Citations

Purpose of Research Lucidity is the transient recovery of abilities and communication that were seemingly lost among people living with dementia (PLWD). This study describes lucid episodes reported by Alzheimer’s dementia (AD) and Lewy Body Dementias (LBD) caregivers. We analyzed survey data from 212 current AD ( n = 191) and LBD caregivers who reported the frequency, duration, and characteristics of 653 lucid episodes witnessed in the past month. Major Findings Most AD caregivers (67%) and LBD caregivers (81%) witnessed a lucid episode within the past month. LBD caregivers reported lucid episodes with greater changes in awareness and communication, compared to AD caregivers. LBD caregivers reported longer lucid episodes and that the PLWD knew about their change in lucidity, compared to AD caregivers. Conclusions Findings suggest that differences in lucid episode intensity, timing, and meta-awareness between AD and LBD are possible and may inform care strategies for PLWD.

ABSTRACT Introduction/Aims Ultrasound (US) guidance may be essential for accurate electromyography (EMG) needle placement in less‐commonly evaluated muscles, such as the extensor carpi radialis longus (ECRL) and brevis (ECRB), and particularly for identifying suitable donor muscles prior to tendon transfers to restore upper extremity function. Our primary aim was to compare the accuracy of trainee palpation‐guided versus first‐attempt US‐guided needle placement. Our secondary aim was to describe the locations of inaccurate needle placement. Methods Seven subjects each performed four needle placements (ECRL and ECRB, both palpation‐guided and US‐guided), totaling 28 placements into a cadaveric specimen. US‐guided needle placement was performed with one attempt after one live demonstration. Results No palpation‐guided ECRL attempts were accurate while only two of the palpation‐guided ECRB attempts were accurate. First‐attempt US‐guided needle placement was significantly more accurate overall (64.3% vs. 14.2%, p = 0.020), and specifically for ECRL (71.4% vs. 0%, p = 0.025). Combining palpation‐guided ECRL and ECRB attempts, the needle was inadvertently placed in the extensor digitorum communis (50%), extensor carpi ulnaris (16.7%), and brachioradialis (16.7%). Both US‐guided ECRL‐intended errors involved placing the needle into the adjacent ECRB. Discussion This study suggests that EMG needle placement into ECRL and ECRB by trainees may be more accurate with US guidance. Accurate preoperative individual needle assessments of both wrist extensors are essential for patients with tetraplegia considering reconstructive surgery to restore functional grasp and should be performed with US guidance.

ABSTRACT Pathogenic variants in AMMECR1 have been associated with a rare multisystem disorder characterized by midface hypoplasia, hearing impairment, elliptocytosis, and nephrocalcinosis (MFHIEN). To date, most reported cases involve copy number variants or presumed loss‐of‐function alterations, with only a single prior report describing a missense variant supported by functional studies. Here, we report a patient with a heterozygous de novo AMMECR1 missense variant, NM_015365.3:c.649G>A p.(Val217Met) presenting with clinical features consistent with MFHIEN, including midface hypoplasia, partial hearing impairment, nephrocalcinosis, and elliptocytosis identified on peripheral blood smear. Comparative review of the literature highlights that while previously reported missense variants in AMMECR1 demonstrated altered intranuclear protein distribution and reduced expression in functional assays, clinical evidence supporting pathogenicity of non‐truncating variants remains limited. The phenotypic overlap between our patient and prior report strengthens the association between missense variations and the MFHIEN phenotype. Our findings support the pathogenic relevance of missense variation in AMMECR1 and emphasize the importance of integrating detailed phenotyping, including hematologic evaluation, with genomic data in the diagnosis of rare multisystem disorders. Additional cases and functional studies are needed to clarify genotype–phenotype correlations and underlying disease mechanisms.

Abstract: Heart valve abnormalities are present in 30% of congenital heart defects. Additionally, there are acquired conditions like rheumatic heart disease. They often require surgery, and in complex cases, valve replacement becomes unavoidable. The current valve replacement options, either mechanical, bioprosthetic, homografts, or autografts, lack key properties for pediatric patient needs: availability, durability, and the ability to grow. Our goal is to review 2 clinically relevant innovations: tissue-engineered heart valves (TEHVs) and partial heart transplantation (PHT). We conducted searches in electronic databases covering the past 25 years using the terms “partial heart transplantation,” “tissue-engineered heart valves,” and their combinations. Decellularized pulmonary homografts outperform cryopreserved homografts and bovine jugular vein conduits in pulmonary valve replacement, showing less stenosis and no infective endocarditis. The European Clinical Study for the Application of Regenerative Heart Valves trial confirmed decellularized pulmonary homograft safety, demonstrating 97.5% freedom from explantation at 5 years. Decellularized aortic homografts showed excellent 97.8% 5-year survival and low endocarditis rates, though increases in transvalvular gradient and regurgitation occurred. Partial heart transplantation uses living valves from donor hearts and accommodates somatic growth. Postoperative immunosuppression in PHT is required but may be limited, as children and valve tissues may possess immune privilege, as evidenced by limited valve injury even in failed orthotopic heart transplants. In a pilot study of 19 infants, with a median follow-up of 26 weeks, increases in annular diameter and leaflet length were observed. Both PHT and TEHVs are promising valve replacement options. While PHT provides a growth-adaptive capability, TEHVs hold the potential for off-the-shelf solutions with minimal immunogenicity.

ABSTRACT Non‐allergic rhinitis is a frequent yet underdiagnosed cause of chronic nasal symptoms, including nasal congestion, rhinorrhoea, and upper airway hyperreactivity. Its pathophysiology involves neurogenic dysregulation, leading to excessive mucus production and vasodilation. While medical therapy remains first‐line, some patients experience persistent symptoms requiring surgical intervention. This review outlines key surgical options for refractory non‐allergic rhinitis: inferior turbinate (IT) reduction, vidian neurectomy, and posterior nasal nerve (PNN) ablation. IT reduction—performed using cold instruments, radiofrequency, laser, coblation, or microdebrider—remains the cornerstone treatment for nasal obstruction, offering durable symptom relief with low complication rates. Vidian neurectomy effectively reduces rhinorrhoea but carries risks of ocular dryness and transient facial numbness, limiting its indication to severe, refractory cases. PNN interventions, including cryotherapy, cold‐instrument techniques, and radiofrequency, provide a minimally invasive, outpatient alternative that selectively targets nasal parasympathetic and sensory fibers while sparing lacrimal innervation, yielding significant and lasting symptom improvement. Surgical management of non‐allergic rhinitis is effective and safe when tailored to symptom profile, anatomy, and prior medical treatment response. Advances in endoscopic and minimally invasive approaches have reduced complications, establishing these procedures as integral options in comprehensive non‐allergic rhinitis care.

Purpose The purpose of this study was to compare graft failure and clinical outcomes following primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft (QA), with or without a modified Lemaire lateral extra‐articular tenodesis (LET). Methods Patients with ACL deficiency who underwent primary QA ACLR with or without LET and completed at least 2‐year follow‐up were included. Patients with a Beighton score ≥4, a preoperative pivot shift grade ≥2, or an intention to return to cutting and pivoting sports were offered LET. The primary outcome variable assessed was graft failure as defined by graft rupture or grade ≥2 pivot shift at any point postoperatively. Secondary outcomes included return to sport clearance rates, the International Knee Documentation Committee and Lysholm scores and postoperative complications. Results There were 122 undergoing QA ACLR with LET (QA + LET group) and 152 undergoing isolated QA ACLR (QA group). The QA + LET group had a significantly lower failure rate of 14.8% versus 29.6% in the QA group ( P = .02). In addition, the QA + LET group had a lower residual pivot shift rate compared with the QA group (11.3% vs. 26.3% respectively; P = .01). There was no difference in graft retear rates between the 2 groups ( P = .37). The QA + LET returned to sport significantly faster at 8.8 months compared with 9.7 months in the QA group ( P = .038). Conclusions The addition of LET to QA ACLR was associated with a significantly lower overall graft failure rate and lower percentage of patients with residual pivot shifts after ACLR compared with QA alone at 2‐year follow up. However, there was no difference between the 2 groups with regard to graft retear rates. The addition of an LET to QA ACLR also allowed athletes to return to sports faster compared with QA alone. Level of Evidence Level III, retrospective comparative study.