People of Asian ethnicity represent one of the fastest-growing populations in the United States and may experience unique social and cultural challenges to accessing sexual healthcare. This analysis explores disparities in annual sexually transmitted infection screening and diagnosis rates per person-year between Asian and non-Asian people with human immunodeficiency virus in Washington, District of Columbia (DC). Using District Columbia cohort data, a longitudinal study of people living with human immunodeficiency virus receiving care in Washington, DC, we analyzed people with human immunodeficiency virus aged 18 or older with at least 1 year of follow-up between 2018 and 2023. Logistic regression was used to examine differences in sexually transmitted infection screening and diagnoses between Asian and non-Asian participants, while linear trend analyses were used to assess changes in the number of screenings and diagnoses between Asian and non-Asian participants. Among 8679 eligible participants, 0.88% (n=76) were Asian. No significant differences in total sexually transmitted infection screenings or diagnoses were observed. However, Asian participants had higher screening rates per person-year for pharyngeal and urogenital gonorrhea, pharyngeal chlamydia, and syphilis. Chlamydia incidence was higher among Asian than non-Asian participants. Over 30% of both groups met the annual screening recommendation during the study period. Asians had comparable screening rates to non-Asians, but the small sample size limited the generalizability of our findings. Nonetheless, this study helps address an existing gap in the literature on Asian sexual health. Larger studies with detailed ethnic and social data are needed to deepen our understanding of sexual health service use within Asian communities.

In this study, we aimed to compare the clinical outcomes of unilateral biportal endoscopic (UBE) lumbar discectomy and open lumbar microdiscectomy (MD) for recurrent disc herniation. Ninety patients who underwent discectomy, including 44 and 46 who underwent UBE and MD, respectively, were enrolled. All surgeries were performed between March 2020 and April 2023. Only patients with single-level recurrence were included; patients with multilevel recurrence or unstable disease, as well as those who had undergone surgery less than 6 months prior, were excluded. Visual analog scale (VAS) scores, recurrence rates, and complications were compared between the groups. The average follow-up periods were 19.09 and 20.45 months in the UBE revision and MD revision discectomy groups, respectively. The mean bleeding loss and hospital stay were shorter in the UBE group than in the MD group. Postoperative short-term back pain was lower in the UBE group (VAS score, 3.32) than in the MD group (VAS score, 7.89) (p<0.001). Radiating pain showed similar patterns in both groups at all time points. Recurrence was more frequent in the MD group; however, this difference did not reach statistical significance, likely owing to the small sample size (p=0.677). Similarly, incidental durotomy occurred less frequently in the UBE group (6.8% vs. 8.7%), but this difference was not statistically significant. Both UBE and MD could achieve good long-term outcomes; however, UBE revision was superior in terms of short-term back pain, bleeding loss, and length of hospital stay after surgery.

Background Critically ill patients exhibit acute physiological changes leading to marked antibiotic exposure variability and an increased probability of either subtherapeutic or potentially toxic exposures. Beta-lactam antibiotics are often affected by these physiological changes, leading to variable and often subtherapeutic exposures. Furthermore, although this medication class is associated with minimal concentration-related adverse effects, recent evidence suggests that beta-lactams may be associated with neurotoxicity and nephrotoxicity. Therefore, methods to increase the probability of a therapeutic exposure may be beneficial for critically ill patients. Model Informed Precision Dosing (MIPD) is an emerging strategy using advanced computer models to individualise dosing in this vulnerable population with or without therapeutic drug monitoring (TDM). By tailoring therapy to the individual patient scenario, MIPD aims to improve clinical outcomes by enhancing the likelihood of effective and safe therapy. Summary MIPD-guided beta-lactam antibiotic dosing may improve the probability of attaining target therapeutic exposures and clinical cure rates compared to standard fixed dosing in critically ill patients. Moreover, MIPD allows clinicians to target higher beta-lactam antibiotic exposures whilst minimising the risk of toxicity, when the goal of treatment is both improving clinical cure rates and suppressing the probability of antibiotic resistance emergence. No differences in mortality and adverse event reduction compared to standard dosing has been currently identified in the literature. However, the exact potential of MIPD has yet to be determined given the significant limitations in the current evidence base, including heterogeneous study designs, small sample sizes, inconsistent implementation strategies and variable outcome definitions. Clinical practice and future research should optimise MIPD performance by selecting appropriate and innovative beta-lactam antibiotic exposure models, as well as identify methods to instigate early MIPD dosing and timely TDM dose adjustments. This may further improve clinical and economic outcomes for critically ill patients.

Gambling disorder (GD) presents significant psychological, financial, and social consequences. Mindfulness-based interventions (MBIs) have emerged as promising adjunctive treatments. However, the evidence base remains heterogeneous. The present systematic review evaluated the current empirical literature on MBIs for GD, focusing on their efficacy, methodological quality, and limitations. Scopus, PubMed, Web of Science, EBSCO, and PsycINFO were searched for English-language studies published between 2012 and April 2025. The final sample comprised 12 studies: five randomized controlled trials, one controlled pilot study, two repeated-measures studies, one mixed-methods study, and three single-group pretest-posttest studies. A narrative synthesis evaluated MBI impacts. MBIs consistently reduced gambling frequency and cravings while enhancing psychological outcomes. Studies combining mindfulness with cognitive behavioral therapy showed significant declines in problem gambling behavior. Psychological distress and cravings also decreased notably across interventions. The mindfulness components employed varied in focus and application, adding nuance to outcome interpretation. However, it remains unclear to what extent the observed effects can be attributed to mindfulness-specific mechanisms. MBIs show promise as a complementary treatment for gambling disorders, although small sample sizes and methodological limitations suggest a need for more robust research.

Approaches to Studying Virus Pangenome Variation Graphs.

ABSTRACT Aims To describe a novel knotless subcuticular suture technique using traditional smooth suture material, and to demonstrate its safety by comparing the post-operative complications with traditional interrupted cruciate skin sutures. Methods Forty-four dogs undergoing ovariohysterectomy were randomised into two groups, whereby the skin was closed using either a knotless subcuticular suture (NKSS; n = 22) pattern or traditional cruciate skin sutures (CSS; n = 22). The surgical wounds were assessed using a semiquantitative scoring system 10–14 days post-operatively. Data was analysed for variables associated with any wound reaction first using univariable comparisons. Then, to address small event counts and complete separation, multivariable analysis was conducted using Firth’s penalised logistic regression. Results Wound reactions occurred in 0/22 dogs with NKSS vs. 5/22 (22.7%) with CSS (p = 0.048). The univariable odds of reaction calculated using Haldane’s correction were lower with NKSS (OR = 0.071 (95% CI = 0.0037–1.37); Fisher’s exact p = 0.0796). Only suture type was retained in the logistic regression, with findings for the protective effect of NKSS consistent in direction but with greater precision (OR = 0.071 (95% CI = 0.000–0.693); p = 0.0190). Conclusions In this prospective cohort, the absolute risk of any wound reaction was 0% with NKSS and 22.7% with CSS. Findings are compatible with reduced odds of wound reactions for NKSS, but precision is limited by the small sample size and few events. Larger, blinded studies are required before firm conclusions about comparative safety can be drawn. Clinical relevance The novel knotless subcuticular suture technique was safe and effective for the skin closure of ovariohysterectomy incisions in dogs, and it may result in lower superficial wound reactions.

Stroke is a sexually dimorphic disease, with different risk factors, incidence, outcomes, and treatment responses in men and women. While sex differences have been documented in preclinical studies, these findings often come from single-site studies with small sample sizes and require validation across diverse research settings. We used data from the SPAN (Stroke Preclinical Assessment Network), a randomized, placebo-controlled, blinded, multilaboratory trial, to determine if sex differences in neurological outcomes are present in preclinical stroke models. We analyzed data from 665 stroke animals treated with saline, including young mice, diet-induced obese mice, aging mice, young rats, and spontaneously hypertensive rats. We compared the corner test index and brain morphology between the sexes using linear random effect models and assessed the mortality rate using Cox proportional hazard regression models. No significant sex differences were found in neurological outcome measured with the corner test on either day 7 or day 30 after stroke, regardless of the mouse or rat stroke model used. Additionally, female and male mice exhibited similar infarct sizes on day 2 magnetic resonance imaging and on brain atrophy measures on day 30 after stroke, indicating a lack of sex differences in brain injury. Similarly, no sex differences were observed in acute or chronic sensorimotor or tissue outcomes in young rats. In 1 subanalysis, sex differences were seen in the spontaneously hypertensive rats cohort. Female rats exhibited a higher corner test index on day 30 than males, indicating more severe sensorimotor injury. In this multicenter preclinical study, we did not detect sex differences in stroke outcomes in mice, although sex differences in behavioral outcomes were observed in spontaneously hypertensive rats. These findings highlight that sex differences may be model-specific and subtle, emphasizing the need for methodological consistency and thoughtful inclusion of diverse animal models in translational stroke research to better understand if sex-specific responses contribute to stroke outcomes.

The increased availability of genomic data from ancient humans allows estimating the strength of natural selection at a given locus using time series data. Several methods have been developed for this purpose and were originally validated through simulations using mostly large sample sizes. However, human ancient DNA (aDNA) data typically have high missingness and include only a small uneven number of individuals per time point, making estimations of selection challenging. Here, we benchmark the inference of selection with aDNA-like time series datasets using extensive simulations and four methods: ApproxWF, BMWS, Slattice, and Sr. We test several sampling schemes of time series data and selection coefficients (s) and focus on whether one can infer selection using time series datasets with sparse data and small sample sizes. We show that detecting selection with aDNA data is possible for strong s with a sample size of ~100 when assuming constant Ne. While ApproxWF performs best across simulations, the other methods present more variable results and do not perform well for typical aDNA datasets. Importantly, generally low false positive rates (<6%) highlight low risks to falsely detect selection when the loci are evolving neutrally. Moreover, relatively high power (>90%) for s ≥ 0.02 (Nes ≥ 200) shows that strong selection can generally be detected with confidence. We also show that more homogenous sampling improves the accuracy of the estimations. Finally, we provide recommendations for future research aiming to estimate selection with aDNA, noting the importance of spreading data evenly across time and avoiding time points with extremely small sample sizes.

Hürthle cell carcinoma (HCC) -recently known as oncocytic carcinoma- is a rare type of differentiated thyroid cancer that presents a diagnostic and therapeutic challenge because of its morphological heterogeneity and uncertain biological behavior. This retrospective single-center cohort study included all the patients with HCC who underwent surgical treatment in our center from January 2009 to May 2024. The epidemiological, clinical, and oncological data of the included patients were analyzed. This study included nineteen cases of HCC (9 males and 10 females). The average age at diagnosis was 54.8 ± 12.2 years. Preoperative fine needle aspiration cytology (FNAC) classified 2 tumors as Bethesda I, 7 as Bethesda III, 6 as Bethesda IV, and 4 as Bethesda V. A variety of surgical procedures were used, including hemithyroidectomy in 3 patients and total thyroidectomy in 12 patients. Two patients underwent neck dissection. The median tumor size was 6.7cm. Pathological evaluation identified 9 patients with unifocal lesions and 10 with multifocal lesions. Only one patient showed positive lymph node involvement. The median times to death, distant metastasis, and locoregional recurrence were 4, 13, and 6 years, respectively. For locoregional recurrence, the restricted mean survival time (RMST) at five years was 4.4 years (95% CI 3.9-4.9), 4.6 years (95% CI 4.1-5.0) for distant metastasis, and 4.1 years (95% CI 3.6-4.5) for overall survival. There was a trend towards worse prognosis in females, younger age, and those with primary surgery outside the center. These differences did not achieve statistical significance, at least partly due to the small sample size. Diagnosing HCC remains challenging due to its overlapping features with other thyroid conditions, making fine-needle aspiration cytology less definitive. Surgical treatment remains the preferred therapeutic option. Age, gender, and the volume of the surgical center for the initial procedure can influence patient outcomes, particularly recurrence and survival rates.

Incarcerated or threatened bowel obstruction with suspected intestinal ischemia requires prompt surgical intervention. This retrospective case series, involving 8 patients undergoing emergency laparotomy, evaluated the feasibility of combining indocyanine green (ICG) fluorescence and Doppler ultrasound for intraoperative bowel viability assessment. Indocyanine green was injected intravenously. Doppler assessment was performed using a high-frequency linear probe along the antimesenteric border. No patients required bowel resection. In 2 cases, initial ICG findings suggested non-viability, but Doppler ultrasound demonstrated preserved arterial flow. A second ICG injection showed fine granular fluorescence, allowing bowel preservation. The combination of modalities helped avoid unnecessary resections. Indocyanine green is safe and repeatable but limited by reduced signal in edematous tissue and subjectivity. Doppler ultrasound offers objective flow confirmation and may guide delayed reassessment. Despite a small sample size and selection bias, these findings support cautious, stepwise approaches in borderline cases and the need for multicenter prospective trials in emergency surgical settings.

Systematic machine learning approach for cerebral aneurysm feature selection and rupture status classification.

Bilateral vestibulopathy (BV) is a rare disorder characterized by loss of vestibular function, leading to unsteadiness and blurred vision during head movements, particularly in visually challenging settings such as driving. Although difficulties with driving have been suggested in BV patients, this pilot study aims to further explore and quantify self-reported driving ability and behavior in this population using both generic and disease-specific questionnaires. Twenty adults with confirmed BV (mean age 61.6 years) were recruited from a tertiary center. Participants completed a novel disease-specific questionnaire, developed collaboratively by ENT specialists and driving research experts to identify traffic situations that are particularly challenging for patients with BV. In addition, they completed the Driver Behavior Questionnaire (DBQ) and the Multidimensional Driving Style Inventory (MDSI). Participants also rated their driving competence and reported on crash involvement and traffic violations. Most patients reported little difficulty while driving in familiar daytime environments but experienced challenges during night driving, in poor weather conditions, on uneven roads, and while multitasking. Ordinary violations were the most common maladaptive behaviors per the DBQ, though errors and lapses were rare. The MDSI showed patient and careful driving styles predominated, with anxious and distress-reduction styles reported by a minority. Only one patient attributed a traffic accident to BV, and few reported recent violations. BV patients mostly adopt safe, adaptive driving behaviors, a pattern also commonly observed among older drivers. However, specific situations requiring stable gaze and spatial orientation pose particular challenges for individuals with BV. Findings are limited by self-reporting and small sample size. Future research using objective driving assessments and control groups is needed to inform evidence-based guidelines for counseling BV patients about driving.

There is some evidence of intrauterine contraceptive devices (IUDs) migrating after insertion; however, these studies had small sample sizes and have not been performed with an Australian population. Furthermore, current guidelines for IUDs provide ambiguous recommendations for post-procedure check-ups 5-8 weeks after insertion. In some cases, it is unclear if a pelvic ultrasound should be used to ascertain IUD position. The clinical usefulness of ultrasound as the primary post-procedure investigation has not been fully elucidated, nor has the migration and position change in an Australian population. To evaluate the migration or change in position of IUDs in an Australian population, and the clinical usefulness of a post-procedure check with an ultrasound following insertion. A retrospective cohort study over 3 years across eight Sydney sites by multiple practitioners. 645 cases were referred for insertion or IUD exchange under ultrasound. In 5% of cases the device was sub-optimally positioned at the time of insertion. On post-procedure follow-up, of the IUDs in the optimal position, 98.5% remained unchanged. 1.3% changed to a suboptimal position, but of these 75% had an underlying uterine anomaly. Of the devices that were sub-optimally positioned at time of insertion, 84% migrated to the optimal fundal position; those unchanged from suboptimal (16%) had anomalies or other causes identified. Once an IUD is inserted into an appropriate position in the fundus, it is extremely unlikely to change position unless the patient has an underlying structural anomaly or a previous hysterotomy. Fundal positioning at the initial insertion was 95%, which on post-procedure check-up improved to 98.7% of cases. Reassuringly, of the IUDs which were sub-optimally positioned, 84% improved their position to an appropriate location 5-8 weeks later. This also suggests migration of devices into an optimal position. With this evidence that most IUDs will migrate to a more appropriate position, we suggest all guidelines remove the 4-8 week check, and that to perform an ultrasound only if symptomatic or if unable to palpate the IUD strings. This study evaluates the migration or change in position of intrauterine contraception devices after initial insertion in an Australian population, and the clinical usefulness of a post-procedure check using ultrasound. The current Australian guidelines are not explicitly clear whether an ultrasound is required in post-procedure check-ups. This study demonstrates that an ultrasound is not a necessary component of post-procedure check-ups, as the vast majority of IUDs will migrate into an appropriate position over a two-month period following insertion.

Pressure injury surveillance in the intensive care unit: Development, validation, and clinical application of a natural language processing algorithm.

This systematic review aimed to assess associations between genotypes and the risk of experiencing postoperative opioid-related adverse drug events (ORADEs). Following PRISMA guidelines and registered with PROSPERO, we searched MEDLINE, Embase and CENTRAL for studies assessing genetic predictors of ORADEs within 24 h postoperatively. Eligible studies included English-written retrospective and prospective cohort studies as well as randomised trials. Risk of bias was assessed using the QUIPS tool. Data were extracted in duplicate, and relative risks with 95% confidence intervals were calculated. Meta-analyses were conducted when ≥ 2 studies assessed the same genetic predictor and ORADE relationship. Of the 119 523 citations, 27 studies (5279 patients) met inclusion criteria. All included studies ranked high risk of bias. Of the 28 investigated predictors, 17 significantly increased or decreased ORADE risk in individual studies. Of the 31 meta-analyses, only two demonstrated significant associations (p < 0.05; COMT rs4680 AA and nausea, and CYP2D6 IM and hyperhidrosis). While finding two significant associations, we would expect one to two significant associations at random given the 31 meta-analyses. Findings were limited by heterogeneity, few studies and small sample sizes. The current evidence does not suggest that genotypes should have a central place in the risk stratification of the occurrence of postoperative ORADEs.

Metagenomic analysis of the gut microbiota in major depressive disorder with different antidepressant efficacy: A prospective cohort study.

LSD microdosing in major depressive disorder: results from an open-label trial.

This study examines the role of ethical standards in Human Resource Management and organizational culture, with an emphasis on their impact in international organizations. The study focuses on the information technology sector in Bosnia and Herzegovina, discussing its development, challenges, and the effects of international companies on the labor market and ethical practices. Although the participating companies operate globally and employ geo-hybrid teams, the study sample consists exclusively of employees in Bosnia and Herzegovina. The empirical research provides insights into the importance of ethics in organizations. The methodology was conducted using a structured questionnaire with 186 participants to assess key aspects of this research. Findings indicate a positive influence of national culture on the implementation of ethical standards. Factors such as satisfaction, awareness, and trust proved significant in linking national culture with the adoption of ethical norms. The study is limited by its small sample size, focus on Bosnia and Herzegovina, and lack of benchmarking with multinational companies, which may affect its generalizability. Future studies should expand the research sample across multiple countries to gain a better understanding of cross-national differences. This research contributes to the understanding of ethics in organizations and provides insights for strengthening ethical practices and promoting positive work environments.

Safety and performance of a Lipiodol-resistant mixing and injection system in conventional trans-arterial chemoembolization: A post-market clinical follow-up.

Hypomineralized Second Primary Molars (HSPM) are qualitative enamel defects that typically involve one to four second primary molars. Although widely investigated, their etiology remains unclear. This review synthesizes current evidence on potential etiological factors. The design of this systematic review complied with the 2020 PRISMA guidelines. The research was conducted using five databases. Study quality and bias were assessed using the Newcastle-Ottawa Scale. Nine articles met the inclusion criteria, underscoring the limited evidence base. Prenatal factors were most frequently associated with HSPM, particularly epigenetic markers in blood (DNA hypermethylation and hypomethylation, p < 0.05), maternal smoking (p = 0.001), and maternal illness (p < 0.001). Though effect sizes varied, and methodological heterogeneity limited comparability. Perinatal factors such as preterm birth (p = 0.024) and delivery complications (p = 0.032) were also reported, but evidence was less robust and often confounded by small sample sizes. Postnatal factors, including recurrent childhood illnesses (asthma, otitis media, episodes of fever, and eczema) were significantly linked to HSPM, yet causality remains uncertain given the dependence on retrospective designs and parent-reported data. Current evidence suggests that HSPM is likely multifactorial with contributions from prenatal, perinatal, and postnatal exposures. However, the overall level of evidence is moderate, constrained by small study numbers, variable quality, low response rate, and the retrospective nature of the studies. Stronger conclusions will require large-scale, prospective studies with standardized diagnostic criteria and rigorous control of bias.