Citations

Objective To investigate sex differences in Alzheimer's disease (AD) related pathology among autopsy-confirmed Parkinson's disease (PD) cases. Background AD and PD frequently co-occur in older adults, yet the influence of sex on AD pathology in the context of PD remains unexplored. Methods All subjects were enrolled in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) and Brain and Body Donation Program (BBDP) and had annual standardized research clinical assessments by neuropsychologists, subspecialty behavioral and movement disorders neurologists, as well as comprehensive neuropathological examinations after death. Results Among 230 autopsy-confirmed PD cases, females exhibited greater amyloid plaque pathology burden than males, regardless of a co-occurring AD diagnosis. Specifically, females with PD had significantly higher mean cortical total plaque scores (mean 6.5/15 vs. 4.9/15, p = 0.045) and greater CERAD neuritic plaque density (mean 1.7/3 vs. 1.3/3, p = 0.035). Females were also more likely to have a higher cortical plaque burden (plaque total ≥ 5: 56.8% vs. 39.7%, p = 0.015). In multivariable logistic regression models, female subjects showed greater than twice the odds of having an amyloid plaque burden ≥5 compared to males (OR = 2.18; 95% CI = 1.17–4.06; p = 0.014), when controlling for ApoE ε4 status, Lewy body density score, and age at death. Conclusions Female sex is associated with increased amyloid plaque pathology in PD, independent of ApoE ε4 status. These findings highlight a sex-specific vulnerability to AD pathology in PD patients and support the need for sex-informed approaches to reseach in mixed neurodegenerative disease.

Abstract Purpose The female waist and torso remain fundamental aesthetic elements in body contouring, yet empirical data describing public preferences for waist-to-hip ratio (WHR) and abdominal muscle definition are limited. Misalignment between patient perceptions and actual aesthetic preferences may influence body dissatisfaction, drive unnecessary procedures, and shape unrealistic surgical goals. This study aimed to (1) evaluate how females perceive their own waist shape and ideal appearance using standardized manipulated images, (2) quantify male preferences for female WHR and abdominal definition, and (3) assess the discrepancy between what women believe men find attractive and men’s actual preferences. Methods An anonymous online survey was distributed internationally and collected 900 responses from adult participants. Two digitally manipulated, standardized female torso images were created: one varying waist-to-hip ratio across five levels (WHR 0.60 to 0.80) and one varying abdominal muscle definition. Male participants rated which WHR and abdominal definition they found most attractive. Female participants reported (1) which WHR and definition most resembled their current appearance, (2) which represented their ideal, and (3) which they believed men found most attractive. Additional demographic and body image variables were collected. Descriptive statistics were generated, and comparative analyses (chi-square tests) were conducted to evaluate differences in preference distributions and female perception versus male reality. Results A total of 900 respondents participated, including 41% men and 59% women. Male respondents showed a clear preference for smaller waist-to-hip ratios (WHR). The lowest WHR (0.60) was the most frequently selected option (38%), with steadily decreasing selections as WHR increased. Men also most preferred mild abdominal definition (Option B). Female responses revealed notable perception gaps: women most often perceived themselves as having midrange WHRs (0.70) but selected lower WHRs (0.65) as ideal, and they substantially overestimated men’s preference for the smallest WHR. Subgroup analyses showed that male WHR preferences varied significantly by continent (p < 0.05), with Europe, North and South America favoring smaller WHRs, while Africa, Australia, and Asia preferred larger ones. Higher male physical activity was associated with selecting smaller WHRs (r = –0.220, p < 0.05) and slightly greater abdominal definition (r = 0.169, p < 0.05). Social media use did not influence male preferences. Among women, physical activity strongly predicted desired abdominal muscularity (r = 0.236, p < 0.05) but not ideal WHR. Perceived social media influence significantly shaped ideal WHR (r = 0.202, p < 0.05), such that women who reported more negative influence selected smaller, more exaggerated WHRs. Time spent on social media did not significantly affect female aesthetic preferences. Conclusion This study provides quantitative evidence describing public preferences for female waist and torso aesthetics, revealing important divergences between perception and reality. Men strongly prefer smaller waist-to-hip ratios and mild abdominal definition, but not to the extreme levels that women commonly assume. Women’s own ideal waist shape aligns directionally with male preferences, yet women significantly overestimate the degree to which men favor the smallest possible WHR. This misperception may contribute to body dissatisfaction, drive interest in unnecessary procedures, or set unrealistic surgical expectations. For aesthetic surgeons, these findings highlight the need for patient-centered counseling that addresses perception gaps, corrects inaccurate beliefs about male preferences, and reinforces natural, proportionate outcomes rather than extreme contouring. The data support a trend toward moderate enhancement rather than highly exaggerated WHR reduction or aggressive abdominal definition in female body contouring. Incorporating these insights may improve patient satisfaction, promote psychological well-being, and guide surgical planning grounded in evidence-based aesthetics.

ABSTRACT Background Babesia microti , a parasite transmitted by the Ixodes scapularis tick, can cause infections ranging in presentation from asymptomatic to fulminant, life-threatening disease. Ocrelizumab, an anti-CD20 B-lymphocyte monoclonal antibody used to treat multiple sclerosis, increases the risk of severe or relapsing infections with tick-borne pathogens. In rare cases, babesiosis may trigger hemophagocytic lymphohistiocytosis (HLH). Case Summary We report a case of babesiosis manifesting in a subacute fashion with secondary HLH in a 51-year-old female on B cell-depleting therapy. She presented in December with generalized weakness and fever and was found to have pancytopenia, transaminitis, and hyperinflammatory markers consistent with HLH. A microbial cell-free DNA next-generation sequencing test detected Babesia microti , with subsequent confirmation by blood PCR and smear demonstrating <0.01% parasitemia. The patient improved following treatment with atovaquone and azithromycin, along with corticosteroids for HLH. Conclusion This case highlights the heterogeneity of babesiosis and its potential to present with minimal parasitemia, yet severe systemic inflammation in immunocompromised hosts. Additionally, this case underscores the importance of maintaining a broad differential in patients on B cell-depleting agents who present with new pancytopenia and systemic inflammatory symptoms. Early utilization of microbial cell-free DNA next-generation sequencing tests may aid in timely diagnosis and treatment.

Heart rate variability (HRV) is a widely utilized approach for investigating cardiovascular health and human performance. Methodological approaches, analyses, and interpretations of HRV can vary extensively, and scientific debates on HRV reliability and utility remain. These debates have been amplified in recent years by the rapid growth and ubiquity of wearable devices, and their incorporation into scientific research studies. The present guidelines paper takes an evidence-based approach to propose more consistent and rigorous measurement and interpretation of HRV within human cardiovascular research and application. First, HRV has some utility as a cardiovascular risk stratification tool, but is not appropriate to employ as a specific marker of cardiac sympathetic outflow or sympathovagal balance. While time-domain and spectral analysis can more accurately reflect respiratory modulation of cardiac vagal (parasympathetic) activity, caution is necessary to avoid overinterpretation, particularly with respect to the concept of “vagal tone”. Numerous experimental, demographic, and environmental factors influence HRV assessment, interpretation, and reliability. Specifically, it is critical to account for non-modifiable (age, sex, race/ethnicity, etc.) and modifiable (i.e., exercise, physical fitness, etc.) factors within participant samples. Furthermore, technical approaches such as the HRV input signal (e.g., electrocardiography vs. photoplethysmography), length of recording, location of recordings (i.e., laboratory vs. field), respiratory rate and depth, and analytical approaches (i.e., time vs. frequency domain) can all impact rigor, reliability, and study interpretations. Finally, with respect to the rapid advancements of HRV assessment using wearable technology, investigators should interpret and contextualize findings within the limitations outlined in this guideline review.

Purpose: To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification in eyes with high myopia versus non-high myopia with open-angle glaucoma. Methods: This retrospective comparative study included 76 eyes with open-angle glaucoma. Eyes were stratified into high myopia (Group 1; axial length ≥26.5 mm, n = 36) and non-high myopia (Group 2; axial length <26.5 mm, n = 40). Baseline parameters including intraocular pressure (IOP), best-corrected visual acuity, and number of anti-glaucoma medications (AGMs) were compared at 2 weeks, 1 month, and 3, 6, and 12 months. Surgical success was defined as IOP ≤21, ≤18, or ≤15 mmHg with a ≥20%, ≥25%, or ≥30% reduction from baseline, respectively. Postoperative complications, secondary interventions, and surgical risk factors were analyzed. Results: The mean (SD) IOP (mmHg) decreased from 20.56 ± 4.71 to 13.32 ± 5.02 in Group 1 and 19.33 ± 4.15 to 12.94 ± 3.48 in Group 2 at 12 months, with no significant difference between groups ( P = 0.92). AGM reduced from 2.11 ± 0.89 to 0.36 ± 0.95 in Group 1 and 1.98 ± 0.89 to 0.06 ± 0.24 in Group 2 at 12 months ( P = 0.07). There was no significant difference in success rate between groups by all criteria at the end of 12 months ( P = 0.77, 0.54, 0.14). Transient hyphema and IOP spikes were common complications. Five eyes required anterior chamber wash (3 in Group 1, 2 in Group 2). Conclusion: GATT with phacoemulsification is a safe and effective procedure in high myopia with open-angle glaucoma, with comparable outcomes to non-high myopia eyes at 12 months.

Overall, our findings expand current understanding of SDRIFE by highlighting both well-recognized and underappreciated medication classes, underscoring the importance of ongoing pharmacovigilance.

Abstract Background Opportunistic bilateral salpingectomy (OBS), the removal of fallopian tubes during hysterectomy or instead of tubal ligation, is recommended to reduce ovarian cancer risk. However, data on the effectiveness of prophylactic OBS is limited. Methods This population-based retrospective cohort included individuals aged 18–80 in Ontario, Canada, who underwent OBS or comparator surgeries (hysterectomy with ovarian and tubal conservation or tubal ligation) from 2011 to 2023. Individuals with gynecologic cancer before or within six months of surgery were excluded. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. Sensitivity analyses varied the time between surgery and cancer diagnosis to account for pre-existing serous tubal intraepithelial carcinomas. Results Among 196,839 individuals, 57,941 underwent OBS and 138,898 underwent comparator surgeries. 142 epithelial ovarian cancers were diagnosed (19 in the OBS group and 123 in the comparator surgery group). OBS was associated with reduced risk of any ovarian carcinoma, with an adjusted hazard ratio (aHR) of 0.60 (95% CI, 0.36 to 0.98). For serous ovarian carcinoma (high- and low-grade combined due to missing grade data), the aHR was 0.47 (95% CI, 0.22 to 0.99). Sensitivity analyses with 12- and 18-month intervals showed aHRs of 0.59 (95% CI, 0.35 to 0.99) and 0.60 (95% CI, 0.35 to 1.01) for all ovarian carcinomas, and 0.49 (95% CI, 0.23 to 1.01) and 0.47 (95% CI, 0.22 to 0.99) for serous ovarian carcinoma, respectively. Conclusions OBS was associated with reduced risk of ovarian carcinoma, supporting its role as a primary prevention strategy.

Background The management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the role of conservative management and injectable orthobiologic strategies in the treatment of OLT. Methods Seventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1–E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%) Results In total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counseling Conclusion These international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.

ABSTRACT Part I of our three‐part series outlines the essential technical and operational components required for successful digital pathology implementation including hardware, software, and IT infrastructure. It reviews the rationale for digitization, highlighting improvements in workflow efficiency, diagnostic collaboration, and preparedness for computational applications. Key components of Whole Slide Imaging (WSI) systems are discussed, including practical considerations for scanner selection, scanning modalities, and performance trade‐offs relevant to dermatopathology. The article also examines image compression strategies and pyramid image representation, with attention to balancing image quality and storage efficiency. Finally, we review DICOM standards and storage infrastructure options, including cloud, on‐premises, and hybrid models, and associated network bandwidth requirements.