function (IIEF), the Masturbation Erection Index (MEI), global response assessment scale, corneal confocal microscopy, the FirmTech® Ring to monitor nocturnal erections pre- and post-peripheral nerve treatment and von Frey filament testing. Mild-moderate erectile function improvement, mild penile sensitivity improvement, and mild nocturnal erection improvement were seen across all three patients. Peripheral neuropathy was noted in two patients via corneal confocal microscopy, however central symptoms remain. The post-drug syndrome appears to consist of a peripheral component which may be treatable using our regimen, as we saw overall improvement in penile sensitivity and erections following treatments. However, patients were still profoundly affected by their symptoms post-treatment and thus there is an urgent need for additional research on this syndrome.

Delayed 3D-FLAIR MRI and vestibular recovery in unilateral acute vestibular syndrome.

MRI has traditionally been employed to rule out alternative diagnoses in unilateral acute vestibular syndrome (UAVS), but delayed 3D-FLAIR sequences offer the potential for imaging to contribute to both diagnosis and management. This study aimed to assess abnormalities on delayed 3D-FLAIR MRI in UAVS patients and correlate these findings with clinical outcomes. A retrospective multicenter study was conducted between January 2018 and May 2024 at a university hospital and a private vestibular clinic, representing a diverse clinical setting. It included 92 patients with UAVS (47 women, 45 men; mean age 50.6years) diagnosed according to Bárány Society guidelines, with acute vertigo lasting at least 24h, spontaneous horizontal-rotatory nystagmus, and a reduced vestibulo-ocular reflex (VOR) on the affected side, without auditory or neurological symptoms. The MRI findings were blindly assessed to identify potential blood-labyrinth barrier (BLB) impairment, nerve enhancement, or canal fibrosis. These imaging abnormalities were then correlated with initial and follow-up video head impulse test (vHIT) results. BLB impairment was found in 63% of patients and canal fibrosis in 14.1%, with no nerve enhancement detected. BLB impairment significantly correlated with initial VOR deficits and was linked to poorer vHIT recovery, suggesting its role in predicting persistent vestibular dysfunction. These findings suggest that delayed 3D-FLAIR MRI can identify biomarkers, particularly BLB impairment, that are predictive of vestibular recovery, highlighting MRI's role in guiding UAVS treatment.

Voiding dysfunctionafter surgery for colorectal deep infiltrating endometriosis: an updated systematic review and meta-analysis.

To define the risk factors of post-operative voiding dysfunction according to the type of surgical procedure performed. A systematic review through PubMed, the Cochrane Library, and Web of Science databases was performed. The Medical Subject Headings terms aimed for English articles about colorectal endometriosis surgery and voiding dysfunction published until December 26, 2022 were used. The primary outcome was the occurrence of post-operative voiding dysfunction. Secondary outcome was the presence of a persistent voiding dysfunction at 1month. MeSH terms included ''deep endometriosis'', ''surgery'', or ''voiding dysfunction''. Two reviewers (AM, PE) assessed the quality of each article independently. A Study Quality Assessment Tool was used to provide rating of the quality of the included studies. 22 studies were included in the final analysis. Rectal shaving was associated with less voiding dysfunction than segmental resection (OR 0.33; 95%CI [0.20: 0.54]; I2 = 0%; p < 10-3). No difference was found between rectal shaving and discoid excision (OR 0.44; 95%CI [0.07: 2.84]; I2 = 55%; p = 0.39), nor between discoid excision and segmental resection (OR 0.44; 95%CI [0.18: 1.09]; I2 = 49%; p = 0.08). Conservative surgery (i.e., shaving and discoid) was associated with less voiding dysfunction than radical surgery (i.e., segmental resection) (OR 0.37; 95%CI [0.25: 0.55]; I2 = 0%; p < 10-3). Regarding persistent voiding dysfunction, rectal shaving and discoid excision were less associated with voiding dysfunction than segmental resection (respectively, OR 0.30; 95%CI [0.14: 0.66]; I2 = 0%; p = 0.003 and OR 0.13; 95%CI [0.03: 0.57]; I2 = 0%; p = 0.007). Conservative bowel procedures are associated with lower rates of persistent post-operative voiding dysfunction and should be considered first when possible.Trial registration: Our meta-analysis was registered under the PROSPERO number: CRD42023395356.

Early-life stress induces persistent astrocyte dysfunction associated with fear generalisation.

Early-life stress can have lifelong consequences, enhancing stress susceptibility and resulting in behavioural and cognitive deficits. While the effects of early-life stress on neuronal function have been well-described, we still know very little about the contribution of non-neuronal brain cells. Investigating the complex interactions between distinct brain cell types is critical to fully understand how cellular changes manifest as behavioural deficits following early-life stress. Here, using male and female mice we report that early-life stress induces anxiety-like behaviour and fear generalisation in an amygdala-dependent learning and memory task. These behavioural changes were associated with impaired synaptic plasticity, increased neural excitability, and astrocyte hypofunction. Genetic perturbation of amygdala astrocyte function by either reducing astrocyte calcium activity or reducing astrocyte network function was sufficient to replicate cellular, synaptic, and fear memory generalisation associated with early-life stress. Our data reveal a role of astrocytes in tuning emotionally salient memory and provide mechanistic links between early-life stress, astrocyte hypofunction, and behavioural deficits.

Early-life stress induces persistent astrocyte dysfunction associated with fear generalisation

Early-life stress can have lifelong consequences, enhancing stress susceptibility and resulting in behavioural and cognitive deficits. While the effects of early-life stress on neuronal function have been well-described, we still know very little about the contribution of non-neuronal brain cells. Investigating the complex interactions between distinct brain cell types is critical to fully understand how cellular changes manifest as behavioural deficits following early-life stress. Here, using male and female mice we report that early-life stress induces anxiety-like behaviour and fear generalisation in an amygdala-dependent learning and memory task. These behavioural changes were associated with impaired synaptic plasticity, increased neural excitability, and astrocyte hypofunction. Genetic perturbation of amygdala astrocyte function by either reducing astrocyte calcium activity or reducing astrocyte network function was sufficient to replicate cellular, synaptic, and fear memory generalisation associated with early-life stress. Our data reveal a role of astrocytes in tuning emotionally salient memory and provide mechanistic links between early-life stress, astrocyte hypofunction, and behavioural deficits.