Citations

Biparietal osteodystrophy, also known as bilateral parietal calvarium bone thinning, is a rare calvarial condition characterized by loss of diploic bone within the parietal region. Although historically described in anthropologic and radiologic literature, current understanding of its epidemiology, pathogenesis, clinical relevance, and management remains fragmented. This review synthesizes current evidence and highlights emerging studies on biparietal osteodystrophy. Epidemiologic reports indicate that biparietal osteodystrophy affects a broad age range but appears most frequently in older adults, with several series suggesting a slight female predominance. Prevalence is difficult to estimate due to incidental detection, though modern imaging has increased recognition of the condition. Histologically and anatomically, biparietal osteodystrophy is marked by thinning of the outer table and loss of the diploic space, with little osteoblastic or osteoclastic remodeling. Proposed pathogenic mechanisms include chronic degenerative change, impaired vascular supply to the diploë, and other theories, although no single explanation fully accounts for its complete presentation. Clinically, most patients remain asymptomatic, with complications such as calvarial fractures and traumatic brain injury being rare but highlighting the structural vulnerability associated with severe thinning. Management strategies are not standardized, and the use of anti-osteoporotic drugs and cranioplasty has been reported to offer benefit in select cases, although no treatment has been formally validated for biparietal osteodystrophy. As the understanding of biparietal osteodystrophy continues to evolve, future research is needed to clarify its natural history, identify potential etiologic pathways, and establish evidence-based management guidelines.

Background: Recent reports suggest increasing trends in injuries, primarily among pitchers and upper extremity injuries, among Major League Baseball (MLB) and Minor League Baseball (MiLB) players. Accordingly, an updated comprehensive report on injury epidemiology in professional baseball is needed. Purpose: To (1) update the literature with a comprehensive epidemiological report of all injuries in MLB and MiLB; (2) provide a detailed breakdown of characteristics of the top 50 injuries; and (3) analyze long-term trends in injuries and days missed (DM) over time. Study Design: Case Series; Level of evidence, 4. Methods: The MLB Health and Injury Tracking System was used to identify injuries in MLB and MiLB players from 2011 to 2023. The inclusion criteria consisted of injuries occurring during spring training, regular season, or postseason activities that resulted in ≥1 DM from play. Basic and advanced player and injury characteristics were analyzed—including a list of the top 50 most common injuries. Results: From 2011 to 2023, a total of 83,215 musculoskeletal injuries occurred among MLB and MiLB players, resulting in 1,280,887 total DM, with a mean (median) DM per injury of 18 (11). The upper extremity accounted for 46% of injuries, and the lower extremity for 30%. The most common injury was hamstring strains (n = 6603; 7.9%); hamate fractures had the highest rate of surgery (81%); and elbow medial ulnar collateral ligament injury resulted in the highest DM (583,070 days). From 2011 to 2023, a significant increase was observed in the number of annual injuries (excluding 2020) ( P = .028) and injuries per game ( P = .003). However, 2018 and 2019 saw the highest number of injuries, and injuries did not rise after 2020. Conclusion: The annual number of injuries and rate of injuries per game increased significantly from 2011 to 2023; however, injuries did not increase over the final 3 years of the study (2021 to 2023). The percentage of overall injuries was dominated by upper extremity injuries among pitchers, although hamstring strains were the most common injury type overall.

Ten patients with known but clinically stable chronic obstructive pulmonary disease (COPD) were studied while breathing low-flow (1-2 L/min) supplemental oxygen by nasal cannula and by biflow nasal mask. Although the increase in inspired oxygen when breathing with the cannula has been documented, the nasal mask has not been tested by measurement of PaO2 change. The mean age of the group was 64.6 years, and their mean PaO2 was 54 ± 10.5 torr while they were at rest and breathing room air. Patients were each given oxygen alternately with the mask and cannula, with no change in flowrate; time was allowed between the two for equilibration and return to baseline values. PaO2 values were compared by t test for nonindependent samples, which provided a t value of 1.893, with P = 0.09. Differences in measured arterial saturation (SaO2) and PaCO2 also proved to be insignificant when patients breathed via the two devices. We conclude that the nasal cannula and the biflow nasal mask produce comparable PaO2 in patients who may need low-flow supplemental oxygen at rest. The mask can be considered an alternative oxygen appliance if preferred by patients because of comfort. (Respir Care 1985;30:250-255.)

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Background and importance Emergency tracheal intubation in critically ill adults is associated with a high risk of peri-intubation adverse events, making first-attempt success a key safety target. Objective This study aimed to evaluate whether the use of neuromuscular blocking agents (NMBAs) improves the proportion of first-attempt success and reduces adverse events during emergent intubations outside the operating room. Methods This was a systematic review and meta-analysis of randomized clinical trials or nonrandomized studies comparing sedative-hypnotic plus NMBA versus sedative-hypnotic alone in critically ill adults undergoing emergency endotracheal intubation in nonoperative settings. Animal, cadaveric, manikin/simulation, and pediatric studies were excluded. Articles were screened on 21 August 2025, in Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection. Main results Of 4736 screened citations, 13 studies (8 cohort; 5 before-after studies) were included in the quantitative analysis, with 14 072 participants. NMBA use was associated with higher first-attempt success, which ranged from 69 to 92% (pooled odds ratio, 2.72; 95% onfidence interval: 1.42–5.21; low-certainty evidence). Secondary outcomes related to adverse events were rated as very low certainty due to sparse data, inconsistent reporting, and serious imprecision. Conclusion NMBA use during emergency intubation was associated with improved first-attempt success, although the certainty of evidence was low.

Abstract Background Recently, a posterior pathway for fluid drainage from the retina to the meningeal lymphatics in the optic nerve (ON) sheath was identified in rodents using intravitreal imaging tracers directly injected into the ocular-globe. Fluid and solute clearance along this pathway may be associated with many diseases. However, intravitreal tracers are rarely used in clinical imaging. As intravenous Gadolinium-based-contrast-agent (GBCA) can enter the globe via the blood-ocular-barriers, it may provide an alternative approach to image this pathway. Purpose To establish a clinically feasible intravenous GBCA-based MRI approach for tracking fluid and solute transport along the posterior lymphatic pathway in the ocular glymphatic system. Materials&Methods This prospective study was conducted from March 2021 to September 2022 in healthy participants. Dynamic-susceptibility-contrast-in-the-CSF (cDSC) MRI was performed before, immediately and 4 hours after intravenous-GBCA administration to track GBCA distribution in aqueous humor (AH) and cerebrospinal fluid (CSF) in regions-of-interest (ROIs) in the globe (anterior-cavity, vitreous-body), in the intraorbital and extraorbital ON, and in the intracranial CSF space proximal to the ON (chiasmatic-cistern, interpeduncular-cistern). Kruskal–Wallis tests with post-hoc Dunn’s tests were used for group comparisons. Results Sixteen healthy participants (mean age±SD: 51±21 years, 5 men) were recruited. Intravenous-GBCA enhancement was observed in all ROIs immediately after injection. At 4-hour-post-GBCA, the vitreous body showed a trend of smaller enhancement area (55±11% versus 49±11%, P =.14) and lower GBCA-concentration (0.044±0.014 versus 0.028±0.010 mmol/L, P =.07) compared to immediate-post-GBCA. The intraorbital ON showed more widespread enhancement (39±5% versus 59±6%, P =.01) and significantly higher GBCA-concentration (0.023±0.009 versus 0.059±0.015 mmol/L, P <.001) at 4-hour-post-GBCA. Conclusion Dynamic fluid and solute transportation along the posterior lymphatic pathway in the ocular glymphatic system in healthy participants was measured by tracking intravenous-GBCAs entering the globe via the blood-ocular-barriers using cDSC-MRI. Summary Statement Dynamic fluid and solute transportation along the posterior lymphatic pathway in the ocular glymphatic system in healthy participants was measured by tracking intravenous-Gadolinium-based-contrast-agents entering ocular-globe via blood-ocular-barriers using dynamic-susceptibility-contrast-in-the-CSF (cDSC)-MRI. Key Results In this prospective study of sixteen participants, Gadolinium-based-contrast-agent (GBCA)-induced signal changes were detected in the aqueous-humor and cerebrospinal fluid immediately following intravenous administration using dynamic-susceptibility-contrast-in-the-CSF (cDSC)-MRI. At 4-hour-post-GBCA, the vitreous-body showed a trend of smaller enhancement area (55±11% versus 49±11%, P =.14) and lower GBCA-concentration (0.044±0.014 versus 0.028±0.010 mmol/L, P =.07) compared to immediate-post-GBCA. The intraorbital-optic-nerve showed more widespread enhancement (39±5% versus 59±6%, P =.01) and higher GBCA-concentration (0.023±0.009 versus 0.059±0.015 mmol/L, P <.001) at 4-hour-post-GBCA.