Citations

Abstract Emotional experiences during focal seizures are often misinterpreted as psychiatric disorders. We aimed to evaluate symptoms involving affective symptoms at seizure onset. We aimed to identify the most prevalent affective symptoms at seizure onset and characterize their localizing and lateralizing value. We performed a scoping review based on Preferred Reporting Items for Systematic reviews and Meta‐Analyses–extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, CINAHL (via EBSCOhost), and Web of Science. Two reviewers independently screened titles/abstracts and full texts; discrepancies were resolved by consensus. This review focused on patients with focal seizures, as affective symptoms may occur in generalized epilepsies. The affective symptoms: fear, anxiety, panic, sadness, mystic, ecstatic, sexual, and mirth were identified, and semiology was evaluated in accordance with ILAE guidelines. Symptom onset, frequency, brain localization, and video‐EEG monitoring technique were evaluated to assess localization and lateralization of regional networks. Scalp EEG, invasive EEG recordings, and electrical stimulation were analyzed. A total of 1276 documents were identified, with 98 studies included for review. Fear was the most frequently reported ictal emotion, identified in 274 patients (66%), predominantly in temporal lobe epilepsy. Sadness and sexual, ecstatic symptoms were also consistently associated with temporal networks. Mirth was more frequently reported with frontal onset seizures. Evidence, primarily from Class IV studies, reported right hemispheric predominance for ecstasy, mystic, and sexual symptoms at seizure onset. Ictal affective symptoms at seizure onset yield localizing information. The limbic system, especially the temporal lobe, followed by the frontal lobe, was the most common site of origin. Fear was the most common spontaneous and electrically elicited symptom, followed by anxiety. While bi‐hemispheric lateralization occurred, right lateralization predominated. Recognizing paroxysmal affective symptoms as ictal phenomena may reduce misdiagnosis and aid presurgical evaluation in drug‐resistant focal epilepsy.

ABSTRACT Measles virus (MeV) is the most contagious human respiratory pathogen. To understand how it spreads in the airways, we infected well-differentiated primary cultures of human airway epithelial cells (HAE). We discovered that the MeV attachment protein (hemagglutinin, H), the fusion (F) protein, and the assembly organizer protein (matrix, M) reach newly infected cells ahead of, and independently from, the replicative complex proteins. To characterize the mechanisms of MeV spread, we generated a replication-deficient adenoviral vector expressing the MeV M, F, and H proteins in a doxycycline-inducible manner. This viral vector formed infectious centers that preserved epithelial function like those from MeV infection. To further dissect this process, we generated Ad vectors expressing individual MeV proteins, termed Ad-M, Ad-F, and Ad-H. Transduction of HAE with single, double, and triple Ad vector combinations revealed that Ad-F and Ad-H are necessary and sufficient to form MeV-like infectious centers. MeV enters and spreads within airway epithelia via H protein binding to adherens junction protein, nectin-4. To disrupt spread, we introduced the point mutation H Y543A , a mutation previously described to inhibit nectin-4 binding, in the Ad-H vector. Co-transduction of Ad-F and Ad-H Y543A did not result in MeV-like infectious center formation. Finally, we assessed whether the MeV-related paramyxovirus Nipah (NiV) attachment and fusion proteins (G and F, respectively) support cell-to-cell spread. Co-transduction of HAE with Ad-NiV-G and Ad-NiV-F did not result in infectious center formation, suggesting that decoupling of the membrane fusion apparatus function from replication is a unique feature of the MeV envelope glycoproteins. IMPORTANCE Measles virus is a highly contagious pathogen. We characterized a mechanism by which measles virus spreads rapidly through the cells that line the human airway in an ex vivo model. We show that the proteins of the viral membrane fusion apparatus, hemagglutinin (H) and fusion (F), move independently from and reach newly infected cells before the proteins of the replicative complex. Thus, viral protein spread is assembled and arranged in order (i.e., marshaled ). Using adenovirus-based vectors, we show that co-expression of H and F proteins promotes rapid sequential spread to multiple cells and the formation of infectious centers. Further elucidation of the mechanism of measles virus amplification and cell-to-cell spread within the lung may help explain its highly contagious nature.

Abstract Positron emission tomography (PET)-based molecular imaging is a clinically important tool for the evaluation of dementia and other neurodegenerative disorders, using radiotracers that target specific molecular and pathophysiological processes. Fluorodeoxyglucose brain PET has historically supported neurodegenerative disorder evaluation through detection of characteristic patterns of regional glucose hypometabolism. In recent years, the molecular imaging of protein aggregates has taken on an increasingly important role. This is evident with the widespread clinical adoption of amyloid PET and early use of tau PET to provide diagnostic and prognostic information for patients with suspected Alzheimer’s disease. Additional classes of radiotracers relevant to neurodegenerative diseases are under active investigation, including those targeting neuroinflammation, synaptic density, and α-synuclein aggregates. We review the major classes of PET radiotracers for neurodegenerative diseases, describing their molecular mechanisms, diagnostic performance, and their current and emerging clinical roles in dementia evaluation. Case examples for clinically used tracers illustrate imaging features relevant to diagnosis and characterization of prognosis and treatment effect. Finally, we discuss early developments and current challenges in the development of theranostic approaches and novel radiotracers for neurodegenerative diseases.

Klippel-Trénaunay syndrome (KTS) is a rare congenital vascular-overgrowth disorder within the broader spectrum of PIK3CA -related overgrowth syndromes. Although clinical, radiologic, and orthopedic manifestations are well described, the histologic spectrum of KTS-associated pathology remains under-characterized. Clinicopathologic findings from 21 patients with clinically established KTS were reviewed, including 18 with longitudinal clinical follow-up and 3 consultation cases of rare malignant mesenchymal neoplasms. Cases were identified from institutional pathology and clinical databases, and available hematoxylin and eosin-stained sections and ancillary studies were reviewed. The cohort included 11 males and 10 females. Among the 18 clinically followed patients, 12 had limb length discrepancy or asymmetric limb overgrowth, 9 had documented deep vascular malformations, 4 had intra-articular/synovial malformations, and 10 underwent initial orthopedic evaluation or intervention before age 18. Orthopedic morbidity clustered into mechanical overgrowth-related, vascular malformation-related, and soft tissue/wound-related complications. Histologic findings included superficial and/or deep slow-flow vascular malformations, ulceration and granulation tissue, hemosiderin-laden reactive synovium, and destructive hemorrhagic arthropathy. Intra-articular disease recapitulated a hemophilic arthropathy-like pattern, with hemosiderotic synovitis, papillary synovial hyperplasia, and progressive joint destruction with loss of articular cartilage, exposed subchondral bone destruction and remodeling, all attributable to long-standing intra-articular hemorrhage. Three consultation cases showed malignant mesenchymal neoplasia, including 2 angiosarcomas. Recognition of these patterns is important for pathologists evaluating specimens from patients with known or suspected KTS, particularly when findings mimic hemophilic arthropathy, diffuse-type tenosynovial giant cell tumor, nonsyndromic vascular malformation, and/or end-stage destructive arthropathy.

Abstract Objective Otolaryngology–Head and Neck Surgery (OHNS) residency remains highly competitive, with persistent disparities in applicant representation. This study presents a cross‐sectional analysis of OHNS residency and faculty demographics using 2025 program rosters, evaluating degree type (MD vs DO), geographic distribution, and leadership influence. Study Design A cross‐sectional review. Setting All US ACGME‐accredited OHNS residency programs, with data collected in 2024 to 2025. Methods Demographic data were collected on OHNS faculty and residents, including post‐graduate year (PGY) 1 through PGY5 trainees at the time of data collection, corresponding to entry years from 2020 to 2024 across all US ACGME‐accredited residency programs. Data was extracted from official program websites, FREIDA, ACGME, NRMP, and social media. Programs with incomplete data, those using the military match, and non‐accredited sites were excluded. Descriptive statistics, χ 2 tests, and correlation analyses were performed ( p < .05). Results Of 131 programs, 125 were analyzed at the program level and 121 at the faculty level. DO residents were concentrated in Michigan (59%), Ohio (50%), and Oklahoma (50%). DO representation correlated with DO faculty ( r = .82, p < .0001), DO program director ( r = .95, p < .0001), and former AOA program designation ( r = .92, p < .0001). A negative correlation existed between program size and DO resident ( r = –.4, p < .0001). Conclusion Despite growing diversity following the single accreditation system, disparities persist in OHNS. DO residents remain underrepresented and geographically concentrated, with representation strongly associated with osteopathic faculty presence, program leadership, and prior AOA affiliation.

Introduction The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy. Methods We collected resource utilization and economic data as part of an RCT of infants aged 0–60 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now. Results A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda. Conclusions The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.

Abstract Background Lower extremity compression therapy has been proposed as an adjunct to mitigate diuretic resistance during acute decompensation of heart failure (ADHF). We evaluated the effect of lower leg compression with elastic bandages on diuretic efficiency in patients with diuretic-resistant ADHF. Methods Historical cohort study enrolling adult cardiac ICU admissions with ADHF who used elastic bandages (EB) at Mayo Clinic in Minnesota from 2007 to 2017. The diuretic efficiency before and after applying EB was the primary outcome. Results A total of 176 patients with heart failure who received elastic bandages were included. The in-hospital mortality rate, the median hospital length of stay, and 30-day hospital readmission were 9.7%, 11.4 days (IQR 7.1–19.0), and 11%, respectively. When EB was applied, the average daily loop diuretic dosage was decreased by a mean difference of 1.19 mg per 40 mg furosemide equivalent (95% CI: 0.22 to 2.2; p = 0.016). The average post-EB diuretic efficiency was 1,355 mL (IQR 1,119, 1,590) per 40-mg furosemide, which was significantly higher than before EB application, with a mean difference of 340 mL per 40-mg furosemide equivalent (95% CI: -554, -125; p = 0.002). A higher diuretic efficiency led to lower diuretic doses. Average daily urine output before and after EB application was not different (2,642 pre-EB vs. 2,792 post-EB mL/day; 95% CI: -455 to 154; p = 0.33). Conclusion EB use enhances diuretic efficacy during ADHF. Further studies are needed to determine the potential clinical benefits and risks of applying EB compression treatment in ADHF.

Précis: In this randomized multicenter trial, both TRAB and CPC lowered IOP at 12 months as primary glaucoma surgeries, with TRAB yielding lower final IOP with fewer medications, while both procedures demonstrated meaningful clinical effectiveness. Purpose: To compare the efficacy and safety of trabeculectomy (TRAB) and slow-burn transscleral cyclophotocoagulation (CPC) as primary surgical treatments for glaucoma. Methods: Prospective, randomized, multicenter trial including one eye per patient from July 2020 to July 2023, with 12-month follow-up. Participants were allocated to TRAB (GI) or CPC (GII). The primary endpoint was surgical success at 12 months, defined by intraocular pressure (IOP) between 6 and 18 mm Hg without non-protocol glaucoma surgery or serious complications. Results: Eighty-six eyes were included; nine were excluded (four in GI; five in GII). Baseline demographics were similar between groups. Both significantly reduced IOP at 12 months (GI: 22.97±8.23 mm Hg to 10.14±2.89 mm Hg; GII: 23.47±6.34 mm Hg to 14.58±3.66 mm Hg; P <0.001 for both). Medication use decreased significantly in both groups, with a lower mean number of medications per year in GI ( P <0.001). An IOP of 6–14 mm Hg was achieved in 91.4% of GI and 39.4% of GII ( P =0.007). Final IOP between 6 and 18 mm Hg was reached by 97.1% of GI and 90.9% of GII ( P =0.708). Qualified success rates were high and comparable (GI: 97.4%; GII: 86.8%; P =0.08), while complications were infrequent (four in GI; one in GII; P =0.3). Quality of life improved after TRAB (EQ-5D: 0.71±0.19 to 0.78±0.14; P =0.031) but remained unchanged after CPC ( P =0.424). Conclusions: Both procedures reduced IOP at 12 months as primary glaucoma surgeries. TRAB achieved lower final IOP, required fewer medications, and was associated with improved quality of life, whereas CPC required more adjunctive medication and retreatment in some eyes.